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2020 activities summary

The European Scientific Working group on Influenza

The European Scientific Working group on Influenza (ESWI) is a group of key scientific experts in influenza who have joined forces to reduce the burden of influenza in Europe: ■ ■

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To realize its objective, ESWI has established structural partnerships with influenza stakeholder organisations:

Ted van Essen, Amersfoort, The Netherlands Gülsah Gabriel, Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany Terho Heikkinen, University of Turku, Finland Susanne Herold, University of Giessen Lung Centre, Germany George Kassianos, GP and National Immunisation Lead Royal College of General Practitioners, UK Edward C. Hutchinson, University of Glasgow, UK Colin Russell, University of Amsterdam, The Netherlands Peter Openshaw, Imperial College London, UK Ab Osterhaus, Research Center for Emerging Infections and Zoonoses Hannover, Germany Roman Prymula, Military Hospital of Hradec Kralove, Czech Republic Sylvie van der Werf, Institut Pasteur, Paris, France Marco Goeijenbier, Erasmus MC, Rotterdam, The Netherlands

euregha European Regional and Local Health Authorities

European Academy of Paediatrics U.E.M.S - Section of Paediatrics - European Union of Medical Specialists

PGEU GPUE Pharmaceutical Group of the European Union Groupement Pharmaceutique de L’Union Européenne

EUROPE

CORONAVIRUS, FLU AND RSV COLLIDING IN THE FALL In the middle of the COVID-19 pandemic and when the world was dealing with the unrelenting daily spread of the novel coronavirus ESWI wanted to look further down the road. In June 2020 already we wanted to warn the world that when flu season comes, there is a possibility that the world would be dealing with two respiratory viruses at the same time – flu and COVID-19. ESWI organised 4 LIVE webinars.

1. INFLUENZA AND RSV IN A COVID-19 WORLD THURSDAY 11 JUNE 2020 16:00-18:00 CET Influenza, RSV and COVID-19: similarities and differences Arnold Monto, University of Michigan , USA Epidemiology: what if COVID-19 strikes in the flu season? Colin Russell, University of Amsterdam , The Netherlands Challenges in serology for COVID-19 Linfa Wang, Duke-NUS Medical School , Singapore Diagnoses for influenza, RSV and COVID-19 and consequences Marco Goeijenbier, Erasmus MC , The Netherlands

CONCLUSIONS It is very difficult to predict what’s going to happen in the coming months. It’s generally accepted that a second wave of COVID-19 is extremely likely, as is the recurrence of seasonal flu. But no one can predict whether the combination of both viruses is going to be less or more severe than the appearance of just one of them. Influenza and COVID-19 together may be less severe due to the COVID-19 mitigation measures, including the TTTQ (Test, Track & Trace, and Quarantine) measures implemented in many countries, which may lessen the influence of influenza too. Moreover, the appearance of one virus may limit the appearance of the other, due to the phenomenon of viral interference. On the other hand, the effects of influenza and COVID-19 together may be more

severe due to the appearance of both of them at the same time. RECOMMENDATIONS

1. Be prepared for the reappearance of both flu and COVID-19 in the fall of 2020. 2. Increase flu vaccination coverage. This is particularly crucial for the high risk groups and for healthcare workers. Minimum coverage for these groups is generally accepted to be 70%, a level that has not yet been reached in most countries of the world. 3. Be prepared to stock and use the flu antivirals available. 4. Continue extensive surveillance and testing for flu, other respiratory viruses such as RSV, and COVID-19.

2. CLINICAL MANIFESTATIONS OF COVID-19, INFLUENZA AND RSV THURSDAY 18 JUNE 2020 16:00-18:00 CET Clinical signs and symptoms: overlap and differences Barbara Rath, Vienna Vaccine Safety Initiative , Germany Risk groups: overlap and differences Daniel Feikin, World Health Organisation , Switzerland Clinical guidance and symptomatic treatment Peter Openshaw, Imperial College London , United Kingdom Co-infections: possible scenario’s Bruno Lina, Université de Lyon , France

CONCLUSIONS There is a large overlap in the clinical symptoms of COVID-19, influenza and RSV. Good laboratory diagnosis is therefore essential, especially as the three infections may coincide, influencing their respective severities in a positive or negative way. Thankfully, more than 80% of all people infected with COVID-19 have relatively mild symptoms. Loss of taste or smell, and severe lung pathology, are seen in both flu and COVID-19 infections, although abnormal coagulation in the lungs tends to be a typical symptom of COVID-19, especially among severely infected or ventilated patients. Generally there is a large overlap in the risk groups for influenza and COVID-19. Interestingly though, children and pregnant women, who are greatly at risk for influenza, seem to be at much less risk for COVID-19. Insufficient data is available for RSV in this respect. As regards therapeutic interventions, treatment of the symptoms is essential at different levels, such as in the front line, nursing homes, hospitals, and ICUs. No specific antivirals have yet been developed. There have been quite high expectations for certain repurposed drugs but the results are unclear. Also, most potential COVID-19 antivirals have not been tested in very early stage patients. Many studies are being carried out amongst Biological Response Modifiers with varying degrees of potential. Dexamethasone might be the most promising with a 30% reduction in clinical symptoms. RECOMMENDATIONS 1. Implement and comply with non-pharmaceutical interventions such as lockdowns, social distancing, and face masks. 2. Very early intervention is key. Earlier implementation of lockdowns could have resulted in significantly fewer casualties. 3. Test, Track & Trace, and Quarantine (TTTQ) all infected patients and their contacts. 4. Use smart apps wherever possible to identify people who might be infected. 5. Ensure first line treatment of patients by GPs. 6. Prepare hospitals and ICUs using the latest data. 7. Promote more extensive flu vaccination and flu antiviral storage.

3. INTERVENTION STRATEGIES FOR COVID-19, INFLUENZA AND RSV TUESDAY 23 JUNE 2020 16:00-18:00 CET Current strategies Ab Osterhaus, RIZ, Hannover , Germany Testing and testing consequences Chantal Reusken, RIVM , The Netherlands Influenza vaccination during COVID-19 Florian Krammer, Icahn School of Medicine , USA

CONCLUSIONS It’s clear that public health and social measures can stop ongoing individual chains of transmission and prevent new outbreaks of COVID-19. A combined strategy of early lockdown with Test, Track & Trace, and Quarantine (TTTQ) measures is important to limit the next wave of outbreaks. Surveillance and testing capacity for COVID-19, flu and RSV is crucial, along with the detection of the viruses and, in the case of COVID-19, the antibodies. Therapeutic strategies currently being investigated have yielded their first encouraging successes, but more studies are needed. Various repurposed antivirals and other anti-infectives such as anti-HIV, remdesivir and hydroxychloroquine show mixed potential. Biological Response Modifiers such as dexamethasone and others are being studied, as are polyclonal and monoclonal antibodies. RECOMMENDATIONS

Antivirals & Biological Response Modifiers

In the absence of a COVID-19 vaccine, and with limited therapeutic options, it becomes even more essential to:

Mike Ison, Northwestern University, USA

1. Thoroughly prepare flu vaccination campaigns for the coming season. 2. Increase the stocks and usage of influenza antivirals.

4. CORNERSTONES OF PANDEMIC PREPAREDNESS AND URGENT ACTIONS THURSDAY 2 JULY 2020 16:00-18:00 CET

CONCLUSIONS

Vaccination

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In “peace time”, significant investments are needed in:

Antivirals

Non-pharmaceutical interventions (NPIs), protocols and necessary materials. Preparedness in primary care, nursing homes, hospitals and ICUs. The scaling up of reliable diagnostic and surveillance capabilities. Protocols for rapid clinical, virological and pathogenesis studies to help understand the virus and the disease. • Broadly protective vaccine platforms. • Broadly active antiviral platforms.

Frederick Hayden, University of Virginia , USA

RECOMMENDATIONS

Ab Osterhaus, RIZ, Hannover , Germany Jonathan Anderson, Seqirus , Australia

1. Prepare for a new COVID-19 wave.

Non-medical interventions Angeliki Melidou, ECDC , Sweden Cross-sector collaboration and communication Sylvie Briand, World Health Organisation , Switzerland

2. Introduce and comply with non-pharmaceutical interventions (e.g. physical distancing, face masks, teleworking, school closures) as early as possible. The countries who introduced lockdown measures the earliest were the most effective. 3. Introduce infection prevention and control measures such as thorough Test, Track & Trace, and Quarantine (TTTQ). 4. Establish more uniform NPI measures based on scientific evidence with the goal of achieving consistency and homogeneous measures across the 28 EU countries and between continents. 5. Continue with vaccine development initiatives. Currently more than 200 COVID-19 initiatives are ongoing worldwide; 17 in humans. 6. Be realistic about promises of the potential of vaccine programmes against COVID-19. 7. Prepare for seasonal flu by developing a vaccination programme targeting a broad population to limit the possible negative effect of two viruses appearing at the same time. 8. Develop antiviral options for treatment and prevention of influenza and COVID-19. Combinations of antivirals can increase potency and decrease the risk of resistance emerging in influenza and possibly also in COVID-19.

CORONAVIRUS, FLU AND RSV COLLIDING IN THE FALL

STATISTICS REPORT

AUDIENCE

STATISTICS REPORT

With a live attendance of 1.728 participants and 8.418 unique views of the recordings we have reached a total audience of 10.146.

1.000

2.000

3.000

Attendees

4.000

5.000

6.000

7.000

8.000

9.000

10.000

Unique views of the recordings

NUMBERS AT A GLANCE ■

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6 invitations and 4 take back home messages were sent to over 12.000 contacts. More than 2.800 people participants registered from more than 95 different countries.

COUNTRY TOP 10 95 different countries were present during the webinars resulting in a top 10: ■

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AFFILIATIONS

ATTENDANCE RATE

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30%

33%

In total more than

2.800 people

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USA UK Saudi Arabia Mexico Belgium Germany Netherlands France Romania Russian Federation

CONCLUSIONS AND RECOMMENDATIONS The four webinars have resulted in a two-pager containing recommendations for clinicians and policymakers. These have been disseminated through an extra e-mail campaign on 9 July 2020, and on the eswiwebinar.org and eswi. org websites. The two-pager was downloaded 1.916 times.

registered for the webinars, 37%

with a total of

1.728

live participants, Pharmaceutical Industry Universities and clinicians Public Health Institutes and governments

which is an

61,6%

attendance rate.

CAMPAIGN: TWITTER

CAMPAIGN: FACEBOOK

In total we made 8 announcements good for 5.949 views and 400 interactions.

The 6 announcements were viewed 965 times with 105 interactions.

We tweeted 4 conclusions which were viewed 2.591 times with 69 interactions.

4 conclusions were posted good for 507 views and 65 interactions.

ESWI management would like to thank

The Organising Committee of the Seventh ESWI Influenza Conference was very excited to launch the Virtual edition of #ESWI2020. We felt it is has never been more important to connect and come together with influenza, RSV disease, COVID-19 experts and policy makers. COVID-19 has clearly shown that a previously unknown pathogen may strike at any time, in any place and without any warning. There is a clear need for countries to have the capacity to maintain effective alert and response systems to detect and quickly react to outbreaks and to share information about such outbreaks rapidly and transparently.

ESWI has been putting influenza pandemic preparedness on the agenda of society for 3 decades now. Influenza and COVID-19 clearly have overlapping pandemic preparedness strategies. Policy makers and scientists responsible for managing this raging COVID-19 pandemic have turned to historical experience with influenza pandemics and for good reason. Intervention strategies perspectives need to be addressed urgently and the clinical perspectives and pathogenesis perspectives of influenza virus, RSV and SARS-CoV-2 need to be discussed between peers and stakeholders. We had hoped to reschedule the Seventh ESWI Influenza Conference “live version” later at the beginning of December, but in September already it became clear that large gatherings would still be prohibited and existing travel bans would still be in place, and additionally we wanted to prioritize the health and safety of our faculty and attendees. We had therefore decided to go ‘virtual’, and to make the 7th ESWI Influenza Conference a virtual Conference.

INFLUENZA

RSV DISEASE

This was our programme: