TY  - JOUR
AU  - Lundberg, Alexander L
AU  - Wu, Scott A
AU  - Soetikno, Alan G
AU  - Hawkins, Claudia
AU  - Murphy, Robert L
AU  - Havey, Robert J
AU  - Ozer, Egon A
AU  - Moss, Charles B
AU  - Welch, Sarah B
AU  - Mason, Maryann
AU  - Liu, Yingxuan
AU  - Post, Lori A
PY  - 2024
DA  - 2024/6/21
TI  - Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Europe: Longitudinal Trend Analysis
JO  - JMIR Public Health Surveill
SP  - e53551
VL  - 10
KW  - Europe
KW  - COVID-19
KW  - history of the pandemic
KW  - method of the moments
KW  - Arellano-Bond estimators
KW  - Albania
KW  - Andorra
KW  - Austria
KW  - Belarus
KW  - Belgium
KW  - Bosnia and Herzegovina
KW  - Bulgaria
KW  - Croatia
KW  - the Czech Republic
KW  - Denmark
KW  - Estonia
KW  - Finland
KW  - France
KW  - Germany
KW  - Greece
KW  - Greenland
KW  - Hungary
KW  - Iceland
KW  - Ireland
KW  - the Isle of Man
KW  - Italy
KW  - Latvia
KW  - Liechtenstein
KW  - Lithuania
KW  - Luxembourg
KW  - Moldova
KW  - Monaco
KW  - Montenegro
KW  - the Netherlands
KW  - Norway
KW  - Poland
KW  - Portugal
KW  - Romania
KW  - San Marino
KW  - Serbia
KW  - Slovakia
KW  - Slovenia
KW  - Spain
KW  - Sweden
KW  - Switzerland
KW  - Ukraine
KW  - the United Kingdom
KW  - the Vatican City
AB  - Background: In this study, we built upon our initial research published in 2020 by incorporating an additional 2 years of data for Europe. We assessed whether COVID-19 had shifted from the pandemic to endemic phase in the region when the World Health Organization (WHO) declared the end of the public health emergency of international concern on May 5, 2023. Objective: We first aimed to measure whether there was an expansion or contraction in the pandemic in Europe at the time of the WHO declaration. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provided the historical context for the course of the pandemic in Europe in terms of policy and disease burden at the country and region levels. Methods: In addition to the updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-tailed t test for whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for 4 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day and 7-day persistence coefficients remained statistically significant, the coefficients were moderate in magnitude (0.404 and 0.547, respectively; P<.001 for both). The shift parameters for the 2 weeks around the WHO declaration were small and insignificant, suggesting little change in the clustering effect of cases on future cases at the time. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became insignificant for the first time in April 2023. Conclusions: While COVID-19 continues to circulate in Europe, the rate of transmission remained below the threshold of an outbreak for 4 months ahead of the WHO declaration. The region had previously been in a nearly continuous state of outbreak. The more recent trend suggested that COVID-19 was endemic in the region and no longer reached the threshold of the pandemic definition. However, several countries remained in a state of outbreak, and the conclusion that COVID-19 was no longer a pandemic in Europe at the time is unclear. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2024/1/e53551
UR  - https://doi.org/10.2196/53551
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38568186
DO  - 10.2196/53551
ID  - info:doi/10.2196/53551
ER  -