Coronavirus: COVID-19

Coronaviruses (CoV) are a large family of viruses that cause symptoms ranging from the common cold to more serious illnesses, i.e. the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The new coronavirus (nCoV) is a new strain of coronavirus that had not yet been identified in humans.

COVID-19 is the infectious disease caused by the latest discovered coronavirus (SARS-CoV-2). This new virus and disease were unknown before the outbreak in Wuhan, China, in December 2019. 

COVID-19 infection remains mild in 80% of cases. In order to delay spreading among the general population and to protect vulnerable and fragile groups in the population, it is important to take a certain number of precautions.

SARS-CoV-2 is a new strain of coronavirus that had not been seen in humans before. The epidemic began in the Chinese city of Wuhan, capital of the Hubei province. At first, the epidemic seemed to be linked to the South China Seafood City market. This market hosts merchants for seafood, poultry, bats, marmots and other wild animals, which indicates a probable animal origin of this virus. The virus was later confirmed to also transmit between humans. Cases have since been discovered in other regions of China and in other countries, often linked to a previous visit of Wuhan. The health authorities of the various affected countries are currently investigating this new coronavirus and the sources of the contamination.

There is no universally applicable definition. However, it can be said that a pandemic is the increased and sustained propagation of an extraordinary infectious human disease that rapidly affects all parts of the world and a large part of the global population.

Symptoms vary from moderate to severe respiratory infection, accompanied by fever, coughing and breathing difficulties. Seniors and people with pre-existing chronic illnesses seem more vulnerable and at risk of complications.

The incubation period, the time between contamination and the appearance of the first symptoms of COVID-19 infection, is maximum 14 days.

No. Only a test on respiratory secretions is currently available to detect the presence of the new coronavirus.

A laboratory test carried out on medical prescription can identify the SARS-CoV-2 infection.  However, this test is of no use in the absence of symptoms. Your personal physician is in the best position to assess the value of the test in your case.

The test result is sent to the physician who requested the test, through a secure channel, who communicates it to the patient without delay. The result is also sent to the Health Inspectorate, in application of the law of 1 August 2018 on the compulsory declaration of certain diseases. At the patient’s request, the result can also be passed on to his/her physician.

The COVID-19 infection is transmitted by people carrying the virus. The disease can be spread from person to person through respiratory droplets expelled from the nose or mouth when a person coughs or sneezes.

These droplets can persist for some time on objects or surfaces around the person in question. An infection with COVID-19 can occur if you touch these objects or surfaces and then touch your eyes, nose or mouth. COVID-19 can also be contracted by inhaling droplets from a sick person who has just coughed or sneezed. This is why it is important to keep a distance of more than two meters from a sick person and to respect basic hygiene measures.

Coronaviruses spread through secretions from humans and animals. According to the WHO, a contamination by a package is not likely.

COVID-19 is not a sexually transmitted disease. However, the virus being present in the respiratory secretions and being able to be transmitted by direct contact of person to person, sexual intercourse is favorable to a transmission of the virus, if one of the partners is infected.

According to what is currently known, the SARS-CoV-2 does not seem to pose a particular threat to pregnant women. Pregnant women are therefore not subject to additional protective measures other than those normally recommended in the context of their pregnancy. 

To this day, the coronavirus has not been associated with fetal anomalies or a heightened risk of a premature birth.

Source: ECDC: https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers

Source: CDC: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnant-women-and-children.html

Stay at home. Limit your social contacts to the strict minimum. Leaving your house is restricted to the following activities:

• purchase of food, pharmaceuticals and basic necessities,
• going to health services in case of an emergency,
• travel to the place of work for the exercise of the professional or commercial activity in so far as telework cannot be applied,
• assistance and care for the elderly, minors, dependent people, disabled people or particularly vulnerable people,
• visiting financial and insurance institutions, if absolutely necessary,
• trips due to a case of force majeure or a situation of necessity,
• leisure activities (going for a walk, jogging, ...), if it is practiced alone and not in a group. Please observe the recommended security distance of at least 2 metres.

At this stage, there is no vaccine yet. Research is ongoing.

There is no specific treatment at this time, although research is ongoing.  The treatment is therefore mainly symptomatic, i.e. it is similar to the treatment for a cough, respiratory problems or high temperature.

Medical teleconsultation has been put in place. This does not necessarily mean that clinics are closed as of now. So as to protect the patients' health, they continue to operate, but only at a distance.  

Your physician has to refer you to the best care option: if this is not possible, he/she has an obligation to refer you to another doctor who provides continuity of care for his patients.

Since 18 March, general physicians' Medical centres receive, by appointment, patients with symptoms of a severe respiratory infection.

The 3 on-call Medical centres in the country will be open on weekdays from 8 a.m. to 4 p.m.. In order to ensure the proper functioning of the Medical centres, please only visit the Medical centres as directed by your treating physician.

Each Medical centre provides a rapid care circuit for patients according to the following organisation: reception and triage - medical consultation - sampling.

Options for setting up a similar medical structure in the east of the country are being analysed.

The same precautions should be taken as for any other respiratory infection.

1. Most importantly: wash your hands regularly and properly. The best way to wash your hands is illustrated online at www.sante.lu
2. Do you cough or sneeze? Do it in a tissue or in the crease of the elbow. Throw the tissue in a bin with a lid.
3. Avoid shaking hands or kissing.
4. Avoid close contact with sick people (keep a distance of at least 2 meters).
5. Stay home if you are sick. Don't go to work!
6. Avoid touching your face with your hands as much as possible.

Individuals are considered vulnerable if they are over 65 years of age or if they are already suffering from one of the conditions mentioned hereafter. Those conditions are:

• Diabetes
• Cardiovascular diseases
• Chronic diseases of the respiratory tract
• Cancer
• An immune deficiency due to a condition or therapy

Stay at home.

If you absolutely have to go out, observe the following recommendations:

• go shopping outside of peak hours, if possible;
• avoid places where it is not possible to keep a security distance of at least 2 metres;
• avoid public transport;

Protect yourself from coronavirus in the same way you'd do for the flu. Follow the 6 instructions and avoid poorly ventilated areas with many people.

Immuno-compromised people protect themselves like vulnerable people. Only people for whom the attending physician has already prescribed specific protective measures (such as wearing a mask in a hospital) should continue to follow these prescriptions.

Wearing a mask in a preventive manner is not recommended by the World Health Organization (WHO) as a means to avoid contamination with the COVID-19 virus.

The use of special masks (FFP2) to prevent infection with coronavirus only makes sense in hospitals where patients infected with coronavirus are treated and in laboratories for the analysis of the body material of these patients.

Isolation applies to people who have a confirmed infection with SARS-COV-2.  This measure is designed to prevent the infected person, who is contagious, from spreading the infection to his surroundings.

Isolation is prescribed by the physician for a minimum of 14 days after the onset of symptoms. During this period of confinement at home, contact with other people must be avoided and a surgical mask must be worn whenever the infected person is in the presence of others.

What you and your family should do when you need to be isolated at home

The auto-quarantine applies to people who have had intimate contact or who live in the same household as a person who is confirmed to be infected. They must stay at home during seven days counting from the day of the confirmed diagnosis. During this period, contact with other people should be avoided.  During the seven days following a self-quarantine, self-monitoring should be carried out.

What to do while in auto-quarantine

Auto-isolation applies to people who have symptoms of illness compatible with COVID-19 but whose infection is not confirmed.  They should stay home for 7 days from the onset of symptoms and avoid contact with other people if possible. Once the symptoms have disappeared, they must stay at home for 24 more hours.

What to do if you have a fever or are coughing and you are staying at home

Auto-monitoring lasts 14 days and applies to people who are likely to have been infected with the virus through contact with a sick person.  The purpose of auto-monitoring is to detect symptoms of infection as soon as they appear.  The person under auto-monitoring measures his or her temperature twice a day and makes sure there are no breathing problems or coughing. During auto-monitoring, normal activities can be continued.

As more and more cases have appeared in Europe and Luxembourg and as it has become clear that it is impossible to keep the virus from spreading throughout the general population, the control strategy has been adapted. The strategy does not rely on quarantine measures anymore, but instead focuses on the protection of the fragile population and individuals who risk developing severe complications.

No. As these facilities care for very vulnerable people, visits and leaves are prohibited until further notice.

Directors of structures may allow, in exceptional cases, exceptions from the prohibition of access and exit for relatives and family members, provided that they do not show symptoms. All persons entering the premises must disinfect their hands and respect the general rules of hygiene.

Given that many hospitalised people are vulnerable, visits of hospital patients are prohibited. If a visit has to take place, all of the necessary protective measures must be taken in order to protect the patients.

Scheduled activities should be cancelled, if possible.

If possible, the leaves of hospital staff should be cancelled.

Hospitals will deploy their staff mainly to urgent and acute activities.  In order to reduce the risk of the virus circulating in hospitals, medical, surgical and care activities which are not short-term indispensable are cancelled. Patients with COVID-19 who do not show severe complications (cases with light symptoms) will be cared for at home, while respecting the recommended isolation measures.

The focus is on a continual monitoring of the hospital requirements, in terms of both personnel and equipment. Hospital capacities will be increased.

Hospitals will signal daily:

• their bed occupancy rate;
• the bed occupancy rate reserved for medical conditions due to COVID-19;
• the number of new COVID-19 patients taken care of;
• the number of patients having left the hospital;
• the bed occupancy rate in intensive care units;
• the number of respirators available;
• the number of available heart/lung machines;
• available personal protective equipment, including hygiene masks, respirators, gloves, overalls, and goggles;
• overcrowding and waiting times in emergency departments.

The implementation of this measure, as well as the establishment of a system for triage of patients requiring hospitalisation, will be carried out on the basis of consultation between the Health Directorate and the hospital sector.

An inter-ministerial coordination group continuously plans and prepares the measures to be taken in order to minimise the impact of the COVID-19-epidemic on the population and our society.

During the initial phase of containment, health authorities have developed procedures to take in charge suspected cases of infection and to follow up with their contacts. These procedures have been communicated to all physicians on several occasions. The National Health Laboratory (Laboratoire national de santé, LNS) is approved by the World Health Organisation (WHO) for the diagnosis of the virus. The national service for infectious diseases at the Centre Hospitalier de Luxembourg (CHL) is prepared to receive possible cases of suspected or confirmed illness. The procedures for quarantine and self-monitoring of contacts have been defined by the Health Directorate and can be implemented quickly by the Health Inspectorate.

Since 12 March, the government has moved to a strategy of reinforcing the protection of vulnerable populations. This strategy implies that efforts are focused on preventing the transmission of the infection to these people rather than on identifying any cases of COVID in the general population.

Luxembourg has a stock of special masks (FFP2) and surgical masks. These masks are intended for caregivers in close contact with a sick person or a person in quarantine. Furthermore, Luxembourg is participating in a joint acquisition with other EU member states aiming to bolster the existing stock.

These masks have been distributed to health professionals (doctors and other professionals) since 7 March 2020. The primary objective of this initiative, which includes different phases of distribution, is to prevent an infected patient from infecting the professionals who provide care. The secondary objective is to prevent professionals, who are in turn infected, from contaminating vulnerable people with COVID-19. The purpose of this measure is to reduce the transmission of the virus during care, to protect patients, to secure the health system and its professionals and to maintain continuity of care.

The amended law of 23 July 2016 on the organisation of the High Commission for National Protection (HCPN) appoints the HCPN to plan and implement a national protection concept. The national protection plan includes, among other things, the prevention and management of large-scale crises which is are events that,

• affect the vital interests or essential needs of the whole or part of the population ;
• require urgent decisions;
• and require coordination at a national level of the actions of the government administrations, departments and agencies.

If necessary, the crisis unit is activated by the Prime Minister and summoned by the High Commission for National Protection. It is chaired by a member of the Government. In the scenario of a health crisis, the crisis unit is chaired by the Minister of Health. It brings together representatives of all departments, administrations and State services concerned by the nature of the crisis.

If necessary, the crisis unit may be supported in its work by other units, such as the "administration and logistics unit" placed under the responsibility of the Chief of Staff of the Army, the "means of communication" unit placed under the responsibility of the Director of the government IT centre or the "legal support" unit placed under the responsibility of a representative of the Minister of Justice.

The crisis unit ensures the political and strategic lead of major crises. It is in charge of

• analysing the situation in the country;
• setting the general strategy of the State's response;
• initiating, coordinating and ensuring the implementation of all measures to deal with the crisis

The Ministry of Health has moved to the next stage of its preparation and planning work, in order to best anticipate the evolution of the crisis and the measures to be taken. An internal crisis unit within the Ministry of Health has been set up.

The Health Inspectorate (Inspection sanitaire) is a division of the Health Directorate. It is responsible, among other things, for ensuring the protection of public health, both in terms of environmental health and the surveillance and control of communicable diseases.

Yes, our hospitals are prepared. A referral service, namely the National Service of Infectious Diseases at the CHL, is in charge of the reception of patients infected with the coronavirus. If the epidemic spreads, other hospitals are prepared to receive patients infected with SARS-COV-2.

Taking into account the evolution of the coronavirus COVID-19 in our neighbouring countries and on the national territory, it is necessary to take additional measures to limit the spread of the virus in the population and to protect
those at risk. It has also become necessary to adapt the organisation of the health care system in order to cope with an increase in the number of people infected with the virus. The proposed measures take into account the pathogenic and contagious nature of the COVID-19 virus. In this context, the respect of appropriate distance rules in interpersonal relations is one of the most effective measures to limit the spread of the virus.

The situation also changed at the international level. As of 11 March, the World Health Organisation (WHO) has qualified the COVID-19 as a global pandemic. Moreover, the European Centre for Disease Prevention and Control (ECDC) published an updated risk assessment on March 12, underlining the 'necessity of an immediate targeted action' in order to dampen the impact of the pandemic. According to this appreciation, the risk of severe complications for elderly people and people with a chronic condition is high.

For these reasons, the strategy for the national strategy to combat the epidemic must be adapted and it no longer relies on confinement and quarantine measures.  From now on, it will have to focus more on dealing with serious cases and protecting vulnerable people. In this, Luxembourg is following the measures taken by many other countries.

Commercial premises which mainly sell foodstuffs remain open.

Commercial premises which sell non-food products may remain open, but only of the are part of the following list:

• pharmacies,
• opticians,
• stores selling mainly pet food,
• telecommunication shops,
• stores selling mainly hygiene and washing products and sanitary equipment,
• sale of fuel and petrol stations,
• distributors and specialized trade in medical-sanitary equipment,
• medical pedicure,
• newsagents,
• financial and insurance institutions,
• dry-cleaning and laundry services,
• funeral services,
• the sale of non-food products between professionals.

Take Away, Drive-In and home delivery services continue to operate.

Hotels and their room service remain operational.

Trade businesses, such as construction companies, can continue to exert activities such as repairs or troubleshooting. Outdoor construction sites remain closed from Friday 20 March 2020.

Since 16th March 2020, the activities of administrations and public institutions are restricted to essential services so as to guarantee their operation and crisis management.

The reception desks of administrations and public establishments will operate at reduced service.

In order to maintain the vital interests of the population and the country, these activities and sectors are maintained:

• production and distribution of energy and petroleum products;
• the health sector with hospital activities and medical analysis laboratories;
• the food sector;
• water distribution;
• the collection and treatment of waste water;
• waste removal and management;
• public transport;
• administrative services involved in the exercise of public authority;
• systems for the exchange, payment and settlement of financial instruments;
• institutional and home assistance and care for elderly and disabled people.

Activities of a cultural, social, festive, sporting and recreational nature are suspended.

Establishments in the cultural, recreational, sports and HORECA sectors remain closed (museums, bars, restaurants, cinemas, cafés, discotheques, libraries, swimming pools, sports halls, etc. ...).

Hotel restaurants and bars, with the exception of room service, remain closed.

This shutdown also applies to shops in supermarket shopping arcades, with the exception of the activities referred to below.

Outdoor construction sites remain closed from Friday 20 March 2020.

Almost all the regions of the world are risk zones and present a risk of infection by the new coronavirus. This is why no particular regions are mentioned.

In general, it is recommended to avoid unnecessary travel. In case of travel, the respect of barrier gestures is indicated:

• Monitor symptoms daily (cough, breathing problems); ;
• Measure your temperature twice a day;
• Wash your hands frequently and properly;
• Avoid contact with vulnerable and fragile people;
• Continue your usual activity.

If these people have not been proven to be in close contact with a sick and contagious person and do not have typical symptoms (cough, fever, breathing problems), they can resume their professional activity.