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Current global situation:

Current situation in the Region:

COVID-19: WHO European Region

Operational Update

Epi Weeks 44–47 (1–30 November 2021)

© World Health Organization 2021. Some rightsreserved. Thiswork is available under the CC BY-NC-SA3.0 IGO license.

Number of new confirmed COVID-19 cases reported by Epi-week in the WHO European Region from 16 February 2020 (epi week 8/2020) to 28 November 2021 (epi week 47/2021)

By the end of November, over 261.1 million confirmed cases and over 5 million deaths due to COVID-19 were reported to WHO. Globally, reported cases have continued to see an increasing trendthroughout November, with just over 3.8 million new cases reported in the week of 22–28 November.A majority of WHO regions reported increasing trends with up to a 93% increase in new weekly casesin the African Region. Both the Americas and South-East Asia regions reported decreasing trends. Thenumber of new weekly deaths also increased throughout November in some regions, with the South-East Asia and African regions seeing 26% and 7% increases in new deaths, respectively.

Please refer to theWHO Weekly Epidemiological Updates for further information.

As of 30 November 2021, close to 87.1 million cases of COVID-19 and 1.6 million deaths have beenreported across Europe. Over the past month, the European Region has continued to see a sharplyincreasing trend with over 2.6 million new weekly cases and 29 000 new weekly deaths by 28November. The Region reached peak levels of cases, with cases exceeding those reported in November2020 by over a third. The impact of these resurgences has prompted many countries to implementpublic health and social measures, travel restrictions and vaccination policies.

Hospitalization rates across the Region have seen a decrease between weeks 45 and 47, to anadmission rate of 10.8 per 100 000. Weekly COVID-19 mortality has also increased rapidly in Europeover the past month, reaching levels previously seen in the spring with a weekly mortality rate of 3.2per 100 000 reported on 28 November. This remains significantly lower than the peak mortality seen inJanuary 2021.

Please refer to the WHO European Region Dashboard and the WHO European Region SurveillanceBulletin for further information.

Update on SARS-CoV-2 variants of concern circulating in Europe

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1–7 November 8–14 November

15–21 November 22–28 November

The current epidemiology of SARS-CoV-2 is characterized by a predominance of the Delta variant, withthe prevalence of other variants continuing to decline among genomic sequences submitted topublicly available datasets or detections reported to WHO.

On 26 November 2021, a new variant of concern (VOC) was designated. First reported to WHO on 24November 2021, the B.1.1.529 variant was designated as a VOC and given the name Omicron. Thedecision to designate it as a VOC was based on the evidence presented to the Technical AdvisoryGroup on SARS-CoV-2 Virus Evolution that Omicron has several mutations, which may enhance itstransmissibility and/or enable some degree of immune escape. As a result of this, the overall globalrisk related to the new VOC Omicron in the context of the COVID-19 pandemic is very high.

Within the European Region, by the end of the November, Omicron had been detected in 11 countriesacross the Region. On 27 November, WHO/Europe and the European Centre for Disease Preventionand Control (ECDC) requested European countries to enhance surveillance and sequencing efforts tobetter understand circulating SARS-CoV-2 variants; submit complete genome sequences andassociated metadata to a publicly available database; report initial cases/clusters associated with VOCinfection through the International Health Regulations (IHR)/Early Warning and Response System(EWRS) mechanism; perform and share results of field investigations and laboratory assessments toimprove understanding of the potential impacts of the VOC on COVID-19 epidemiology, severity,effectiveness of public health and social measures, diagnostic methods, immune responses, antibodyneutralization, or other relevant characteristics.

See WHO/Europe and ECDC Surveillance Bulletin.Refer to the WHO webpages on VOIs/VOCs for more information.

Emergency public health measures taken across the Region:

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Across the European Region, the use of COVID-19 Certificates as proof of Vaccination, Recoveryand/or negative Test (CVRT) has been a major component in 2021 of Member States’ strategies forkeeping businesses and schools open, allowing events and gatherings to take place, and ensuringdomestic and international travel to continue. More recently, six Member States are no longeraccepting a negative test result as valid proof within their certificate requirements, opting for either avaccination certificate or proof of recovery from COVID-19.

• Countries such as Austria, Czechia, Greece and Latvia have issued CVR (COVID-19 Certificates asproof of Vaccination and Recovery) requirements for leisure activities, certain businesses, andmass gatherings. From December 2021, Italy will also implement CVR requirements.

• Italy’s “super green pass” will take effect on 6 December 2021 and will drop the option for peopleto present a test, instead requiring proof of vaccination or recovery from COVID-19 to accesscinemas, theatres, gyms, nightclubs, ski lifts and stadiums, as well as to be served indoors at barsand restaurants.

• Countries such as Estonia, Germany and Slovakia have issued requirements for CVR or CVRT basedon either regional epidemiological situations or specific indicators (i.e. mass gatherings, particularbusinesses, concerts, etc.).

• While Estonia limits gatherings (inside to 1000 and outside to 2000), participants 12–18 years ofage may also use the certificate with a negative 72-hour polymerase chain reaction (PCR) or 48-hour rapid antigen test (in addition to recovery from COVID-19 and being fully vaccinated). Allother participants must provide either a COVID-19 vaccination certificate or proof of recovery.

• Slovakia’s "complete vaccination" mode has changed to CVR mode, meaning that people whoovercame COVID-19 will have the same opportunities as fully vaccinated people. Thus, CVR, CVRTand "baseline" (all, regardless of immune status) are applicable based on the established trafficlight system and local epidemiological situations in each region.

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WHO Regional Office for Europe’s response to COVID-19:

Key figures: Responding to COVID-19 in the WHO European Region

WHO has conducted 318 missions and deploymentsto 25 countries and territories in the Region*

253In-country

technical support

missions

16Rapid support

teams

3Virtual country

missions

7Intra-action

review missions

39Operational

partner deployments

The WHO Regional Office for Europe’s response is built around a comprehensive global strategy to endthe acute phase of the pandemic and build resilience and readiness for the future by targeting fourareas: prepare and be ready; detect, protect and treat; reduce transmission; innovate and learn.

WHO has sent laboratory test kits

and supplies to 33 countries and

territories in the Region*

WHO has sent essential medical supplies to 31 countries

and territories in the Region

639 280Laboratory

tests

(PCR)

1 286 550Antigen rapid

diagnostic tests (RDTs)

1 440 359Laboratory supplies

66 420 800

19 083 600

6 555 250

2 791 948

1 891 800

611 100

5 429

463 Ventilators

Oxygen concentrators

Goggles

Gowns

Face shields

Respirators

Gloves

Masks

* The data presented have been adjusted following retrospective analysis of WHO’s records.

For additional information on essential supplies delivered, please see the WHO/Europe COVID-19 Country

Support Dashboard for Operational Support and Logistics.

For additional information on missions and deployments, please see the WHO/Europe COVID-19

Country Support Dashboard for Missions and Deployments.

In Focus

Training in clinical management of acutely ill

patients with COVID-19 in Kazakhstan

9–18 November2021

The WHO Country Office in Kazakhstan completed atraining session for 36 health-care professionals, including physicians, nurses andrepresentatives from medical universities fromeight regions on the multidisciplinary care ofcritically ill patients with COVID-19.

This practical, simulator-basedtraining introduced participants tointernationally recognized treatment approaches,allowing for the prioritization ofmedical interventions to provide quality careand preserve the lives of patients withcritical conditions.

The training incorporated a practical approach totime-sensitive emergency care, based on the WHO-International Committee of the Red Cross BasicEmergency Care guidelines. It also focusedon sustaining core capacities to provide essentialhealth services during the pandemic response andthe use of effective interpersonal communicationduring the provision of emergency care.

The training was also intended as a starting point toform a pool of national trainers to ensuresustainability. Therefore, WHO enrolled eightnational clinical professionals in the ToT programme.Throughout the programme, the participants willacquire essential skills in managing adult learnersand conducting simulation-based education. WithWHO support, the national trainers will conductsimilar simulation courses in all 17 regions ofKazakhstan in 2022.

Prepare and be ready

The WHO Regional Office for Europe continues

to work hand in hand with frontline health

workers and health policy-makers as they work

to scale up their national responses.

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In Armenia, in week 45, the WHO CountryOffice provided training of trainers (ToT) todoctors on Basic Emergency Care to initiateroll-out of similar training across Armenia.This will help to ensure that lifesavinginterventions are provided during theCOVID-19 pandemic as well as in other typesof emergencies that have serious healthconsequences.

In week 45, the WHO Georgia CountryOffice provided support in preparingmonitoring visits to ambulatory settingswhere infection prevention control (IPC)assessments are being conducted by theMinistry of Health. An outpatient IPCmonitoring tool was developed by theproject working group and training wascarried out for 10 auditors.

The newly developed monitoring tool waspiloted in Tbilisi and surrounding areas andwill be further used in 84ambulatory/outpatient health-care settings.

In Turkmenistan, on 9 November, aworkshop on Hospital Operational Plans forHealth Emergencies was conducted with 20representatives from the Ministry of Healthand medical industry and health-careworkers. Follow-up workshops were alsoconducted with 30 health-care workers inthe regions of Ashgabat and Lebap.

In the Republic of Moldova, in week 46, the

WHO Country Office provided a hybrid

online and offline training for 40 health-care

workers from the Transnistrian region on

clinical case management of severe COVID-

19 from 18 to 19 November.

© WHO

WHO continues to work with national authoritiesto strengthen capacities to rapidly identify andisolate COVID-19 cases, treat patients, and trace,quarantine and test contacts.

© WHO/ B-FAST and DEMA EMTs

Detect, protect and treat patients with COVID-19

In Focus

WHO/Europe supports Serbia’s public health

laboratory financing system

9–10 November2021

In Serbia, from 9 to 10 November 2021, a trainingsession was held on the laboratory test costing tool(LTCT) and laboratory expenditure tool (LET) withfinancial and laboratory experts from the samelaboratories to empower both parties andencourage conversation and transparency withinthe laboratory setting. This combined training withboth laboratory and financial planning counterpartswas the first of its kind in Serbia.

Costing is particularly important during the COVID-19 pandemic when reliance on surge laboratorycapacity is needed, which is sometimesunpredictable. The training aimed to supportregional laboratory staff in using the LTCT tool toprovide proof of incurred costs when carrying outCOVID-19 testing and to ensure that the costs oftesting are fully covered by existing fundingsources. Following the training, WHO/Europelaboratory experts will provide support inevaluating the costs of tests in the regionallaboratories of Serbia through field visits in thesecond half of November. This work will helpsustain the laboratory systems put in place duringand after the COVID-19 pandemic.

This same activity has also been performed in twoother countries in the World Health EmergenciesBalkan Hub, the Republic of Moldova and NorthMacedonia. These activities are implemented bythe WHO/Europe COVID-19 incident managementsupport team (IMST) and supported by Canadaunder the ACT-Accelerator Health SystemConnector.

© WHO

In Moldova, the WHO CountryOffice provided training forlaboratory professionals onsequencing methodsconducted from 1 to 4November 2021. This type ofcapacity-building activityensures SARS-CoV-2sequencing and monitoring inthe country.

In Azerbaijan, in week 46, a round table andworking group meeting was held on“Strengthening the laboratory networkinvolved in COVID-19 response measures”with the support of the European Union’ssample collection points and laboratoriesand Solidarity for Health Initiative, andCanadian funding for the Health SystemConnector.

The event’s objective was to inform therevised national testing strategy, qualitymanagement and biosafety regulations.

In North Macedonia, in week 46, the WHOCountry Office supported the NationalProgram for the Sequencing of SARS-CoV-2and other high-threat pathogens. This helpedto strengthen sequencing capacities in thecountry and the National Sequencing Strategy.

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© WHO

© WHO

Reduce transmission

WHO is committed to supporting health authoritiesand communities in strengthening the public healthresponse to the pandemic to slow and stop furtherspread of the virus.

In Focus

5 November 2021

On 5 November 2021, 14 senior epidemiologists

from 12 regions in Ukraine participated in a

virtual ToT on COVID-19 contact tracing. The ToT

was conducted by the WHO/Regional Office for

Europe in collaboration with the WHO Country

Office in Ukraine. It complements the

implementation of the recently launched

national COVID-19 contact-tracing protocol as

well as the roll-out of the WHO/Global Outbreak

Alert and Response Network (GOARN) outbreak

investigation data management tool, Go.data,

across the country.

The ToT provides the basis for cascade training

of contact tracers in all regions of Ukraine and

provides senior epidemiologists with a

standardized training package that can be

adjusted to the local context and thereby ensure

a well-trained contact-tracing workforce, which

places emphasis on RCCE as an integral part of

contact-tracing operations.

Thus far, 600 senior epidemiologists and/or

contact tracers from nine Member States across

the WHO European Region have participated in

the training sessions on COVID-19 contact

tracing. These are part of the Regional Office’s

COVID-19 response efforts and aim to increase

and improve capacities related to COVID-19

contact tracing in the WHO European Region.

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© WHO

PHOTO HERE

© WHO

In Armenia, on 10 November, the WHO CountryOffice launched a “Fostering Safe Schooling”campaign with the participation of 140schoolteachers and nurses in the training sessions.The campaign will continue through the end ofDecember 2021 and engage all schools.

In Serbia, in week 44, the WHO Country Officestarted to implement the COVID-19 vaccination riskcommunication and community engagement (RCCE)project. Community engagement activities startedwith selected civil society organizations (CSOs)completing vaccination outreach work with medicalteams in rural areas and communities with a lowvaccination uptake. Several faith-based organizationswere selected for outreach to different religiouscommunities – Orthodox, Muslim, Catholic andProtestant.In Albania, in week 44, the WHO Country Officesupported a national rapid training needs assessmentfor health-care operators to identify priority areas fortraining on contact tracing. WHO helped to identifytraining needs and develop training programmes tostrengthen the knowledge of health-care operatorstaff on surveillance, disease investigation, testing andcare. The aim is to strengthen the knowledge of rapidresponse teams of health-care operators in thecountry.

As part of the ongoing technical support WHO/Europeprovided to Romania in October, several other WHOteams were deployed to engage with nationalcounterparts and support their response efforts,including a high-level mission to Romania of theWHO/Europe Regional Emergency Director and theWHO/Europe Executive Director from 3 to 4November.

© WHO

Innovate and learn

WHO continues to assist Member States inoptimizing and adjusting their COVID-19response through high-level policy dialogues.

In Focus

First Risk Communication and CommunityEngagement Training with Rospotrebnadzorsuccessfully completed

19 November2021

For the first time, an RCCE training was delivered on19 November 2021 with Rospotrebnadzor, theRussian Federal Service for Surveillance on HumanWellbeing. Conducted by WHO/Europe’s COVID-19IMST, it engaged 40 high-level participants fromalmost all regions of Russia on Essentials of RCCE,including Infodemic Management, domains that havebecome increasingly central to the fight against theCOVID-19 pandemic.

The participants had a chance to reflect on their fieldexperiences the during COVID-19 response and askquestions about challenges in RCCE. Members of thetraining team provided insights and tailored thediscussion to issues of interest.

At the end of the training, both sides agreed tofurther the collaboration in different RCCE areas,including capacity-building, community engagementand infodemic management at both country andsubregional levels.

Rospotrebnadzor is also the National Coordinator forthe WHO International Health Regulations (2005) inthe Russian Federation and the national focal pointof the International Food Safety Authorities Network(INFOSAN).

WHO also continues to employ innovativemethods to ensure continuous learning,listening and improvement in COVID-19response efforts.

In the Republic of Moldova, in week 45, theWHO Country Office initiated support to reviewhealth information systems for vaccination andsurveillance of communicable diseases. The aimis to ensure the collection and efficientmanagement of epidemiological field data,especially in the context of COVID-19.

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From 1 to 5 November 2021, WHO Europe, at

the invitation of the Minister of Health of North

Macedonia, conducted an intra-action review

(IAR) on the country’s response to COVID-19.

The activity was financially supported by the

WHO/EU Directorate-General for

Neighbourhood and Enlargement Negotiations

(DG NEAR) Western Balkan Project, whose aim is

to strengthen and maintain all-hazards

preparedness and response capacities in the

Western Balkan region. Technical support

throughout the IAR was provided by both

WHO/Europe and Germany’s Robert Koch

institute (RKI).

© WHO

In Focus

WHO support mission addresses the urgent COVID-19 and broader health needs of vulnerablepopulations in Belarus

19–23 November 2021

Increased migratory pressure at the border betweenBelarus and bordering European Union countries hasbeen observed since this summer. A growing numberof migrants of diverse origins, with Iraqi migrantsaccounting for the majority, have gathered close tothe Belarus border with Poland, Lithuania and Latvia.As only a small number have crossed the border intoneighbouring countries, it is estimated that up to8000 individuals remain in Belarus, among themclose to 2000 in a warehouse as a temporary shelterclose to the border, and with some still reported tobe living outdoors in the surrounding forests.

In increasingly difficult winter conditions, and with arecent surge in COVID-19 transmission reportedacross Belarus throughout October, an urgentassessment of the health situation was conducted byWHO and other partners to ramp up support to thosein need.

From 19 to 23 November 2021, WHO/Europedeployed a high-level mission to Belarus to workalongside national and regional authorities, andpartners, to identify and address the health needs ofmigrants.

A rapid health assessment, including for COVID-19,was conducted at the largest temporary shelterhousing close to 2000 people. The team also met andvisited local health facilities involved in the carepathway for emergency cases. During these fieldvisits, the WHO team established contact withmigrants to collect critical information on access tohealth care and to evaluate their overall healthneeds.

Leaving no one behind:

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The Regional Office continues to work withnational authorities and alongside internationalpartners to tailor their responses specifically tohigh-risk groups and vulnerable populations.

Through a community engagement initiative,WHO has been working with Roma communitiesfrom four municipalities in North Macedonia sinceMarch 2021. The aim is to empower Roma peopleto respond to the COVID-19 pandemic, whilesimultaneously building their capacity to respondto any future emergencies. Led by the Associationfor Emancipation, Solidarity and Equality ofWomen (ESE), it is one of eight engagementprojects initiated across the WHO EuropeanRegion. Read more about the project here.

In Serbia, the WHO Country Office in week46, in cooperation with leading mental healthclinics, supported and promoted online andphone services for mental health and COVID-19 targeting different population groups.

© WHO

© WHO

In week 46, in Armenia, the WHO CountryOffice delivered a remote two-day coursefrom 14 to 16 November with a total of eightmodules developed by the IMST. The trainingwas targeted and delivered to prison doctorsand provided to a total of 76 participants.

The modules included the WHO guidance onPreparedness, prevention and control ofCOVID-19 in prison settings and other placesof detention, epidemiology updates, guidanceon public health and social measures in thecontext of prisons, SARS-CoV-2 laboratorytesting methods, COVID-19 vaccination,clinical management of patients with COVID-19 and practical training on testing.

WHO continues to work to accelerate vaccinedeployment by providing training to health-careworkers and introducing the COVID-19 vaccine.

Accelerating equitable access to vaccines:

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In Focus

COVID-19 training projects on vaccination inAzerbaijan

November2021

In Azerbaijan, in week 44, capacity-buildingactivities were held under the EU-fundedCOVID-19 vaccination support project. TheWHO Country Office conducted the secondsession of the ToT at “Yeni Klinika” for 21health-care professionals. It was dedicated toenriching the pool of trainers in variousdistricts of Azerbaijan.

In addition to the recent updates on COVID-19vaccines, the training provided participantswith techniques on how to facilitate theirrespective training sessions in accordance withinteractive teaching methods andappropriately address vaccine recipients’questions. At the end of the session, allparticipants who completed the programmewere awarded certificates.

Overall, the programme aims to support thepromotion of the mass vaccination campaignin Azerbaijan through advancing technical andcommunication capacities of vaccinators andother health-care workers.

WHO continues to support the integration of COVID-19 vaccine roll-out as part of routineimmunizations.

In Moldova, in week 45, the WHO Country Officesupported the development of awarenesscampaigns on COVID-19 vaccination in partnershipwith the pharmacists’ association and informationcampaign among students and youth called “Rollup your sleeve, get vaccinated” with support ofthe ministries of health, education and science,association of medical students, residents andcouncil of rectors.

In Georgia, in week 46, the WHO Country Office supported the National Centre for Disease Control(NCDC) in its vaccination marathon, which in November focused on Gurjaani Municipality. With WHOsupport, NCDC professionals conducted sessions for doctors in Gurjaani on immunization guidelines,types of vaccines, and communication skills with patients. Overall, 29 meetings were held in largevillages of Georgia on COVID-19 vaccination, including ethnic minorities, and reached 820 beneficiaries– community leaders and the elderly. In a number of locations, the NCDC mobilized vaccinationvehicles and communities were able to be vaccinated on the spot.

In Ukraine, in week 45, the WHO Country Officeheld a series of round tables within the project“Advocacy in support of COVID-19 vaccinationstrategies” from 9 to 12 November. These tookplace in Dnirpo, Kramatorsk, Luhansk and Kharkiv.Each round table opened with a video messagerequesting community-level authorities to engagein and coordinate the delivery of COVID-19vaccination to their population.

In Albania, in week 47, the WHO Country Office supported theMinistry of Health in establishing an e-referral system for rapid testunits and vaccination centres in the public health-care system. Avaccination information management system for tracking COVID-19vaccination data (electronic and paper-based) has been identified andprepared prior to COVID-19 vaccine deployment in the country. Inaddition, service delivery platforms and mechanisms to deliver COVID-19 vaccines to target population groups have been outlined anddeveloped as part of the micro-plans for vaccine deployment.

In Georgia, in week 44, the WHO Country Officesupported a Flu Awareness campaign 2021 named“Q&A on flu in the context of COVID-19”. Theawareness materials were translated anddisseminated to more that 450 media outlets. Inaddition, the awareness-raising campaign inSenaki and Chkhorotsky engaged 25 priests onmitigation measures against the spread of COVID-19.

Further developing the COVID-19 knowledge base:

New WHO technical guidance published in November 2021

Rehabilitation after COVID-19: what wecurrently know and resources we have

Nine new or updated global guidance documents

have been published, including the following

highlighted documents

The technical briefing aimed to provide MemberStates of the WHO European Region withinformation and resources to supportrehabilitation after COVID-19infection.

The aim of this technical briefing is to providebackground on the importance of rehabilitationfollowing COVID-19 infection, followed by anoverview of rehabilitation service models formanaging the post-COVID-19 condition, includingexamples from a number of Member States.

The post-COVID-19 condition, termed long COVIDby patient groups, was also considered from thepatients’ perspective, as well as the importance ofincluding patients in research. WHO has produceda variety of resources for different stakeholders onrehabilitation following COVID-19 infection andstands ready to support Member States.

Enhancing readiness for Omicron (B.1.1.529): technical

brief and priority actions for Member States

Published 28 November 2021COVID-19 vaccine trial designs in the context of

authorized COVID-19 vaccines and expanding global

access: ethical considerations

Published 29 November 2021Guidance on operational microplanning for COVID-19

vaccination

Published 16 November 2021Guidance for the European Region:WHO Regional Office for Europe recommendations on

influenza vaccination for the 2021/2022 season during

the ongoing COVID-19 pandemic

Published November 2021A timeline of WHO’s response to COVID-19 in the WHO

European Region: a living document (update to version

2.0 from 31 December 2019 to 31 July 2021)

Published November 2021

A new study by the WHO Regional Office for Europe and the European Centre for Disease Preventionand Control (ECDC) published in Eurosurveillance estimates that 470 000 lives have been saved amongthose aged 60 years and over since the start of COVID-19 vaccination roll-out in 33 countries across theWHO European Region. The calculation considers what would have happened without any vaccines,using the actual weekly reported death counts. This estimate does not include lives saved byvaccinating people under 60 years nor lives saved from the indirect effect of vaccination because of areduction in transmission. WHO/Europe and ECDC calculated the number of lives saved due to COVID-19 vaccination as the difference between these estimates and the reported number of deaths fromDecember 2020 to November 2021 for those aged 60 years and over.

• Estimates showed that COVID-19 vaccination saved 469 186 lives in this age group in the33 countries during the study period – reducing the expected number of deaths byapproximately half. In 30 countries with data also available in smaller age groups, the largestnumber of lives saved was among those aged 80 years and over (261 421 lives).

• Uptake of the complete dose series of COVID-19 vaccines in those aged 60 years and overnow ranges from 20% to 100% among the 33 countries under study. The study estimatedthat the largest number of lives saved was in countries where COVID-19 vaccination roll-outwas early and uptake in the target group was also high.

Vaccination is one part of the toolbox of important measures needed to curb the pandemic. Until thepandemic is over, countries must keep in place strong public health measures, such as free-of-chargetesting and contact tracing to break the chains of transmission, as well as urgently reaching out to allindividuals in priority groups for vaccination who have not already received a full series. Read morehere.