Discussion
Our results indicate that the number of notified cases of COVID-19 is rapidly increasing in the EU/EEA and the UK. The observed trends in the cumulative incidence of COVID-19 suggest that the pandemic is progressing at a comparable speed in all countries. This is despite countries being at different stages, variations in national public health responses, and possibly different case definitions in countries and different protocols for selecting patients that must be tested for confirmation of COVID-19, including catch-up testing.
Early March 2020, doctors in the affected regions of Italy described a situation in which ca 10% of patients with COVID-19 required intensive care [7] and media sources reported that hospitals and intensive care units in these regions had already reached their maximum capacity [8=13]. Data on admission of COVID-19 cases in a hospital and/or an intensive care unit are currently available at EU/EEA level for only 6% and 1% cases, respectively (data not shown). They should, however, be collected in a systematic fashion to complement current surveillance data that focus on the number of reported cases and the number of deaths. A study performed in 2010–11 showed a large variation in the availability of intensive care and intermediate care beds in Europe, ranging from 29.2 in Germany to 4.2 beds per 100,000 population in Portugal [14]. This means that countries may have more or less resources than Italy (12.5 intensive care and intermediate care beds per 100,000 population in 2010–11). Modelling scenarios related to healthcare capacity saturation, with estimates for each EU/EEA country and the UK of the prevalence of hospitalised COVID-19 cases associated with a > 90% risk of exceeding intensive care bed capacity, are provided in the sixth update of the ECDC rapid risk assessment on COVID-19 [1]. Since cases have so far clustered in certain regions in EU/EEA countries and the UK, and hospitals and intensive care units usually serve a defined regional catchment population, information about cases and intensive care beds should preferably be made available at the Nomenclature of territorial units for statistics 2 (NUTS-2) level.
The experience from Italy and the current trends in other countries show that the COVID-19 pandemic is progressing rapidly in the EU/EEA and the UK. Countries, hospitals and intensive care units should thus prepare themselves for a scenario of sustained community transmission of SARS-CoV-2 and an increase in the number of patients with COVID-19 requiring healthcare, and in particular intensive care, such as the one occurring in the affected regions of Italy. As pointed out in the recent ECDC rapid risk assessment, a rapid, proactive and comprehensive approach is essential to delay the spread of SARS-COV-2, with a shift from a containment to a mitigation approach, as the anticipated rapid increase in the number of cases may not provide decision makers and hospitals enough time to comprehend, accept and adapt their response accordingly if not implemented ahead of time [1]. The rapid risk assessment also lists the public health measures to mitigate the impact of the pandemic. There is a short window of opportunity during which countries have the possibility to further increase their control efforts to slow down the spread of SARS-CoV-2 and decrease the pressure on healthcare. Failing this, it is likely that the healthcare systems of other EU/EEA countries will face a surge of patients that require intensive care within the coming days or weeks.