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Weekly surveillance summary

Overall situation

  • At the end of week 30 (week ending Sunday 1 August 2021), the overall COVID-19 case notification rate for the European Union and European Economic Area (EU/EEA) was 214.0 per 100 000 population (201.3 the previous week). This rate has been increasing for five weeks. Overall hospital admissions due to COVID-19 have been stable for nine weeks. The 14-day COVID-19 death rate (4.7 deaths per million population, compared with 3.6 deaths the previous week) has increased compared to previous week.

  • ECDC’s assessment of each country’s epidemiological situation derives from a composite score based on the absolute value and trend of five weekly COVID-19 epidemiological indicators. As shown below, for week 30, the epidemiological situation in the EU/EEA overall was categorised as of moderate concern (the same as the previous week). Two countries were categorised as of high concern, 12 countries as of moderate concern, eight countries as of low concern and eight countries as of very low concern.

  • Ensemble model forecasts produced for each EU/EEA country on 2 August 2021 by the European COVID-19 Forecast Hub provide predictions for weeks 31 to 32. During this period and compared to the current week, stable trends in COVID-19 cases and deaths are forecast, reaching 224.0 cases per 100 000 population and 6.9 deaths per million population, by the end of week 32. At the country level, increasing trends in cases are forecast for 17 countries (Austria, Belgium, Bulgaria, Croatia, Denmark, Estonia, Finland, France, Germany, Iceland, Ireland, Italy, Latvia, Lithuania, Norway, Romania and Sweden) and increasing trends in deaths are forecast for three countries (France, Greece and Spain). Note that the uncertainty present in these forecasts, not shown here, increases the further ahead predictions are made.

  • By the end of week 30, the median of cumulative uptake of at least one vaccine dose among adults aged 18 years and above was 72.8% (country range: 19.2–91.2%). The median of cumulative uptake of full vaccination among adults aged 18 years and above was 59.8% (country range: 17.3–86.5%).

  • The estimated distribution (median and range of values from 14 countries) of variants of concern was 89.6% (52.3–99.0%) for B.1.617.2 (Delta), 5.6% (0.0–17.3%) for B.1.1.7 (Alpha), 0.1% (0.0–4.2%) for B.1.351 (Beta), 0.0% (0.0–1.7%) for P.1 (Gamma) and 0.0% (0.0–0.5%) for B.1.1.7+E484K.

  • The current epidemiological situation, characterised by a high number of reported of cases, is expected to continue given the ongoing increase in the occurrence of the Delta variant, which has now been dominant in the EU/EEA for some weeks. To date, the highest notification rates have been reported among younger age groups. However, increases in cases in older age groups, as well as increases in COVID-19 hospitalisation indicators, have also been observed in several countries.

Individual indicators

Intensity of COVID-19 in the EU/EEA as of week 30

Case notification rates

  • The 14-day case notification rate for the EU/EEA for week 30, based on pooled data collected by ECDC from official national sources in 30 countries, was 214.0 per 100 000 population (country range: 4.3–1 242), compared to 201.3 (country range: 3.6–1 514) in week 29. This pooled rate has been increasing for five weeks. The rate per 100 000 population was <40 in eight countries, 40–<100 in six countries, 100–<300 in seven countries and 300 or higher in nine countries. Increasing trends were observed in 17 countries.

Testing rates and test positivity

  • Notification rates are dependent on several factors, one of which is the testing rate. The weekly testing rates for the EU/EEA for week 30, based on pooled data reported by 30 countries, was 3 774 per 100 000 population (country range: 478–45 966), compared to 3 522 (country range: 478–59 219) in week 29. This pooled rate has been stable for nine weeks.

  • Pooled test positivity for the EU/EEA for week 30 was 2.8% (country range: 0.1–14.2%), compared to 3.0% (country range: 0.1–14.3%) in week 29. This indicator has been stable for two weeks. Test positivity was <2 % in 16 countries, 2–<4 % in nine countries, 4–<10 % in four countries (Estonia, France, Ireland and Sweden) and 10 % or higher in one country (Spain). Increasing trends were observed in six countries.

Severity of COVID-19 in the EU/EEA as of week 30

Case notification rates in people 65 years and older

  • The 14-day case notification rate in people aged 65 years or older for the EU/EEA, based on data reported by 25 countries, was 59.7 per 100 000 population (country range: 0.0–356.1), compared to 51.0 (country range: 4.5–467.9) in week 29. This pooled rate has been increasing for four weeks. The rate per 100 000 population was <20 in 11 countries, 20–<50 in five countries (Belgium, Estonia, Italy, Lithuania and Luxembourg), 50–<150 in six countries and 150 or higher in three countries (Cyprus, Iceland and Spain). Increasing trends were observed in 14 countries.

Rates of hospitalisation and ICU admission and occupancy

  • The hospital admission rate for the EU/EEA, based on data reported by 25 countries, was 2.1 per 100 000 population (country range: 0.0–17.6), compared to 2.6 (country range: 0.0–24.8) in week 29. This pooled rate has been stable for nine weeks. As a percentage of each country’s pandemic peak, this rate was <10 % in 18 countries, 10–<25 % in five countries (France, Lithuania, Malta, the Netherlands and Portugal), 25–<50 % in one country (Iceland) and 50 % or higher in one country (Cyprus). Increasing trends (of duration in weeks) were observed in four countries (France (one), Iceland (one), Lithuania (one) and Malta (one)).

  • The hospital occupancy rate (mean daily occupancy in the last week per 100 000 population) for the EU/EEA, based on data reported by 23 countries, was 4.6 per 100 000 population (country range: 0.4–32.2), compared to 5.6 (country range: 0.4–28.2) in week 29. This pooled rate has been decreasing for one week. As a percentage of each country’s pandemic peak, this rate was <25 % in 22 countries and 75 % or higher in one country (Cyprus). Increasing trends (of duration in weeks) were observed in four countries (Cyprus (six), Iceland (one), Luxembourg (one) and the Netherlands (two)).

  • The ICU admission rate for the EU/EEA, based on data reported by 13 countries, was 0.7 per 100 000 population (country range: 0.1–3.4), compared to 0.5 (country range: 0.0–2.8) in week 29. This pooled rate has been increasing for two weeks. As a percentage of each country’s pandemic peak, this rate was <10 % in seven countries, 10–<25 % in four countries (France, Greece, Ireland and the Netherlands), 25–<50 % in one country (Malta) and 50 % or higher in one country (Cyprus). Increasing trends (of duration in weeks) were observed in five countries (Cyprus (one), France (one), Greece (two), Malta (one) and the Netherlands (two)).

  • The ICU occupancy rate for the EU/EEA, based on data reported by 16 countries, was 0.8 per 100 000 population (country range: 0.1–4.5), compared to 1.0 (country range: 0.0–3.1) in week 29. This pooled rate has been decreasing for one week. As a percentage of each country’s pandemic peak, this rate was <25 % in 15 countries and 75 % or higher in one country (Cyprus). Increasing trends (of duration in weeks) were observed in five countries (Cyprus (four), France (one), Ireland (one), the Netherlands (one) and Portugal (one)).

Mortality

  • The 14-day COVID-19 death rate for the EU/EEA for week 30, based on data collected by ECDC from official national sources for 30 countries, was 4.7 per million population (country range: 0.0–41.7), compared to 3.6 (country range: 0.0–25.9) in week 29. The rate per million population was <20 in 29 countries and 40 or higher in one country (Cyprus). Increasing trends (of duration in weeks) were observed in four countries (Cyprus (two), Greece (one), Portugal (two) and Spain (one)).

Variants of concern (VOCs) and variants of interest (VOIs)

  • Sequencing capacity varies greatly across the EU/EEA. ECDC uses data reported to the GISAID EpiCoV database or The European Surveillance System (TESSy) to estimate the distribution of variants in countries reporting an adequate average weekly volume of SARS-CoV-2-positive cases sequenced (to estimate the proportion with sufficient precision for a variant prevalence of 5% or lower). Due to reporting delays in many countries a two-week window excluding the most recent week (weeks 28 to 29, 12 July to 25 July 2021) was used.

  • In this period, 14 countries (Austria, Belgium, Denmark, France, Germany, Greece, Iceland, Ireland, Italy, Latvia, the Netherlands, Norway, Slovenia and Spain) reported an adequate average weekly sequencing volume (five with sufficient precision at a variant prevalence of 1% or lower, seven with sufficient precision at a variant prevalence of >1% to 2.5% and two with sufficient precision at a variant prevalence of >2.5% to 5%), 12 countries reported an inadequate sequencing volume without sufficient precision at a variant prevalence of 5% and four did not report any data.

  • Among the 14 countries with an adequate sequencing volume in this period, the median (range) of the VOC reported in all samples sequenced was 89.6% (52.3–99.0%) for B.1.617.2 (Delta), 5.6% (0.0–17.3%) for B.1.1.7 (Alpha), 0.1% (0.0–4.2%) for B.1.351 (Beta), 0.0% (0.0–1.7%) for P.1 (Gamma) and 0.0% (0.0–0.5%) for B.1.1.7+E484K.

  • The median (range) of the VOI reported in all samples sequenced in the period for these 14 countries was 0.0% (0.0–1.5%) for B.1.617.1 (Kappa), 0.0% (0.0–1.0%) for B.1.621, 0.0% (0.0–0.6%) for B.1.525 (Eta), 0.0% (0.0–0.1%) for B.1.617.3, 0.0% (0.0–0.1%) for B.1.620 and 0.0% (0.0–0.0%) for C.37 (Lambda)

Long-term care facilities (LTCFs)

  • Based on data reported to TESSy from eight countries (Austria, Belgium, Croatia, France, Lithuania, Luxembourg, the Netherlands and Sweden), in week 30, the pooled incidence of COVID-19 cases among long-term care facility (LTCF) residents was 53.3 per 100 000 LTCF beds, the pooled incidence of fatal COVID-19 cases was 4.7 per 100 000 LTCF beds, and 6.6% of participating LTCFs reported one or more new COVID-19 cases among their residents.

  • Comparing week 30 to weeks 26 to 29, the trends in the incidence of confirmed cases and fatal cases, and the proportion of affected LTCFs, were as follows:

  • For confirmed COVID-19 cases, four countries (Belgium, Croatia, Lithuania and Luxembourg) reported a decrease (a relative rate decrease of at least 10%, or an absolute decrease of 10 cases per 100 000 beds) and four countries (Austria, France, the Netherlands and Sweden) reported an increase.

  • For fatal COVID-19 cases, three countries (Austria, Lithuania and Sweden) reported a decrease (a relative rate decrease of at least 10%, or an absolute decrease of 10 fatal cases per 100 000 beds) and four countries (Belgium, Croatia, Luxembourg and the Netherlands) reported an increase.

  • For the proportion of LTCFs that reported one or more new COVID-19 case, two countries (Belgium and the Netherlands) reported an increase (at least 10% relative increase) and two countries (Croatia and Lithuania) reported a decrease (at least 10% relative decrease).

1 Introduction

1.1 Surveillance objectives for COVID-19

This is a weekly surveillance report for COVID-19 in the EU/EEA produced by ECDC on 5 August 2021 at 19.15. The data presented here are provisional surveillance data that may be subject to errors and subsequent change.

The report’s aim is to provide an detailed presentation of COVID-19 epidemiology in the EU/EEA using data collected by and submitted to ECDC (see next section). Considerable work still needs to be done to establish and strengthen robust population-based surveillance required to reliably estimate indicators to monitor the intensity, geographical spread, severity and impact of COVID-19 in the EU/EEA.

ECDC’s COVID-19 country overviews is a second weekly surveillance output which provides a concise overview of the evolving epidemiological situation for the COVID-19 pandemic by country, using weekly and daily data from a range of sources.

These two weekly reports present information with reference to the objectives of the ‘Strategies for the surveillance of COVID-19’ (see below). Currently included are data for selected indicators under objectives 1 and 3, together with additional information on data quality in TESSy, descriptive epidemiology of COVID-19 cases reported to TESSy and a description of the national COVID-19 and influenza surveillance systems in the EU/EEA. The scope of these reports may change once more data become available and additional analyses of the existing data have been completed. Surveillance outputs related to objective 2 include ‘ECDC Primer Scan’, which shows primer and probe sequence matches for several publically available real-time PCR assays.

1.2 Data sources and navigation

Data are included from the following sources:

  1. ECDC’s epidemic intelligence (EI), last updated in the morning of 2 August 2021: officially reported numbers of new cases and deaths per country, collected weekly
  2. Data on individual COVID-19 cases submitted by Member States to TESSy: this report is based on data extracted on 4 August 2021 at 17.15, comprising 16 738 655 case-based records from 16 countries that have submitted these data throughout the pandemic and up to at least the most recent three weeks (see table below).

Figures will expand when clicked upon. For most figures, a table of the underlying data is included, either directly underneath the figure or in one of the subsequent tabs. These tables are interactive, allowing sorting and filtering of columns and the number of records to display.

Please use the floating table of contents and tabs to navigate between sections and sub-sections.

The report should not be opened in Internet Explorer as it may not display all features correctly.

1.3 Content of sections

Sections 2-5 of this report contain the following:

  • Severity: age-sex distributions of cases and different levels of severity, rates of severe outcomes and European excess mortality monitoring
  • Changes in risk groups: distribution of preconditions among cases with severe outcomes and changing age- and age-sex distributions of severe cases over time
  • TESSy data quality: an overview of completeness, data availability and possible duplicates in aggregate and case-based TESSy data
  • Surveillance system description: a summary of the definition of deaths (by case classification, setting and time limit) included in each country’s COVID-19 death totals and an overview of national surveillance systems for COVID-19 and influenza

2 Severity

2.1 Notes about the data

We present up to five different indicators of severity from two populations of cases:

  1. among all cases: rates of a) hospitalisation, b) severe hospitalisation, and c) death
  2. among hospitalised cases: rates of d) severe hospitalisation, and e) death

A case requiring ‘severe hospitalisation’ is one that has been admitted to intensive care and/or required respiratory support.

Figures and tables that simply describe distributions (population pyramids) among cases at different levels of severity include the additional category ‘mild’, which is a case that has not been reported as hospitalised or dead. The inclusion criteria above do not apply to these figures, so all cases reporting the outcome in the dataset are included. ‘Mild’ and the three other categories are mutually exclusive, whereas the same case can be counted in more than one of the other categories (hospitalisation, severe hospitalisation or death).

TESSy data are not complete for all variables. Estimates of rates for severe outcomes (age-sex-period-specific comparisons of cases that have/have not reported the outcome) are based on data from countries with at least 50% completeness for the severity variable and at least 50 cases overall among the relevant population (all cases or hospitalised cases).

2.2 Age-sex pyramids

2.2.1 EU/EEA

Data source: TESSy COVID-19 case-based data

Age-sex distributions of all cases reported at different levels of severity are shown below. Cases reported to TESSy are older than the general population, with very few cases in people aged below 20 years. This reflects the age distribution of people who met the requirements for being tested and is unlikely to reflect the actual distribution of infections in the population. Males and older age groups are over-represented among more severe cases (hospitalised, severely hospitalised or fatal).

2.2.2 Data (pooled and countries)

2.3 Age-specific rates of severe outcome by sex and period

2.3.1 EU/EEA

Data source: TESSy COVID-19 aggregate data

Age and age-sex-specific attack rates are shown for five indicators of severity across all (a–c) and hospitalised (d–e) cases. The risk of hospitalisation and death increases sharply with age. The reduced risk of severe hospitalisation among the oldest age groups may reflect clinical decisions about the use of limited ICU or ventilator capacity and is a pattern that is observed in many countries. Males have a higher risk of severe outcomes than females, and this sex difference tends to becomes more marked in the older age groups. Values of case-fatality may be underestimated for countries with deaths under-reported relative to cases in TESSy

2.3.2 Data (pooled and countries)

2.4 Mortality surveillance

EuroMOMO, hosted at Statens Serum Institute in Copenhagen and supported by ECDC, publishes weekly analyses of all-cause excess mortality (a statistically significant excess compared to expected levels for a given week of the year) every Thursday around noon. The network currently receives data from up to 26 participating countries. Numbers of deaths by age group are shown in a pooled European analysis; individual country curves are also displayed. The number of deaths over the last weeks should be interpreted with caution as adjustments for delayed registrations may be imprecise, but given the challenges with the attribution and reporting of COVID-19-related deaths, all-cause excess mortality can be an important and objective measure of the impact of the pandemic, particularly during periods when competing drivers of excess mortality (influenza and high/low temperatures) are largely absent.

3 Risk groups most affected

3.1 Preconditions: frequency distribution by severity

4 TESSy data quality

4.1 Completeness of reporting

Data sources: TESSy COVID-19 case-based and aggregate data and daily counts of reported cases and reported deaths collected by ECDC epidemic intelligence

The number of cases and deaths reported to TESSy as a proportion of the official figures collected by epidemic intelligence before 10am each day; >100% may be due to TESSy being more up to date than epidemic intelligence or due to duplicate records in TESSy.

4.2 Variable completeness

Data sources: TESSy COVID-19 case-based data

Variable completeness in case-based data, where completeness is defined as the proportion of records that are not coded as either ‘unknown’ or missing.

Some variables have been constructed by combining information from multiple variables: number_symptoms: number of symptoms reported based on ClinicalSymptoms and ClinicalSymptomsOther; hcw: based on Occupation and HealthcareWorker; hosp: based on Hospitalisation, DateofHospitalisation, IntensiveCare, RespiratorySupport and RespiratorySupportOther; severe: hosp cases who need intensive care and/or respitatory support, dead: based on Outcome and DateOfDeath).

5 Surveillance system description

5.1 Definition of COVID-19 deaths by country

5.2 National surveillance systems for COVID-19 and influenza