The European Centre for Disease Prevention and Control (ECDC) today warned in its latest COVID-19 risk assessment that cases are rapidly increasing in all of Europe, following rises that look similar to those of China's Hubei province and Italy and that the risk of overwhelmed health systems is high.

The report comes as cases in Western Europe soar and activity accelerates elsewhere, lifting the overall global total to 460,250 cases in 172 countries, according to the Johns Hopkins online dashboard. Three of the five worst-hit countries are in Europe: Italy, Spain, and Germany. Also, the global number of confirmed deaths passed 20,000 today, with 20,857 reported so far.

WHO advice for locked-down countries

At a media telebriefing today, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said the many countries that are on lockdown now have a second window of opportunity to suppress the disease.

"We understand that these countries are now trying to assess when and how they will be able to ease these measures," he said. "The answer depends on what countries do while these population-wide measures are in place."

On their own, the measures don't extinguish epidemics, but they reduce pressure on the health system and allow other more precise measures to stop transmission, Tedros said. He urged countries on lockdown to take six key steps: expand and train the public health workforce, implement systems to find every case, ramp up testing, identify facilities to treat patients, develop a quarantine plan, and refocus the entire government on suppressing and controlling the pandemic coronavirus.

"These measures are the best way to suppress and stop transmission, so that when restrictions are lifted, the virus doesn't resurge, Tedros said. "The last thing any country needs is to open schools and businesses, only to be forced to close them again because of a resurgence."

ECDC warns of Italian-type trajectories

The ECDC, in its seventh COVID-19 assessment, said that, since Mar 12, all European countries have now reported cases and that 63% of the global cases have been in Europe. With current testing capacity and if nations do not enact mitigation strategies, Europe could see by the middle of April a scenario similar to what China experienced in Hubei province at the beginning of the outbrak.

In Italy, cases peaked on Mar 21, and the number of cases appear to be decreasing, about 2 weeks after lockdowns were ordered, first in northern Italy, followed a few days later by a similar order for the whole country. Other European countries reporting large numbers of cases are likely to see overrun intensive care unit capacities, similar to what hospitals in northern Italy experienced.

The agency's analysis of the crude case-fatality rates show that the risk and numbers of deaths increase rapidly in those age 60 and over. Of hospitalized patients, 15% have severe disease, and, of those, 12% are fatal. Overall, the ECDC said the risk of severe disease is moderate for the general population and very high for older people and those with underlying health conditions.

The group added that, with effective mitigation measures in place, the risk of widespread community transmission is moderate, but the risk is very high if mitigation measures are inadequate.

Italy, with the world's second most cases, behind China, today reported 5,210 new cases, along with 683 more deaths, raising its respective totals to 74,386 infections and 7,503 deaths.

Spain, the fourth worst-hit country, after the United States, reported 5,552 new infections today, including 443 more deaths, putting its total at 47,601 cases, 3,434 of them fatal. And Germany reported 2,749 new cases, as well as 27 more deaths, lifting its respective totals to 35,740 and 2,749.

Report: China's easing of social distancing successful so far

China today reported no new local cases, though it did report 47 more imported cases, according to the latest daily report from the National Health Commission.

In a related development, a modeling group based at Imperial College of London yesterday published an analysis that suggests China's easing of strict social distancing measures has at this point been successful. The investigators used intra-city movement as a measure of economic activity. Their analysis for Hong Kong also suggests that intermediate levels of local activity can be maintained while holding off a large outbreak.

The modelers emphasized that the findings don't preclude future epidemics in China, but they do hint that, after intensive social distancing that contained the disease, the country has so far been successful in exiting them. They also stressed that China's epidemic is at a more advanced stage, but, once it achieves containment, its experience can help guide other countries.

Some parts of Asia are battling a recurrence of COVID-19 activity, following an initial gush of cases in the wake of China's outbreak. Hong Kong today reported 24 new cases, including 19 patients who had a travel history. And Singapore today reported 73 new cases, 38 of them imported.

Developments in Egypt, Iran

The WHO's Eastern Mediterranean office (EMRO) today said it wrapped up a technical mission to Egypt and added that the country has solid efforts under way to control its outbreak, especially in disease detection, contact tracing, lab testing, and patient referral.

In light of local transmission, however, the country has an opportunity to prevent community spread with a whole-of-government approach, officials said. They said the WHO will work with Egypt on infection prevention and control, alternate testing methods, and communication, especially with high-risk groups.

Egypt has reported 442 cases so far, 21 of them fatal, according to the WHO.

In Iran, the Middle East country with the most cases, health officials reported 2,206 more cases and 143 more deaths, putting the respective totals at 27,017 and 2,077.