Severity: Warning Alert

Health: Widespread COVID-19 continues in Western Europe since Jan. 2020. Local transmission in some areas; maintain strict basic health precautions.

The locations affected by this alert are:

  • Albania
  • Andorra
  • Austria
  • Belgium
  • Bosnia and Herzegovina
  • Bulgaria
  • Croatia
  • Cyprus
  • Czech Republic
  • Denmark
  • Estonia
  • Finland
  • Gibraltar
  • Greece
  • Iceland
  • Vatican City
  • Hungary
  • Italy
  • Latvia
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • North Macedonia
  • Malta
  • Monaco
  • Netherlands
  • Norway
  • Poland
  • Portugal
  • Romania
  • San Marino
  • Serbia
  • Slovakia
  • Slovenia
  • Spain
  • Sweden
  • Switzerland
  • London, England
  • Ireland
  • Paris
  • Berlin
  • San Marino

This alert began 13 Mar 2020 16:36 GMT and is scheduled to expire 15 Mar 2020 23:59 GMT.

  • Incident: Coronavirus disease (COVID-19): imported cases, local transmission
  • Affected Area(s): Western Europe (map)
  • Period: January-March 2020

Summary
Several countries and territories in western Europe have identified imported cases of coronavirus disease (COVID-19) and human-to-human transmission from those imported cases. Some countries provide more detailed location information than others. As of March 13, the following countries and territories have identified confirmed COVID-19 cases:

Community disease transmission

  • Italy: 15,113 cases reported nationwide. Most local transmission reported in Lombardy, Emilia Romagna, and Veneto regions. US CDC maintains an "Alert-Level 3" travel health notice, the highest of three levels that indicates authorities recommend avoiding nonessential travel to the country
  • Spain: 4,209 cases. Nearly half of the cases are reported in Madrid and Pais Vasco. Imported cases in Mallorca and the Canary Islands.
  • France: 2,867 cases reported throughout the country. Localized outbreaks reported in Haut-Savoie, Oise, Haut-Rhin, and Morbihan departments.
  • Germany: 2,369 cases. The most affected states are North Rhine-Westphalia. Bavaria, and Baden-Wurtemberg. Increasing cases in Bavaria.
  • Switzerland: 1,125 cases reported among the following cantons: Aargau, Appenzell Ausserrhoden, Baselland, Basel-Stadt, Bern, Freiburg, Geneva, Glarus, Graubunden, Jura, Lucerne, Neuchatel, Nidwalden, Obwalden, Schaffhausen, Schwyz, Solothurn, St. Gallen, Ticino, Thurgau, Vaud, Valais, Zug, and Zurich.
  • UK: 590 cases reported throughout the country, including Northern Ireland and Scotland
  • Norway: 750 cases among Viken, Vestland, Agder, Oslo, Toms of Finnmark, Rogaland, Nordland, Innlandet, Bergen, More of Romsdal, Telemark of Vestfold, and Trondelag.
  • Sweden: 809 cases
  • Netherlands: 804 cases
  • Denmark: 788 cases
  • Belgium: 556 cases
  • Austria: 504 cases, primarily in the states of Tyrol, Upper Austria, Vienna, and Lower Austria.
  • Finland: 155 cases
  • Greece: 133 cases
  • Iceland: 117 cases
  • Czech Republic: 116 cases
  • Slovenia: 96 cases
  • Portugal: 78 cases
  • Ireland: 70 cases
  • San Marino: 67 cases
  • Romania: 64 cases
  • Poland: 49 cases
  • Estonia: 27 cases
  • Luxembourg: 26 cases
  • Croatia: 25 cases
  • Serbia: 24 cases
  • Albania: 23 cases
  • Bulgaria: 23 cases
  • Slovakia: 21 cases
  • Latvia: 16 cases
  • Hungary: 16 cases
  • North Macedonia: 9 cases
  • Bosnia and Herzegovina: 11 cases


Imported cases only

  • Malta: 9 cases, primarily in Valletta
  • Liechtenstein: 4 cases
  • Andorra: 1 case
  • Lithuania: 3 cases
  • Gibraltar: 1 case
  • Cyprus: 6 cases
  • Monaco: 1 case
  • Vatican City: 1 case



Background and Analysis
On March 11, the WHO declared the ongoing COVID-19 outbreak a pandemic. This shift in posture from an earlier briefing indicating the WHO would no longer use the term "pandemic" to describe disease transmission is reflective of the current COVID-19 global impact. The March 11 statement specifically noted "Describing the situation as pandemic does not change WHO's assessment of the threat posed by this virus. It does not change what WHO is doing, and it does not change what countries should do."

The US CDC maintains an "Alert-Level 2" travel health notice for the global COVID-19 outbreak. This indicates older individuals and those with chronic medical conditions or otherwise compromised immunity should take special precautions to avoid becoming ill, especially where sustained community transmission of COVID-19 has been identified.

Older individuals, infants, and those with chronic illness are more susceptible to infection and are at increased risk for severe complications. Human-to-human transmission can occur, though it remains unclear how easily the virus spreads between people.

Coronavirus disease 2019 (COVID-19) is a viral respiratory disease caused by infection with the SARS-CoV-2 virus (previously known as 2019-nCoV). Symptoms occur 1-14 days following exposure (average of 3-7 days). These symptoms include fever, fatigue, cough, difficulty breathing, sometimes worsening to pneumonia and kidney failure - especially in those with underlying medical conditions.

Advice
Emphasize basic health precautions, especially frequent handwashing with soap and water, or an alcohol-based hand sanitizer if soap and water are unavailable. Practice good coughing/sneezing etiquette (i.e., covering coughs and sneezes with a disposable tissue, maintaining distance from others, and washing hands). There is no evidence that the influenza vaccine, antibiotics, or antiviral medications will prevent this disease, highlighting the importance of diligent basic health precautions.

Resources
WHO advice for international travel

WHO coronavirus knowledge base

US CDC Global COVID-19 Travel Health Notice

WHO: Getting your workplace ready for COVID-19

US CDC Guidance for Businesses and Employers

US CDC Travel Health Notice for Italy