1.

Epidemiological criteria showing that the spread of the disease has significantly decreased and stabilised for a sustained period of time. This can, for example, be indicated by a sustained reduction in the number of new infections, hospitalisations and patients in intensive care.

2.

Sufficient health system capacity, in terms of, for instance, occupancy rate for Intensive Care Units, adequate number of hospital beds, access to pharmaceutical products required in intensive care units, the reconstitution of stocks of equipment, access to care in particular for vulnerable groups, the availability of primary care structures as well as sufficient staff with appropriate skills to care for patients discharged from hospitals or maintained at home and to engage in measures to lift confinement (testing for example). This criterion is essential as it indicates that the different national health care systems can cope with future increases in cases after lifting of the measures. At the same time, hospitals are increasingly likely to face a backlog of elective interventions that had been temporarily postponed during the pandemic’s peak so Member States’ health systems should have recovered sufficient capacity in general, and not only related to the management of COVID-19.

3.

Appropriate monitoring capacity, including large-scale testing capacity to detect and monitor the spread of the virus combined with contact tracing and possibilities to isolate people in case of reappearance and further spread of infections. Antibody detection capacities, when confirmed specifically for COVID-19, will provide complementary data on the share of the population that has successfully overcome the disease and eventually measure the acquired immunity.

1.

Action should be based on science and have public health at its centre: the decision to end restrictive measures is a multidimensional policy decision, involving balancing public health benefits against other social and economic impacts. At the same time, the protection of public health in the short and long term should remain the primary goal of Member States’ decisions. The available scientific evidence must inform as much as possible Member States’ decisions and Member States should be ready to revise their approaches as more scientific evidence appears.

2.

Action should be coordinated between the Member States: a lack of coordination in lifting restrictive measures risks having negative effects for all Member States and creating political friction. While there is no one-size-fits-all approach, at a minimum, Member States should notify each other and the Commission in due time through the Health Security Committee before they announce lifting measures and take into account their views. . Communication and discussion should take place in the context of the Integrated Political Crisis Response.

3.

Respect and solidarity between Member States remains essential: a key success factor in this phase is to build on each other’s strengths. Not all health systems are under the same pressure, there is a wealth of knowledge to be shared between professionals and Member States and mutual assistance in times of crisis is key. Though coordination and solidarity between Member States were put into question at the outset of the pandemic, the past few weeks have seen growing examples of solidarity throughout the EU such as the treatment of intensive-care patients in other Member States, the sending of doctors and nurses, the supply to other countries of protective suits and masks as well as ventilators. 17 Member States have so far organised flights, many of them facilitated and funded through the EU‘s Civil Protection Mechanism, to bring home European citizens of all nationalities that were stranded abroad. Clinicians are sharing, through a dedicated online EU platform, experience in treating COVID-19 patients. This is the right approach and it should be continued. (5) It will lead the way to further solidarity measures at EU level to support some Member States and regions that will need it to overcome the pandemic or that will be even harder affected than others by the ensuing economic crisis. (6)

1.

Gather data and develop a robust system of reporting: gathering and sharing of data at national and subnational level by public health authorities in a harmonised way on the spread of the virus, the characteristics of infected and recovered persons and their potential direct contacts is essential to better manage the lifting of measures. At the same time, with increasing evidence that a large number of people may be asymptomatic carriers of COVID-19 or may only present limited symptoms, information on cases reported to health authorities may only represent the tip of the iceberg. Significant unknowns remain. Mathematical models are thus being used to understand the spread of COVID-19 and to predict and evaluate the potential impact of the various containment measures put in place by the Member States. Social media and mobile network operators can offer a wealth of data on mobility, social interactions, as well as voluntary reports of mild disease cases (e.g. via participatory surveillance) and/or indirect early signals of disease spread (e.g. searches/posts on unusual symptoms). Such data, if pooled and used in anonymised, aggregated format in compliance with EU data protection and privacy rules, could contribute to improve the quality of modelling and forecasting for the pandemic at EU level. The Joint Research Centre (JRC) and ECDC can centralise this data collection and modelling work.

2.

Create a framework for contact tracing and warning with the use of mobile apps, which respects data privacy: mobile applications that warn citizens of an increased risk due to contact with a person tested positive for COVID-19 are particularly relevant in the phase of lifting containment measures, when the infection risk grows as more and more people get in contact with each other. As experienced by other countries dealing with the COVID-19 pandemic, these applications can help interrupt infection chains and reduce the risk of further virus transmission. They should thus be an important element in the strategies put in place by Member States, complementing other measures like increased testing capacities. The use of such mobile applications should be voluntary for individuals, based on users’ consent and fully respecting European privacy and personal data protection rules. When using tracing apps, users should remain in control of their data. National health authorities should be involved in the design of the system. Tracing close proximity between mobile devices should be allowed only on an anonymous and aggregated basis, without any tracking of citizens, and names of possibly infected persons should not be disclosed to other users. Mobile tracing and warning applications should be subject to demanding transparency requirements, be de-activated as soon as the COVID-19 crisis is over and any remaining data erased. Taking into account network effects, the widespread take-up of a pan-EU reference app, or at least interoperability and sharing of results between such apps, would allow for a more effective warning of people concerned and a more efficient public health policy follow-up. The Commission adopted on 8 April 2020 a Recommendation (7) that sets up a process with Member States for developing a common European approach (“Toolbox”) to the use of digital means which empower citizens to take effective and targeted social distancing measures (8). This common approach will be complemented by Commission guidance that will specify relevant privacy and data protection principles. Confidence in these applications and their respect of privacy and data protection are paramount to their success and effectiveness.

3.

Expand testing capacity and harmonise testing methodologies: in the absence of a vaccine, the population must be protected as much as possible from the infection. Therefore, the availability of large-scale testing that can provide fast and reliable results is key to tackle the pandemic and also a precondition for lifting social distancing measures in the future (and is also important for the effectiveness of contact tracing apps as outlined above).

A three-pronged approach is needed to improve testing in the Member States:

The alignment of testing methodologies is a critical component of this approach and requires sharing of experiences in order to achieve comparable results across the EU and within Member States’ regions. The Commission is presenting Guidelines on different COVID-19 tests and their performance, based on consultation with the ECDC, which has addressed testing in its regularly updated risk assessment. Work will continue to aligning approaches to test performance at EU level. The Commission will facilitate the compilation of all relevant scientific studies and act as a single contact point to make emerging data and results accessible to Member States and researchers. It will, in cooperation with Member States and in consultation with the ECDC, establish a network of COVID-19 reference laboratories across the Union, together with a supporting platform.

4.

Increase the capacity and the resilience of health care systems: gradually lifting certain confinement measures will inevitably lead to new infections. It is thus essential that new COVID-19 patients can appropriately be taken care of by the health care systems and, in particular, in case of need, by hospitals. Sufficient hospital capacity and a strong primary care, the protection of the financing capacity of the healthcare system, well-trained and recovered health care staff and guaranteed access to health care to all will be decisive for the resilience of health systems in the transition. The Commission has mobilised EU budgetary instruments to provide additional resources – including staff – for supporting health care systems in the fight against the COVID-19 crisis and thereby save lives (9).

5.

Continue to increase the medical and personal protective equipment capacity: the COVID-19 crisis has led to a massive surge in demand for medical and personal protective equipment, such as ventilators, testing kits and masks. Yet, this demand is not always matched with sufficient supply. The first weeks of the crisis were thus characterised by competition between national, regional and EU-level joint procurements, disruptions of supply chains including export restrictions, and the lack of information of different Member States’ needs. Vital products are not reaching their destinations or arriving with significant delay. Competition between Member States and international partners have led to a significant increase in prices. This has highlighted the importance of coordination to ensure adequate supplies across the EU. The Commission is acting accordingly together with the Member States (10).The most effective use of available personal protective equipment should be based on the evolving knowledge and advice (11).

Medical equipment – like ventilators – is normally assessed and certified by a notified body at national level through conformity assessments or self-certification. This can take several months. The Commission calls on notified bodies to prioritise essential medical equipment in the fight against COVID-19, based on a list to be agreed with Member States.

With regard to assessment of safety and performance of medical devices and personal protective equipment, national authorities should share best practices and seek a consensus on common approaches with the assistance of notified bodies as appropriate. Member States should set up a single contact point for all questions related to personal protective equipment and medical devices to link testing bodies and relevant market surveillance authorities.

Ensuring sufficient supplies of equipment and medicines for enabling the lifting of confinement measures may require a higher than normally allowed degree of cooperation between firms, including competitors, in some ecosystems. The Commission is and will be providing, as necessary, antitrust guidance and comfort for cooperation between firms in ecosystems to overcome shortages on goods and services required to enable the gradual de-escalation from containment measures. The Commission and the National Competition Authorities will, via the European Competition Network (ECN), also ensure a coherent application of this guidance in their respective enforcement actions.

6.

The development of a safe and effective vaccine is crucial to help put an end to the COVID-19 pandemic. Its development and fast track introduction are therefore essential. The Commission is mobilising additional funding to foster research towards a vaccine. Based on the information currently available and past experience with vaccine development timeframes, the European Medicines Agency (EMA) estimates that it might take a year before a vaccine against COVID-19 is ready for approval and available in sufficient quantities to enable widespread and safe use. The Commission, in cooperation with the EMA, is streamlining the needed regulatory steps, from clinical trials to marketing authorisations, to ensure an acceleration in the process while ensuring safety. It will steer the research community and industry to join forces in large clinical trials and explore how to support the scaling up of the production of vaccines in the medium term. Joint procurement and equal access to vaccines, once available, will be guiding the Commission’s action. At international level cooperation will be fostered, notably to promote access to the vaccine.

7.

At the same time, the development of safe and effective treatments and medicines, including notably by repurposing existing medicines currently authorised for other diseases or conditions, could limit the health impact of the virus on the population in the months to come and allow the economy and society to recover sooner. The EU is financing access to supercomputing and artificial intelligence know-how to accelerate the identification of potential active molecules among existing drugs and compounds. Clinical trials for these treatments have started and like for vaccines, the Commission and EMA are preparing for an acceleration of the regulatory steps from clinical trial to market authorisation. Preference needs to be given to setting up large, as much as possible European, clinical trials as these are necessary to generate the robust data required. Joint procurement for large scale purchases of the potential COVID-19 therapies is at an advanced stage of preparation.

1.

Action will be gradual, as measures will be lifted in different steps and sufficient time should be left between the steps (e.g. one month), as the effect of their lifting can only be measured over time.

2.

General measures should progressively be replaced by targeted ones. This would allow societies to gradually go back to normality, while continuing to protect the EU population from the virus. For example:

3.

The lifting of measures should start with those with a local impact and be gradually extended to measures with a broader geographic coverage, taking into account national specificities. This would allow to take more effective action, tailored to local conditions where this is appropriate, and to re-impose restrictions as necessary, if a high number of new cases occurs (e.g. introducing a cordon sanitaire). This approach would allow first relaxing measures affecting people’s lives more directly. This would finally allow Member States to take better into account regional differences of the COVID-19 spread within their territories.

4.

A phased approach for the opening of our internal and external borders is needed, eventually restoring the normal functioning of the Schengen area.

5.

The re-start of the economic activity should be phased in, thus ensuring that authorities and businesses can adequately adjust to increasing activities in a safe way. There are several models (jobs with low interpersonal contact, jobs suitable for teleworking, economic importance, shifts of workers, etc.), but not all the population should go back to the workplace at the same time, with an initial focus on less endangered groups and sectors that are essential to facilitate economic activity (e.g. transport). As social distancing should remain largely in place, teleworking should continue to be encouraged. At the work place, occupational health and safety rules imposed by the pandemic should be observed.

The Commission will create a rapid alert function to identify supply and value chain disruptions, relying inter alia on existing networks such as Enterprise Europe Network (EEN), Clusters, Chambers of Commerce and trade associations, SME Envoys as well as other actors such as the European-level social partners. Best available solutions will be sought to tackle these disruptions, which can have their origin in an asymmetrical lifting of containment measures (inside or outside the EU), the bankruptcy of businesses or third country actor interference.

6.

Gatherings of people should be progressively permitted. When reflecting on the most appropriate sequencing, Member States should focus on the specificities of different categories of activity, such as:

The gradual reintroduction of transport services should be adapted to the phasing out of travel restrictions and the phasing in of particular types of activities while taking account of the level of risk in the areas concerned. Lower-risk, individualised transport (e.g. private cars) should be allowed as soon as possible, while collective means of transport should be gradually phased in with necessary health-oriented measures (e.g. reducing the density of passengers in vehicles, higher service frequency, issuing personal protective equipment to transport personnel and/or passengers, using protective barriers, making sanitizing/disinfecting gel available at transport hubs and in vehicles, etc.)

7.

Efforts to prevent the spread of the virus should be sustained: awareness campaigns should continue to encourage the population to keep up the strong hygiene practices acquired (use of sanitizers, washing of hands, coughing/sneezing etiquette, cleaning high-contact surfaces, etc.). Social distancing guidelines should continue to apply. Citizens should be provided with full information on the situation in order to contribute to stemming the transmission of the virus by means of individual measures and responsibility. The latest ECDC guidance (16) advises that the use of non-medical facemasks in public may be useful. The use of facemasks in the community could be considered, especially when visiting busy, confined spaces, such as grocery stores, shopping centers, or when using public transport. The use of non-medical facemasks made of various textiles could be considered, especially if – due to supply problems and priority use by healthcare workers – medical facemasks are not available for the public. The use of facemasks in the community should nevertheless only be considered as a complementary measure and not as a replacement for established preventive measures, such as physical distancing, respiratory etiquette, meticulous hand hygiene and avoiding touching the face, nose, eyes and mouth. The use of medical facemasks by healthcare workers must always be given priority over the use in the community. Recommendations on the use of facemasks in the community should carefully take into account evidence gaps, the supply situation, and potential negative side effects.

8.

Action should be continuously monitored and preparedness developed for returning to stricter containment measures as necessary, in case of an excessive rise in infection rates, including the evolution of the spread internationally. Decisions whether or when to reinstate stricter measures should be based on a formal plan, using explicit criteria. Preparedness should entail the reinforcement of health care systems to be able to cope with possible future surges of the virus. The Commission will task the ECDC with developing advice on a common EU approach for future lockdowns, in view of a possible resurgence of the disease, taking account of lessons learnt so far.