COVID-19: last chance for Europe to avoid a return to the spring situation

Europe is facing the last chance to avoid returning to a scenario like that of spring. Health Commissioner Stella Kyriades warned this in the presentation of the 12th report of the European Center for Disease Control and Prevention (ECDC).

The text warns that after the “necessary” relaxation of restrictions during the summer, the COVID-19 epidemic is reaching worrying levels in many countries, often worse than during the peak of the first wave, in the spring.

It points to young people as drivers of contagion in many countries and calls to protect the mental health of citizens against the possibility of new restrictions and to prepare for a scenario of widespread transmission of the virus.

To remedy this, the ECDC calls for intensifying “non-pharmaceutical actions” (hygiene, protection measures and physical and social distancing) as long as there is no vaccine against the virus.

The other recommendation of the center is greater precision in the testing and quarantine control policies of infected people.

According to the center, there are two groups of countries: those that maintain a stable or low infection rate (Germany, Cyprus, Finland, Greece, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Poland and Sweden) and the rest that are in a situation “worrying”.

The problem, according to the ECDC, is that in countries with moderate contagion rates and that occur mainly in the young population, the global health risk is moderate, but fragile people (mainly older people and with heart problems, obesity or diabetes ) are highly exposed to severe forms of the disease.

In countries with high rates of infection such as Spain, France and the United Kingdom, the risk of contagion in the general population is high, the possibility of developing moderate severe forms, but the risk is very high for frail people.

The center also warns of the risk of saturation of health centers during the cold and flu season in winter and therefore recommends that vaccination programs be strengthened.

The ECDC warns that we are still a long way from herd immunity and that the prevalence indicates that few countries exceed 15% of people who have had the disease. Also, it is not known for sure if you can contract the disease multiple times.

It recognizes that the high number of cases observed is due in part to the multiplication of the number of diagnostic tests, but shows that the positivity rate (ratio between the number of cases and the number of positives) is growing steadily.

_Since July there has been an increase in the number of COVID-19 cases detected in Europe. This may be due in part to improved testing strategies. However, it may also indicate that current measures are insufficient to reduce or control exposure to the virus.

ECDC proposals to avoid the worst possible scenario in Europe

The center has drawn up a list with a series of recommendations for the health authorities.

Preparing for a generalized transmission scenario – The center calls for an “energetic” response, both in containment and mitigation measures and with special attention to the areas least affected during the first wave.

Key target populations

– control transmission between older children and adults under 50 years of age

– protect medically vulnerable people

– protect health workers, particularly those involved in the provision of primary care.

Non-pharmaceutical interventions (NPI) – the center recognizes that many of them, such as confinements, can have a negative impact on well-being, society and the economy. “Therefore, its use should be guided by the local epidemiological situation.”

Diagnostic testing strategies – ECDC recalls that a fluid test system is essential to ensure the location of contacts and the isolation of cases.

Contact tracing – Rapid tests, independent of symptoms and quarantine of high-risk contacts are recommended. ECDC also recommends testing in high-risk settings (eg, nursing homes).

Quarantine – A fourteen-day quarantine is recommended for people who have had contact with confirmed cases of SARS-CoV-2. This can be shortened to 10 days after exposure if the PCR test on day 10 is negative.

Strong messages to promote compliance with key protective behaviors – Risk communication messages should emphasize that the pandemic is far from over. “This is a marathon, not a sprint”; and “We must not lower our guard.” People’s behavior remains the key to controlling the pandemic.

The reduction in compliance with protection measures by young people is increasingly worrying. “It is essential that young people see themselves as part of the solution and actively participate in pandemic control strategies, as well as recovery efforts,” says the center.

Mental health protection – “The current return to high incidence rates and the consequent possibility that restrictive measures will be re-imposed in some countries is likely to provoke further tensions.” This may be exacerbated by the return of shorter and colder days, which make it difficult to safe socialization of people abroad. “For this reason, the report calls for influencing protection strategies.

They also point out the effects of the illness itself on mental health. “There is evidence that COVID-19 patients can experience delirium, depression, anxiety and insomnia when they are sick,” says the ECDC warning that in many cases (56% according to one study) patients continue to suffer some symptoms one month after physical recovery. “Although it is not yet known how long these symptoms can continue, it is a potentially serious long-term concern that requires attention, given the high psychiatric burden that these conditions can carry both at the individual and community level,” comments the report.

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