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severe COVID-19 cases. These options are listed under ‘Options for response’ and recent ECDC guidance documents [55]. The implementation of these mitigation measures will determine the eventual level of impact of the epidemic on health system capacity. RAPID RISK ASSESSMENT Novel coronavirus disease 2019 (COVID-2019) pandemic: increased transmission in the EU/EEA – What is the risk associated with transmission of COVID-19 in health and social care institutions with large vulnerable populations? The risk associated with transmission of COVID-19 in health and social institutions with large vulnerable populations is considered high. This assessment is based on the following factors: · The number of reported COVID-19 cases in the EU/EEA and the UK has increased in the last 10 days, very quickly in several EU/EEA countries, and the probability of increased clusters in local areas is considered high. In some settings, transmission within healthcare settings, including long-term care facilities has been reported. It is plausible that a proportion of transmissions occur from cases with mild symptoms that do not provoke healthcare-seeking behaviour, however these cases can still transmit the virus. If health and social institutions are exposed to the virus by health workers or family members with mild infection, the virus could spread quickly in such a setting, in the absence of very early detection and highly effective infection control. The probability of transmission in such settings can be modified by the level of implementation of robust IPC measures and early detection and isolation of introduced cases in patients, residents or staff. · The great majority of the most severe illnesses and deaths have occurred among the elderly and those with other chronic underlying conditions. Thus, the impact on vulnerable groups in affected hospitals or healthcare facilities would be severe, in particular for the elderly. The impact would be especially high if a large number of healthcare or social care workers need to be isolated or become infected. 4 Preparedness and public health response Five scenarios describing the possible progression of the COVID-19 outbreak in EU/EEA countries were presented in ECDCs fifth Rapid Risk Assessment on COVID-19 (Annex 1) [56]. Currently, EU/EEA countries’ epidemiological situation varies by region, but analysis of the epidemic progression indicates that the situation in Italy and other EU/EEA countries are generally following the epidemic curve that was noted in China during January and February and by South Korea in recent weeks. While most countries in the EU/EEA and the UK are currently in scenario 2, all available data indicates that they are very rapidly moving toward a scenario of sustained community transmission of COVID-19 (scenario 3). The situation is evolving quickly, and the currently notified cases reflect a situation in terms of transmission pressures about a week ago. Therefore, a proactive and aggressive approach is needed to delay transmission, as containing transmission in a specific area or country in the EU/EEA is no longer considered feasible (Figure 1). A rapid shift from a containment to a mitigation approach is required as the rapid increase in cases anticipated in the coming days to few weeks may not provide decision makers and hospitals enough time to realise, accept and adapt their response accordingly if not implemented ahead of time. All EU/EEA countries should immediately and proactively initiate appropriate, proportional and evidence-based response options to prevent a situation of evolution to scenario 4, where the intensive care capacity is saturated and health systems are overwhelmed. The options provided below, therefore, focus on scenarios 2-4, which describe local and nationwide transmission scenarios. Options for scenarios 0 and 1 can be found in ECDC’s previous risk assessment [56] In the current phase of the pandemic in the EU/EEA, priority response measures should focus on high-risk groups, healthcare systems and healthcare workers in order to ensure rapid detection and diagnosis of cases and protect healthcare staff, patients and other contacts from exposure. Measures to ensure appropriate functioning of the healthcare system (including laboratories) with increasing numbers of cases should be implemented. Social distancing measures and risk communication remain essential pillars to effective mitigation approaches, while rational testing, contact tracing and surveillance approaches can be implemented to match resource availability and capacity. The options proposed for preparedness and response aim to limit the impact of the pandemic on healthcare systems and vulnerable population groups by delaying the epidemic peak and decreasing the magnitude of the peak. Figure 1. Illustration of the objectives of community mitigation measures in a scenario of widespread community transmission of COVD-19 Activation of pandemic preparedness plans All EU/EEA Member States should have activated their pandemic preparedness plans in the context of COVID-19. In scenarios 3 and 4, it is crucial that all critical elements of pandemic preparedness plans are up to date and response strategies are already being implemented in a coordinated fashion across government departments and sectors
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