COVID-19: Taking stock and moving forward together

Statement by the WHO Regional Director for Europe at an emergency meeting of ministers of health from the WHO European Region on COVID-19 projections for the winter season

29 October 2020, Copenhagen, Denmark

The latest epidemiological data concerns us.  

• This week, the European Region registered the highest weekly incidence of COVID-19 cases since the beginning of the pandemic, with over 1.5 million cases reported in the past 7 days. The total number of confirmed cases has moved from 7 to 9 million in just 14 days, and, today, Europe exceeded 10 million cases.
• A very high 14-day incidence of over 200 cases per 100 000 population is being seen in a significant majority of European countries.
• Hospitalizations have risen to levels unseen since the spring (over 10 per 100 000 population in a third of reporting countries in Europe).
• Mortality has also taken a sharp ascent (a 32% increase across the Region last week). The virus has spread back into older and at-risk groups, and the youth exclusivity in the share of the spread no longer applies. Early all-cause mortality signals from some countries give a clear warning: we can quickly recede into significant excess mortality.
• As testing systems have not kept pace in a context of very high-speed transmission, test positivity rates have reached new highs, with positivity levels exceeding 5% in a majority of European countries.

Europe is at the epicentre of this pandemic once again. At the risk of sounding alarmist, I must express our very real concern and convey our steadfast commitment to stand beside you and support you as best we can.

I convened this meeting to present an opportunity for you to express your most serious concerns and for us to collectively reflect and share experiences. I feel the seriousness of the situation warrants it.

Our partner, the Institute for Health Metrics and Evaluation (IHME), presented today to the 53 Member States of the WHO European Region projections for COVID-19 for the Region over the winter period. Although the projections are sobering, they also demonstrate modelling on the effectiveness of strategies that can help us to reduce the foreseen negative impact on our populations and our health systems.

The key question that many countries are asking is whether or not to lock down, and when does a lockdown become necessary?

We know that lockdowns, at the scale of those seen earlier this year, will cut community transmission and give the health system much needed space to recoup and scale up so that it can attend to severe COVID-19 cases and provide essential health services.

But we also know that full lockdowns will propel mental health-care demand and spur an increase in domestic violence while decreasing hospital attendance for chronic conditions, resulting in premature deaths from those conditions.

The indirect impact associated with people falling into financial hardship and turning to social security would result in further economic impact and extend economic recovery time. Given these realities, we consider national lockdowns a last-resort option because they bypass the still-existing possibility to engage everyone in basic and effective measures.
So-called lockdowns need not mean what they meant in March or April. As we collectively redefine what we mean by this rather unfortunate term, I would like to contribute some reflections and points that may serve to prompt our discussion.

First, there are several lessons we have learned.

We can take action that makes a difference and saves lives while maintaining livelihoods. Modelling by IHME suggests that the systematic and generalized wearing of masks (at a rate of 95% from now) may save up to 266 000 lives by 1 February across our 53 Member States in the Region.

The data also suggest that encouraging people to work from home where possible, restricting large gatherings and proportionately shutting down places where people gather can go a long way to preserve lives and livelihoods.

On the other hand, we are also confident that children and adolescents are not considered primary drivers of COVID-19 transmission. Therefore, school closures are not considered to be an effective single measure and should continue to be a measure of last resort.

Second, we cannot underestimate the impact that COVID-19 fatigue is having on the well-being of our communities and the effectiveness of our ongoing responses.

We need to engage citizens to help us create solutions. It’s important that we communicate to manage expectations in the coming season with empathy. Any actions that we take need to be viewed in terms of their effectiveness in slowing down transmission, but also in terms of their negative impacts. Effective communication using credible data projections and solutions based on science can help us to engage individuals, families and communities to support our efforts to control the pandemic as we head into a difficult winter.

Third, regarding our health workforce and system.

While in March the critical limiting factors were intensive care units, ventilators and personal protective equipment, today the single issue of greatest concern is the health workforce. Our health workforce is exhausted, people are burning out.

We have no COVID-19 response if we do not care for our health-care and essential workers: their needs and well-being must be prioritized.

These are exceptional times and they require decision-makers to go an extra mile in supporting the workforce, for example, by compensating their unused leave or allowing them to carry this leave to the next calendar year, and by providing additional support services to them and their families, including psychosocial support or child care.

Our systems require adaptation.

When we can no longer ramp up testing and tracing at scale, we need to assess where to focus our resources. Adapting testing and tracing so that they are used in a targeted way for maximum impact, focusing on the events that trigger highest spread within communities, may become necessary. But we cannot give up on these critical systems.

My last point is that while supporting an already-stretched health system, we must try to maintain a dual-track health system to minimize the effects of ongoing COVID-19 responses. Adequate resourcing (human and capital), stronger referral mechanisms and alternative service delivery platforms (digital) can all help us to achieve this goal.

We need to understand how close our health systems are to being overwhelmed, and here is where we need to improve the quality of the data available. In turn, this will enable us to improve the modelling scenarios.

It is time to draw on our reserves to communicate empathy and gratitude – gratitude to communities, to our health and essential workforce, to the general public, for their courage and resilience.

People need hope. At the heart of this is understanding, honesty and transparency.

We entered this pandemic together, we bear the hardship together, and there is no doubt in my mind that we will triumph together.