Across Europe, the COVID-19 pandemic is causing excess deaths, placing a burden on societies and health systems and harming the economy. European governments have yet 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 reducing cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Vaccines will help control the virus, but not until late 2021.
If European governments do not act now, further waves of infection are to be expected, with consequential damage to health, society, jobs, and businesses. With open borders across Europe, a single country alone cannot keep the number of COVID-19 cases low; joint action and common goals among countries are therefore essential. We therefore call for a strong, coordinated European response and clearly defined goals for the medium and long term. Achieving and maintaining low case numbers should be the common, pan-European goal for the following reasons.
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First, low case numbers save lives, and 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.
Second, low case numbers save jobs and businesses. 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. China and Australia have shown this is possible. In contrast, the economic costs of lockdowns increase with their duration.1
Third, the control of the spread is most effective at low case numbers. 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 quickly and efficiently help mitigate the spread.2, 3 Hence, milder and more targeted physical distancing measures are sufficient, and schools and businesses can stay open.
Fourth, contact tracing and quarantine is not feasible at high infection prevalence. Assuming a state with 300 new cases per million per day, ten 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.
Fifth, aiming for naturally acquired population immunity is not an option.4 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.
Sixth, planning is possible. 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 bring them down again—and the earlier, the better.5, 6, 7 To better manage the COVID-19 pandemic, we propose a strategy with three core elements (panel).
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THE LANCET 2020
