Statement – Where do we stand today on COVID-19, and what have we learned?
Statement to the press by Dr Hans Henri P. Kluge, WHO Regional Director for Europe
8 April 2020, Copenhagen, Denmark
Good morning.
The figures
Today, we are in the fifteenth week of our global battle with the novel coronavirus. The first cases in the European Region were reported on 24 January 2020. Given the monumental changes that have taken place in the intervening time, I would like to take this opportunity to look more closely at the current epidemiological situation and trends we have observed across the 53 countries in the WHO European region. What we have learned about the virus and how response efforts are progressing.
As of today, Europe remains very much at the centre of the pandemic – and on the one hand we have reason to be optimistic, and on the other to be very concerned.
New confirmed cases continue to increase overall in the European Region. The total number of laboratory confirmed cases this morning was 687,236, including 52,824 people who sadly have passed away. These data are from 53 countries and 7 territories. We can see there is now community transmission in many countries.
Cases in Europe account for about half of those globally, with the worldwide toll having increased exponentially. This sharp global increase is due, in particular, to the spread of the disease in the United States, which now ranks as the country with the highest number of cases.
But the dramatic rise in cases across the Atlantic skews what remains a very concerning picture in Europe: seven of the top ten countries that are most affected across the globe are located in the European Region: Following USA, we have Spain, Italy, Germany, France, and then after China, and Iran, the United Kingdom, Turkey and Switzerland.
We are also seeing higher, or much higher than expected levels of mortality from all causes in some countries. (Italy, Spain, the UK, Belgium and Switzerland). This unexpected increase is mainly in people over the age of 65, and is a marker for COVID-19 activity since mid-March.
The countries
Governments across Europe have responded to COVID-19 using interventions that have imposed different degrees of restriction on the public, schools and workplaces. On the ground, we can see two main trends:
Some of the countries with community transmission are starting to show signs of a decline in the rate of increase in new cases,following the combination of public health and clinical interventions put in place;
While other countries are experiencing a rapid increase in cases or a fresh surge.
Looking more closely at the first trend, Spain now has more cases than Italy. However, after 15-20 days since restrictive measures were implemented, the growth in cases appears to have slowed and the rate of new deaths is now also showing signs of decline. WHO has just completed a mission to the country, and later in this briefing we will hear further insights from my colleague Dr Bruce Aylward, Senior Advisor to the Director-General, who led this mission.
After weeks of strong lock-down, it seems that in Italy, although the number of cases continues to rise, the rate of increase is slowing considerably.
However, cases within countries are not evenly spread. Lombardy in Italy and Madrid in Spain are bearing the brunt of the pandemic in their countries. Thankfully in both, the daily death toll is levelling off.
Ten days after the implementation of broad public health and social measures, cases began to decline in Germany. Mortality rates and the median age of confirmed cases in Germany are lower than the average elsewhere. This is linked to a range of factors – including population demography and widespread testing.
Further good progress is being observed in Austria, the Netherlands and Switzerland...
We are concerned that Turkey has seen a dramatic increase in virus spread over the last week. 60% of cases were reported from Istanbul. Cases in Israel, Ukraine, Belgium and Norway are on the rise. And there is a fresh surge in Sweden.
The virus
Turning now to what we know about the virus, the COVID-19 response in countries in the WHO European Region is giving us useful information with which to compare the virus in Europe and in China. We now know that the virus behaves in the same way – so we are also learning more about how it can be controlled.
Infection occurs across all ages, although proportionally less in children under the age of 15. But the burden of severe disease is greater in older people, particularly men, and those with underlying chronic conditions.
Every death from this virus is a tragedy. My thoughts and deepest sympathy are with those who have lost loved ones, or are seriously ill themselves. While adults over the age of 60 are at higher risk from complications, the recent death of a 5-year-old in the UK and of a 12-year-old in Belgium tell us that in rare cases, the disease can also be fatal for children and younger adults.
Although the majority of cases remain mild, almost 40% result in hospitalization and 5% require intensive care.
Among those who have sadly lost their lives, two thirds are male, and 95% are over the age of 60. Most of these individuals had one or a combination of underlying conditions: cardiovascular disease (66%), diabetes (29%) and renal disease (21%).
The response
Knowledge of COVID-19 and some positive signs from some countries do not yet represent victory – they offer a rare chance for us to tighten our grip on the virus. Now is not the time to relax measures. It is the time to once again double and triple our collective efforts to drive towards suppression with the whole support of society.
I call on all countries, whatever their current status of transmission, to strengthen their activities in three areas:
Firstly, we must protect and strengthen the health workforce and health services at all levels to save lives. Health workers are the back bone of our health services – now more so than ever. We are indebted to all those working day and night to care for people with COVID-19, as well as keep other essential health care services operating.
Defeating COVID-19 depends on:
- training and preparing the workforce so they can provide safe and appropriate information and care to people and communities;
- protecting their physical health and prioritizing their mental health; and
- ensuring they have the support they need so that their responsibilities at home are taken care of.
Yesterday was World Health Day, an opportunity to recognize and applaud the work of nurses and midwives around the world. Once again, I would like to thank them, and others working tirelessly on the front line, for their bravery, their commitment and their resolve. Protecting them, with the right training, personal protective equipment and support has to be our top priority.
I cannot say it better than Laura, a newly graduated nurse in the Abruzzo region of Italy. In her own words,
“For the future…I want to hear discharged patients say, ‘I have survived COVID-19’. That is what motivates me and keeps me going. We will do everything that is humanly possible to overcome this situation together and we will succeed – we must. Never underestimate us nurses. The only thing we ask you is to stay at home for us. We will stay at work for you.”
There are Lauras in every country of our Region – thank you for your heroism.
This brings me to the second area that we must strengthen. It is essential to cut the engine of the pandemic at its source: separate healthy people from suspected and probable cases. This requires implementing a comprehensive set of early public health measures that consistently includes case isolation, testing, contact tracing and quarantine. Sustain these measures to delay, slow and stop the spread of the COVID-19 virus.
And thirdly, governments and authorities must maintain command-and-control structures and functions, communicate continuously and engage communities to achieve collective buy-in to current and possible future measures.
Not yet -Transition strategy
As is clear from the data and our current level of knowledge - We still have a long way to go in the marathon - and the progress we have made so far in fighting the virus is extremely fragile. To think we are coming close to an end-point would be a dangerous thing to do. The virus leaves no room for error or complacency, we need to remain committed and vigilant across all regions, all countries, and in all communities.
Any shift in our response strategy, relaxing of lockdown status or physical distancing measures, requires VERY careful consideration. It can only happen with confidence and knowledge of where the virus is and how our respective health services are coping. At a minimum, to keep transmission suppressed, we must prioritize maintaining extensive testing, isolation and contact tracing measures and planning these ahead, including for the period when widespread physical distancing measures are slowly and gradually relaxed. This is of fundamental importance.
At the WHO Regional Office for Europe we are taking concerted action to support governments to make these decisions, as they ‘transition’ through phases of their response and eventual recovery. We will deliver guidance on the political and economic, social and behavioural, and health system considerations and implications of strategic shifts in this response. I am convening the European Regional Strategic Advisory Group of experts on COVID-19 next Tuesday, to review this stream of work. Next week, on Friday, I will convene the Ministers of Health of the 53 Member States of the European Region, to share our guidance.
Also, developed by the Regional Office, this week we are launching surge planning tools to support Member States to visualize acute and intensive care capacity needs over time; and the severity of the peak of the outbreak. This is supplemented with policy recommendations on how to create surge capacity in acute and intensive care, and includes helpful country examples we are sharing. We focus on the four S’s of surge planning and delivery: space, staff, supplies, and systems.
In other news: two days ago, we deployed a multidisciplinary team to Belarus, to provide support and advice to the country response. And, I am pleased to report that a Polish Emergency Medical Team was deployed to Brescia, north Italy on 30 March, under WHO’s framework of Emergency Medical Teams, to support the conversion of the surgical ward in Brescia’s main hospital into the 6th ICU in the town.
Leaving no one behind
Solidarity, collective responsibility and perseverance are needed now more than ever to defeat the virus and leave no one behind.
While we know that people living with underlying medical conditions are particularly vulnerable, the European Region is also home to many others who are vulnerable to outbreaks of respiratory infections, including COVID-19, because of their limited access to basic health services and health promotion activities.
Refugees, migrants and displaced people; people affected by humanitarian crises; people in prisons and residents of confined care settings, the disabled, the mentally ill, orphans, those addicted to substance abuse; the homeless and those living among us but on the fringes of our societies: they are all part of the same response, but they deserve additional special attention to address their needs.
Many of these vulnerable people cannot easily follow protection measures such as hand hygiene or staying at home. For those experiencing homelessness, their existing health needs must be met, together with as COVID-19-specific testing and treatment, and access to food and safe shelter. We must stop stigmatization and show solidarity to those who need us - facing this together.
We have already seen the impact of COVID-19 in some of these groups. On 1 April, Greece detected the 1st case of COVID-19 in a refugee setting, and now 23 more refugees in the Ritsona refugee camp have tested positive. The camp, which is a temporary home to over 2,300 persons, has now been placed under quarantine. Further cases have since been reported in other refugee camps where similar measures have been applied. It is our ethical duty to offer support – to leave no one behind.
Dear colleagues, this pandemic and its impact on our lives is exceptional, but every day, every minute, we are gathering evidence, sharing knowledge and taking steps to stop this virus, and to make our health response more robust, and sustainable.
The virus arrived with us in the dark weeks of winter. Many of us are looking forward to celebrate Easter, with better weather. But this is not the time to lower our guard. We must soldier on. We are in this situation together, and we will get through this, together.
Thank you.
