Covid-19: ECDC lists Bulgaria among countries with ‘trends of high concern’

In its latest report on the Covid-19 situation, the European Centre for Disease Prevention and Control (ECDC) has named Bulgaria as among countries with trends of high concern.

Countries with trends of high concern are those that have high or increasing notification rates in older cases and, consequently, an increased proportion of hospitalised and severe cases.

“In these countries, increasing or high death notification rates are already observed (as of September 13, in Bulgaria, Croatia, Czechia, Hungary, Malta, Romania and Spain), or may be observed soon,” the ECDC said.

“In some local/regional areas of these countries, healthcare provision is already under pressure, with high hospital and ICU bed occupancy rates and high levels of fatigue among healthcare workers.”

The improvements that have been made in case management, supportive treatment and care are still not enough to avoid severe disease and death in a large proportion of vulnerable patients, the ECDC said.

Implementing stricter NPIs (non-pharmaceutical interventions), which proved to be effective in controlling the epidemic in all EU/EEA countries and the UK in spring 2020, appears to be the only available strategy that may be able to ensure a moderate (as opposed to high) impact of the disease on individuals and on healthcare provision, the report said.

Therefore, in these countries, even with a timely and strict implementation of NPIs, the overall risk of Covid-19 is assessed as high for the general population and very high for vulnerable individuals, the centre said.

It added in an update as of September 23 that the epidemiological situation is rapidly evolving in many EU/EEA countries and the UK.

As of September 20, Norway moved from the group with concerning trends to the group of countries with stable trends, while Belgium and Sweden moved from the group with stable trends to the group with concerning trends.

The epidemiological situation of the 20 countries with concerning trends appears to be deteriorating with the majority of these countries now appearing to meet the criteria for classification as countries with high concerning trends, often because of an increase in the 14-day case notification rates in the older age groups (65-79 years old and/or 80 years or older), the ECDC said.

The ECDC said that Covid-19 case notification rates have increased steadily across the EU/EEA and the UK since August 2020, but this is not having the same impact in all countries.

In several countries the observed upsurge correlates with increased testing rates and intense transmission among individuals between 15 and 49 years of age.

In such countries most detections concern mild or asymptomatic cases.

However, in a number of other countries, the upsurge coincides with high or increasing notification rates in older individuals and, consequently, an increased proportion of hospitalised and severe cases.

The observed increased transmission levels indicate that the non-pharmaceutical interventions in place have not achieved the intended effect, either because adherence to the measures is not optimal or because the measures are not sufficient to reduce or control exposure.

In addition, the vulnerability of the population to infection remains high, as available data from seroprevalence studies suggest that the level of immunity in the population is less than 15 per cent in most areas within the EU/EEA and the UK, the report said.

“The current epidemiological situation in many countries is concerning as it poses an increasing risk of infection for vulnerable individuals (individuals with risk factors for severe Covid-19 disease, such as the elderly) and healthcare workers, particularly in primary care, and calls for targeted public health action,” the ECDC said.

The ECDC’s updated risk assessment shows that notification rates have increased steadily across the EU and the UK since August, and that the measures taken have not always been sufficient to reduce or control exposure.

“It is therefore crucial that member states roll out all necessary measures at the first sign of new outbreaks. This includes stepping up testing and contact tracing, improving public healthcare surveillance, ensuring better access to personal protective equipment and medicines and ensuring sufficient health capacity, in line with the actions presented by the (European) Commission in July.”

The ECDC’s risk assessment finds non-pharmaceutical interventions such as physical distancing, hygiene and the use of face masks have shown not to be sufficient to reduce or control exposure.

At the same time, the impact of the increased rates varies across countries.

While in some countries, the increase affects mainly younger people (15 to 49 years of age) resulting mainly in mild and asymptomatic cases, in other countries the rise leads to more deaths among the elderly.

“The current epidemiological situation poses an increasing risk for risk groups and health care workers and calls for immediate targeted public health action.”

The ECDC identifies in its risk assessment several response options such as strengthening healthcare capacities and targeting public health actions on medically vulnerable individuals and healthcare workers.

It calls for non-pharmaceutical interventions, testing strategies, contact tracing, quarantine measures, adequate risk communication and measures protecting mental health.

In its guidelines on non-pharmaceutical interventions against Covid-19, the ECDC presents available options for such interventions in various epidemiologic scenarios. The guidelines assess the evidence for the effectiveness of these interventions and address implementation issues, including potential barriers and facilitators.

For the rest of The Sofia Globe’s continuing coverage of the Covid-19 situation in Bulgaria, please click here.

The Sofia Globe’s coverage of the Covid-19 situation in Bulgaria is supported by the Embassy of Switzerland.

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The Sofia Globe staff

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