European experts address the COVID-19 pandemic

August 10, 2021

How should Europe deal with the COVID-19 pandemic in the future? Which strategies should be pursued and what specific risks should be considered? To answer these questions, researchers from the Max Planck Institute for Dynamics and Self-Organization brought together more than two dozen experts from all over Europe and jointly prepared a detailed situation analysis for the coming months and years. The results have recently been published in the renowned journals The Lancet and The Lancet Regional Health - Europe.

Following a significant decline in COVID-19 incidence across Europe in spring, many countries have relaxed or even completely lifted their containment measures. However, in combination with the spread of the new delta variant, this led to a renewed increase in case numbers: recent research data suggest that this variant is significantly more infectious than the previous ones. In addition, even people who have already been vaccinated can pass on the virus with some probability, even though the vaccination itself is very effective in protecting against a severe course of infection. Increased travel, the planned opening of schools after the summer vacation, and increased transmission of the virus in the upcoming wet and cold season emphasize the need for a cross-national strategy. "It was very important to me that we develop such a European perspective," says Viola Priesemann, who helped coordinating the publications. "In every European country, the situation is slightly different. Nevertheless, we need a common strategy, because the virus doesn't stop at borders."

To this end, the authors use current data to produce a comprehensive analysis of the situation, which was published at the end of July 2021. From this, they derived various possible scenarios for the future and explain what conditions would have to precede each of them. In a supplementary publication, the authors now pointed out how a low incidence can have a beneficial impact on the pandemic. The content of this experts' view is reproduced below:

“We have considered two opposing strategies: 1) continue to rapidly lift restrictions, assuming the combination of past natural exposure and current vaccination coverage would allow a high incidence, without overburdening healthcare systems; or 2) lift restrictions at the pace of vaccination progress with the core aim to keep incidence low, given this effectively and efficiently controls the pandemic via test-trace-isolate (TTI) programs.

Given current immunization levels (August 2021), the first strategy can lead to an incidence of several hundred per 100,000 people and per week, whereas the second would require an incidence of well below one hundred. Such a discrepancy of incidence poses considerable friction to European cooperation, economy and society: high incidence in one country puts the low-incidence strategy in a neighboring country at risk. Because of this conflict of interest, some countries impose testing and quarantine requirements, hampering international exchange. Thus, either strategy can only work effectively if European agree on a common strategy. It’s about time for this, as no country is able to stop the pandemic on its own.

Comparison of COVID-19 pandemic in a selection of European countries, grouped by geographic proximity. Many differences in reported incidence, reported deaths, and excess mortality can be observed. Although there is considerable uncertainty in the reported figures, the differences between countries and between waves are evident. Data sources: https://ourworldindata.org/covid-cases and https://ourworldindata.org/excess-mortality-covid (accessed August 5, 2021). Figure modified from Iftekhar et al.

To nonetheless facilitate cross-border travel, the European Union’s Digital Covid Certificate for vaccinated people was introduced. However, no vaccine is yet completely effective at preventing virus transmission. Therefore, the implementation of the certificate must be accompanied by systematic evaluation regarding its contribution to the spread of present and future variants of concern. This also requires the development of a European strategy for testing travelers and commuters on a routine basis.

The advantages of a low incidence are known and include (1) reduced mortality, morbidity and Long COVID-19, (2) solidarity with those not yet protected, (3) lower risk of new VOCs emerging and spreading, (4) increased feasibility of comprehensive TTI, (5) less workforce in quarantine and isolation, including those in healthcare, (6) ensuring schools and childcare remain open during the coming autumn-winter season. In contrast, a high incidence might still overwhelm hospitals and intensive care units in some countries. The insufficient vaccination coverage in many European countries, uncertainties regarding child vaccination and the time required for full immunization of adolescents are additional factors to be considered in this. Thus, we recommend that all European countries act together to achieve low incidence, at least until everyone has had the opportunity to get vaccinated. A high incidence in one country challenges the pandemic response for others, in Europe and across the world. Maintaining low incidence represents an act of solidarity and becomes easier with the increasing vaccination coverage.

To improve measure effectiveness, three further challenges must be overcome: (1) vaccination availability, access, and hesitancy; (2) the widespread misconception that freedom would be maximized when ignoring high incidence. However, it has been recognized that low incidence facilitates containment and safeguards the freedom of all, including the most vulnerable people; and (3) the lack of a coherent pandemic response and communication strategy. The perceived risk, the motivation and health literacy are important predictors of the people's health-seeking behavior and adherence to measures. Public trust must be maintained through timely, consistent and persistent communications, including systematically developed dissent for misinformation.

We have yet to overcome the pandemic, but an end is conceivable: Restrictions can be lifted when high vaccination coverage is reached, and if vaccines remain highly effective against new variants of the virus. Until then, a common European strategy should be implemented to minimize economic and societal costs for Europe and the world as much as possible.

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