COVID-19: Together against COVID-19

The number of new infections began to rise soon after the start of the new school year. The evolution of the situation from October onwards reached its peak during the week of 26 October to 1 November, with an incidence rate of 750 cases per 100,000 inhabitants. The situation then stabilised at a very high level for several consecutive weeks. A notable easing of the situation could only be observed since the beginning of 2021, with an incidence rate of 135 cases per 100,000 inhabitants over 7 days for the period from 18 to 24 January.

However, with the recent discovery of new variants of the virus, which are more virulent in terms of transmissibility, increased vigilance is required. Depending on the degree of spread of these variants in Luxembourg, a new wave cannot be ruled out, risking once again exposing hospitals and health professionals to pressure that would be difficult to manage after so many exhausting months.

The main strategic objectives of the fight against COVID-19 are based on 3 pillars: the protection of public health and the maintenance of the health system, as well as socio-economic and ethical factors.

As the Minister pointed out: "My top priority will always be the protection of vulnerable people and high quality care for our patients. This ambition must go hand in hand with a safe working environment for health and care staff. So our first objective is to flatten the curve to preserve the capacity of our healthcare system."

It has to be said that the health crisis and the uncertainties that accompany it, persist and that it would be far too early to relax, despite the experience gained in relation to COVID-19 and the arrival of the coronavirus vaccines.

Combined with the other elements of the overall policy to fight the virus, namely prevention, diagnosis and screening (testing), isolation of infected persons, tracing and quarantining of contacts, management of COVID-19 patients and awareness raising and information, vaccination will play a crucial role in saving lives, containing the pandemic, protecting the health system and contributing to the recovery of our economy.

"The access to a safe and quality vaccine against COVID-19 is a crucial part of the national response to the pandemic. It will complement the other tools put in place, but will not replace them," Paulette Lenert pointed out.

Vaccination campaign: definition of the different phases of prioritisation

As announced at the press briefing on 25 January, in the second phase of the campaign it is planned to vaccinate people aged 75 and over, both healthy and vulnerable, starting with the oldest. At the same time, highly vulnerable residents, with no age limit, will also be eligible to get vaccinated.

On 29 January, based on the opinion issued on 27 January by the High Council for Infectious Diseases (CSMI), the Government Council decided to prioritise vaccination in several successive phases, based on age categories and different degrees of vulnerability associated with severe forms of infection and a risk of mortality. Moreover, the CSMI indicates in its opinion for each degree of vulnerability the pathologies concerned.

A consultation took place between the Ministry of Health and medical professionals, represented by the Association of Physicians and Dentists (AMMD) and the Circle of General Practitioners (CMG), on the criteria applicable when issuing medical certificates attesting to this state of vulnerability. It will be the responsibility of the treating physician to certify, on the basis of the CSMI's recommendations, the vulnerability of the patient, thus determining when the patient will be eligible to be vaccinated.

Paulette Lenert was reassured by the compliance rate among nursing home residents (86%) who are vaccinated on site by mobile teams. The participation rate of people invited to be vaccinated at the Vaccination Centre is relatively low at this stage, with 48.1% during the 1st wave of mailings and 43.3% for the 2nd round of invitations.

It should be noted that the second phase of the roll-out of the vaccination campaign cannot start until the first phase has been completed, i.e. in principle at the beginning of March, subject however to the delivery and availability of sufficient doses of vaccine.

The Ministry of Health will inform citizens in due time when they can go to their doctor to have their vulnerability certified. In the meantime, it is not advisable to request a medical certificate for vaccination purposes.

Testing strategy: what's new?

As the second phase of the Large-Scale-Testing programme (Large-Scale-Testing 2/LST 2) expires on 24 March 2021 at the latest, on 29 January the Government Council agreed to the bill authorising the State to participate in the financing of the third phase of the Large-Scale-Testing programme in the context of the COVID-19 pandemic.

There are several reasons for continuing the Large-Scale-Testing system beyond the second phase, based on the lessons learned from the previous phases.

First of all, this programme made it possible, throughout its successive phases, to quickly interrupt transmission chains by identifying a certain number of positive people, who, in the absence of this programme, would have risked contaminating others in turn. Thus, since the beginning of the second phase of the LST, i.e. between 16 September 2020 and 16 January 2021, 9,211 positive cases have been detected.

However, LST 3 will differ in several respects from LST 2, in order to adjust the orientation of the screening programme to the specific needs to be addressed in the critical months ahead. For example, the mobile teams will be strengthened so that they can focus more on accommodation facilities for the elderly and other vulnerable people, to address their very high vulnerability until enough people have been vaccinated. The frequency of intervention by mobile teams in educational structures will also be increased.

In addition to verifying the presence or absence of antibodies, serological tests will now also be used to establish the level of antibody concentration. This quantitative result can give an indication of the level of immunity in the population. 6 sampling centres are planned for taking blood samples for serological tests. As of 10 January, the prevalence rate was 7%.

This new phase also aims to monitor the effectiveness of the vaccination campaign by identifying people who have been vaccinated but infected. To date, it cannot be ruled out that a vaccinated person may transmit the virus to others if he or she becomes infected after the vaccination. Cross-referencing the data from the LST with the data obtained from the vaccination campaign could help to gain more knowledge on this very important matter.

Moreover, this third phase is also justified by the arrival of new variants in Luxembourg and everywhere else in the world. Indeed, international health authorities, including the ECDC, recommend increasing testing and sequencing capacity to gain a better view of the spread of these new variants. The results of the tests carried out by the LST will contribute to this testing capacity which will be the focus of genomic sequencing efforts.

The third phase will be launched no later than 15 March 2021 and will end on 15 July 2021. Its extension until 15 September 2021 could be foreseen if the epidemiological situation justifies it and/or if herd immunity is not reached by then.

The cost estimate, based on a maximum of 53,000 tests per week and 1,000 serological tests per week, amounts to a total of approximately €42.83 million for the period from 15 March to 15 July.

It should be recalled that the "Large Scale Testing" test centre located at the airport has been temporarily closed since 29 January. This offer is no longer necessary at this stage, as since that date, any person aged 6 years and older, regardless of nationality, wishing to travel by air to the Grand Duchy of Luxembourg, must present a negative result of a viral detection test by PCR of the SARS-CoV-2 viral RNA or of a viral rapid antigen tests carried out carried out within 72 hours of take-off. The testing centre's capacities will be redirected towards the retirement homes for the elderly. Any person travelling by air from a third country will have to undergo an additional viral rapid antigen test on arrival at Luxembourg airport. This test offer will remain in place, but will be subject to a fee (10 euros) from 1 February.

"We haven't forgotten the people living in precarious conditions."

This press conference was also an opportunity to present the results of the study on the impact of COVID-19 on the consumption practices of high-risk drug users and their use of the specialised services put in place.

Details can be found in the presentation under "More".

Press release by the Ministry of Health