ECDC: Rapid Risk Assessment Covid-19- March 4, 2020

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Source: https://www.ecdc.europa.eu/en/curren...irus-situation
Daily risk assessment on COVID-19, 4 March 2020

Risk assessment
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The risk associated with COVID-19 infection for people in the EU/EEA and UK is currently considered moderate to high

This assessment is based on the following factors:

• Most cases reported in the EU/EEA and the UK outside some regions in Italy have identified epidemiological links. However, there is an increasing number of cases without a defined chain of transmission. Extraordinary public health measures have been implemented in Italy and other EU/EEA countries and the UK, and strong efforts are being made to identify, isolate and test contacts in order to contain the outbreak. Despite contact tracing measures initiated to contain further spread, there continue to be cases exported between EU/EEA countries, and an increasing number of sporadic cases across EU/EEA countries. The probability of further transmission in the EU/EEA and the UK is considered high. There is still a level of uncertainty regarding several unpredictable factors in a situation that is still evolving.
• The possibility of new introductions from other countries outside China into the EU/EEA appears to be increasing as the number of countries reporting cases continues to rise. A list of these countries can be found here.
• The evidence from analyses of cases to date is that COVID-19 infection causes mild disease (i.e. non-pneumonia or mild pneumonia) in about 80% of cases and most cases recover, 14 % have more severe disease and 6% experience critical illness. The great majority of the most severe illnesses, and deaths, have occurred among the elderly and those with other chronic underlying conditions. In addition to the public health impacts with substantial fatal outcomes in high-risk groups, COVID-19 outbreaks can cause huge economic and societal disruptions.

The risk of acquiring the disease for people from the EU/EEA and the UK travelling/resident in areas with no cases, or multiple imported cases, or limited local transmission, is currently considered low to moderate

This is assuming surveillance in the area is activated, tests are carried out on suspected cases and that there is sufficient testing capacity in the area. If these surveillance and case detection conditions are not met, the risk is considered moderate to high, but with a high level of uncertainty.
The risk for people from the EU/EEA and the UK travelling/resident in areas with more widespread local transmission is currently considered to be high

This assessment is based on the following factors:

• The overall number of reported cases in areas with more widespread local transmission is high or increasing. However, there are significant uncertainties regarding transmissibility and under-detection, particularly among mild or asymptomatic cases.
• The evidence from analyses of cases to date is that COVID-19 infection causes mild disease (i.e. non-pneumonia or mild pneumonia) in about 80% of cases and most cases recover, 14 % have more severe disease and 6% experience critical illness. The great majority of the most severe illnesses and deaths have occurred among the elderly and those with other chronic underlying conditions. The areas with local transmission are also likely to increase as importations in unaffected areas keep occurring.

The risk of the occurrence of clusters associated with COVID-19 in other countries in the EU/EEA and the UK is currently considered moderate to high

This assessment is based on the following factors:

• The current event in Italy indicates that local transmission may have resulted in several clusters. The accumulated evidence from clusters reported in the EU/EEA and the UK indicates that once imported, the virus causing COVID-19 can be transmitted rapidly. It is plausible that a proportion of transmissions occur from cases with mild symptoms that do not provoke healthcare-seeking behaviour. The increase in case numbers and the number of countries outside China reporting those cases increases the potential routes of importation of the infection into the EU/EEA and the UK. Importations from other European countries have already occurred.
• The impact of such clusters in the EU/EEA would be high, especially if hospitals were affected and a large number of healthcare workers had to be isolated. The impact on vulnerable groups in the affected hospitals or healthcare facilities would be severe, in particular for the elderly.
• The rigorous public health measures that were implemented immediately after identifying the Italian COVID-19 cases will reduce but not exclude the probability of further spread.

The risk of widespread and sustained transmission of COVID-19 in the EU/EEA and the UK in the coming weeks is moderate to high with more countries reporting more cases and clusters

This assessment is based on the following factors:

• There is an increasing number of countries with local or widespread local transmission around the world and in Europe that are exporting cases to unaffected areas. These exportations have caused transmission in previously unaffected areas. The control measures have up to now been able to only slow the further spread, but not to stop it.
• Cases with mild symptoms are numerous and able to transmit the infection. Cases with mild symptoms are not always aware of their potential infectivity and have sought medical care, infecting healthcare workers.
• Previously unaffected areas are reporting cases with travel history to a country that did not appear to have widespread local transmission.
• The WHO increased their assessment of the risk of spread and the risk of impact of COVID-19 to very high at a global level.

The risk for healthcare system capacity in the EU/EEA and the UK in the coming weeks is considered moderate to high.

This assessment is based on the following factors:

• As the number of reported COVID-19 cases in the EU/EEA and the UK is increasing, the probability of widespread infection is increasing from low to moderate.
• The majority of countries reported widespread influenza activity for week 8/2020, but the proportion of specimens tested positive in sentinel surveillance is slightly decreasing; some EU/EEA countries might have already moved past the peak period of high influenza circulation. For the latest influenza update see the joint ECDC–WHO/Europe weekly influenza update.
• If there is a significant increase in COVID-19 cases in the coming weeks, the potential impact on the public health and overall healthcare systems would be high. Increasing numbers of imported cases and local transmission chains would require additional resources for case management, surveillance, and contact tracing. Risk communication to concerned members of the public and healthcare professionals would tie up further resources. Further increased transmission could result in a significant increase of hospital admissions at a time when healthcare systems are may already be under pressure from the current influenza season. This would be exacerbated if substantial numbers of healthcare workers became infected. Specimens for COVID-19 could therefore lead to bottlenecks not only in healthcare but also in diagnostic capacity. Containment measures intended to slow down the spread of the virus in the population are therefore extremely important as outlined below in the ‘Options for response’ and recent ECDC guidance documents.