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This statement was originally published in The Lancet on 2020-12-18.

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Calling for Pan-European commitment for rapid and sustained reduction in SARS-CoV-2 infections

Authors: Viola Priesemann, Melanie Brinkmann, Sandra Ciesek, Sarah Cuschieri, Thomas Czypionka, Giulia Giordano, Deepti Gurdasani, Claudia Hanson, Niel Hens, Emil Iftekhar, Michelle Kelly-Irving, Peter Klimek, Mirjam Kretzschmar, Andreas Peichl, Matjaž Perc, Francesco Sannino, Eva Schernhammer, Alexander Schmidt, Anthony Staines, Ewa Szczurek

Across Europe, the SARS-CoV-2 pandemic is causing excess deaths, placing a burden on societies and health systems, and harming the economy. Yet, European governments still have to develop a common vision to guide the management of the pandemic. Overwhelming evidence shows that not only public health, but also society and the economy benefit greatly from low COVID-19 case numbers. Vaccines will help control the virus, but not until late 2021. If we do not act now, further waves of infection are to be expected, with consequential further damage to health, society, jobs and businesses. Given open borders within Europe, a single country alone cannot keep the number of COVID-19 cases low; thus joint action and common goals among countries are essential. We, therefore, call for a strong, coordinated European response and clearly defined medium- and long-term goals.

Achieving and maintaining low case numbers should be the common, pan-European goal because:

Fewer people will die or suffer from long-term effects of COVID-19. In addition, medical resources will not be diverted from other patients in need.
The economic impact of COVID-19 is driven by viral circulation within the population, and economies can and will recover quickly once the virus is greatly reduced or eliminated (e.g. China and Australia). In contrast, the economic costs of lockdowns increase proportionally with their duration 1.
Easing restrictions while accepting higher case numbers is a short-sighted strategy that will lead to another wave, and thus to higher costs for society as a whole. Testing and tracing capacities are limited: only with sufficiently low case numbers can the test-trace-isolate-support strategy (TTIS) quickly and efficiently help mitigating the spread 2,3. Hence, milder and more targeted physical distancing measures are sufficient, and schools and businesses can stay open.
Assuming a state with 300 new cases per million per day, 10 contacts per case, and 10 days quarantine: Then 3% of the population would need to be in quarantine, resulting in strong reductions of the workforce.
The heavy burden in terms of morbidity and mortality, reflected also in the current excess mortality, and the uncertain duration of immunity should strongly discourage this approach.
When case numbers are low, there is no need for rapid policy changes. This reduces the economic damage and the uncertainty and strain on mental health. However, if case numbers rise too high, preventive measures must be taken decisively to reduce them again - and the earlier, the better 5,6,7.

To better manage the COVID-19 pandemic, we propose a strategy with three core elements:

  1. Achieve low case numbers.
    1. Aim for a target of 10 new COVID-19 cases or less per million people per day. This target has already been reached in many countries, and can be reached again throughout Europe by spring, at the latest.
    2. Take firm action to reduce case numbers quickly. Strong interventions have proven efficient, and balance the rapid achievement of low case numbers against the negative impact of the interventions on mental health and the economy.
    3. To avoid a ping-pong effect by importing and reimporting SARS-CoV-2 infections, the reduction should be synchronized across all European countries and start as soon as possible. This synchronization will allow European borders to stay open.
  2. Keep case numbers low.
    1. At low case numbers, restrictions may be eased, but this should be carefully monitored. Targeted mitigation measures, such as mask wearing, hygiene, contact regulation and TTIS will be continued and improved.
    2. Even if case numbers are low, a strategy for surveillance testing (of at least 300 tests per million people per day) should be in place, covering the most important population groups at risk so that an increase in case numbers can be detected in time.
    3. Local outbreaks require a rapid and rigorous response, including travel restrictions, targeted testing, and possibly regional lockdowns, to achieve a rapid reduction in prevalence.
  3. Develop a longer-term common vision.

    Develop context-sensitive regional and national action plans as well as European-level goals, depending on the COVID-19 prevalence. Develop strategies for elimination, screening, vaccination, protection of those at high risk, and support for those most affected by the COVID-19 pandemic 8.

It is crucial to clearly communicate the advantage of low SARS-CoV-2 incidence. The success of these measures depends crucially on the cooperation and involvement of the public. Making the case for the economic and social benefits of reducing case numbers will, if clearly communicated, greatly foster public cooperation.

Controlling COVID-19 will become easier: In the near future, increased immunization, more testing, and an improved understanding of mitigation strategies will further facilitate the control of SARS-CoV-2.

We urge governments throughout Europe to agree on clearly formulated common goals, to coordinate their efforts, to develop regionally-adapted strategies to reach the goals, and thereby work resolutely towards low SARS-CoV-2 case numbers.

References

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This work by Ewa Szczurek is licensed under CC BY 4.0