"COVID is here to stay," emphasized World Health Organization (WHO) Regional Director for Europe, Hans Kluge, MD, at a press briefing on January 16, 2024. He stressed the need for continuing vigilance and efforts to keep the disease at the top of the political and healthcare agendas, while attention may be drifting to other major global events.
The WHO estimated that COVID-19 vaccines have saved at least 1.4 million lives in the WHO European Region, which encompasses 53 countries across a broad geographical area including the European Union (EU) and countries like Russia and Israel. Kluge said that at present, COVID-19 rates "remain elevated but are decreasing." However, he emphasized that the region is seeing widespread circulation of other respiratory viruses, including influenza, respiratory syncytial virus, and measles. The WHO was concerned that health services should prepare for an upsurge in the full range of respiratory virus hospitalizations in the next few weeks.
Kluge said that the unpredictable nature of the SARS-CoV-2 virus means that the emergence of new variants could cause the current situation to rapidly worsen.
A Complex Picture
Edoardo Colzani, MD, the Principal Expert on Respiratory Viruses at the European Centre for Disease Prevention and Control (ECDC), told Medscape Medical News that in the EU and European Economic Area, "Countries report a mix of increasing and decreasing trends in SARS-CoV-2 activity, COVID-19 hospitalizations, and ICU admissions and deaths, with severe outcomes predominantly among those aged 65 years and above."
The ECDC monitored the results of COVID-19 tests in selected sentinel sites chosen to give a representative sample. The percentage of positive tests in primary care sites increased from week 44 to week 49 of 2023 but fell since week 50.
Colzani said that many countries also conduct testing at non-sentinel sites, such as hospitals, schools, primary care facilities, laboratories, and nursing homes. "At the EU and EEA level, SARS-CoV-2 detections and testing in non-sentinel data were similar to those reported for sentinel data, with most countries reporting decreasing trends. However, in some countries, SARS-CoV-2 positivity and detections in non-sentinel data are notably increasing, especially in those aged 65 years and above," he explained.
Despite a decreasing trend in COVID-19 across Europe overall, data from the WHO reported an increasing trend in SARS-CoV-2 positivity in four EU reporting countries in the second week of January: Poland, Portugal, Switzerland, and Slovakia.
In terms of disease severity, Colzani said, "We wouldn't go as far as saying that there is declining severity, but surely it's not increasing...But if [vaccination] is not kept up to date, then we may see an increase in severity due to waning immunity, particularly among groups at risk."
The data available collectively from the ECDC and WHO revealed a complex picture of increasing and decreasing trends, covering rates of positive testing, hospital admissions, intensive care unit (ICU) admissions, and COVID-19–associated deaths. The values were changing significantly from week to week.
In terms of death rates, the WHO stated that although levels remained relatively low in the second week of January, Malta reported a marked increase in COVID-19 death rates in people aged 65 years and older, while 10 of the 14 countries reporting age-specific death data documented a marked decrease.
Challenges, Lessons, and Plans
"Member States should be ready for the possible need to increase emergency department and ICU capacity, in terms of adequate staffing and bed capacity, for both adult and pediatric hospitals," said Colzani. "Hospital administrators and managers should ensure that resources, such as medical and nursing staff and equipment, are also available."
As the virus continues to evolve, the ECDC view, generally shared by the WHO, is that there are currently no new variants of concern, but there are some variants of interest that are being closely monitored. "JN.1, which is a sub-lineage of the BA.2.86 variant, has been particularly increasing in proportion recently, but without so far causing a visible impact on the epidemiological indicators," said Colzani.
The prevalence of the diverse range of issues characterized as long COVID is another major aspect of the disease. The WHO estimated that 36 million people across the WHO European region may have developed long COVID over the first 3 years of the pandemic.
Several speakers at the WHO briefing highlighted lessons learned from the pandemic to help prepare for future ones, including the importance of regional resilience, with nations and regions needing to become self-sustainable in the manufacturing of medical and other supplies and in conducting clinical trials.
Looking to the future, Catherine Smallwood, MD, COVID-19 Incident Manager of WHO/Europe, told the press briefing, "We are working…in the European region and beyond to revise and update pandemic plans [to ensure] that what we've experienced in the last pandemic can be documented and included in the pandemic plan for the next one."
Hans Kluge concluded, "…It's so important [to get] an international agreement, a pandemic accord…to tackle some issues like much quicker exchange of information, of data on clinical trials, and of sharing also the different medical countermeasures."