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or confirmed to be infected with COVID-19; - the suspension of mass gatherings, taking into consideration the size of the event, the density of participants and if the event is in a confined indoor environment; - social distancing measures at workplaces (for example teleworking, suspension of meetings, cancellation of non-essential travel); - measures in and closure of schools, taking into consideration the uncertainty in the evidence of children in transmitting the disease, need for day care for children, impact on nursing staff, potential to increase transmission to vulnerable grandparents; - cordon sanitaire of residential areas with high levels of community transmission. · Ensuring the public is aware of the seriousness of COVID-19. A high degree of population understanding, solidarity and discipline is required to apply strict personal hygiene, coughing etiquette, self-monitoring and social distancing measures. Community engagement and acceptance of stringent social distancing measures put in place are key in delaying and reducing further spread. · Prevention and control of COVID-19 in hospitals and long-term care facilities is an immediate priority in order to: (1) slow the demand for specialised healthcare, such as ICU beds; (2) safeguard populations vulnerable to severe outcomes of infection (3); protect healthcare workers that provide care; (4) minimise the export of cases to other healthcare facilities and the community. · Every healthcare facility should initiate training for all staff and those who may be required for healthcare provision during surge capacity. Countries should identify healthcare units that can be designated to care for COVID-19 cases, to minimise transmission to non-cases and to conserve PPE. Countries and healthcare institutions should identify additional facilities that can be used for the cohorting of cases with mild symptoms, in the event that surge capacity is exceeded by healthcare facilities. The highest priority for use of respirators (FFP2/3) are healthcare workers, in particular those performing aerosol-generating procedures, including swabbing. · If resources or capacity are limited, rational approaches should be implemented to prioritise high-yield actions, which include: rational use of confirmatory testing, reducing contact tracing to focus only on high-yield contacts, rational use of PPE and hospitalisation and implementing rational criteria for deisolation. Testing approaches should prioritise vulnerable populations, protection of social and healthcare institutions, including staff. · National surveillance systems should initially aim at rapidly detecting cases and assessing community transmission. As the epidemic progresses, surveillance should monitor the intensity, geographical spread and the impact of the epidemic on the population and healthcare systems and assess the effectiveness of measures in place. In circumstances with capacity shortages and strict implementation of social distancing measures, surveillance should focus on severe acute respiratory infections, sentinel surveillance in outpatient clinics or collection of data through telephone helplines. A strategic approach based on early and rigorous application of these measures will help reduce the burden and pressure on the healthcare system, and in particular on hospitals, and will allow more time for the testing of therapeutics and vaccine development. What is new in this update? · Updated data on the epidemiological situation in the EU/EEA and the UK · Recent findings on disease and transmissibility, including during the asymptomatic period · Risk associated with COVID-19 for people from the EU/EEA and the UK · Risk of local and widespread national community transmission in the EU/EEA and UK in the coming weeks · Risk to healthcare systems capacity being exceeded in the EU/EEA and the UK in the coming weeks · Risk of transmission of COVID-19 in health and social institutions with large vulnerable populations · Options for preparedness and response focused on the mitigation phase, including rational measures in case of resource constraints or shortages · Updated surveillance objectives and methods for the mitigation phase Regularly updated information on severe acute respiratory syndrome coronavirus COVID-19 outbreak is available on ECDC’s website [1], the European Commission website [2], and the World Health Organization’s (WHO) website [3]. This risk assessment is based on published information available as of 12 March 2020. 1 Event background For more detailed event background information, please visit ECDC’s website [4]. Since ECDC’s fifth update on novel coronavirus published on 2 March 2020 and as of 11 March, the number of cases and deaths reported in the EU/EEA has been rising, mirroring the trends seen in China in January-early February and in northern Italy in late February. If this trend continues, based on the quick pace of growth of the epidemic observed in China and northern Italy, it is likely that in days, or a small number of weeks, similar situations may be seen in other EU/EEA Member States. The main developments since the 2 March 2020 risk assessment can be summarised as follows: · All EU/EEA countries are now affected and more than 100
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