COVID-19 weekly report - 28th of September

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CIPH report for the previous 7 days and daily report for the Republic of Croatia on the 28th of September 2020. 

Tested Confirmed cases Active cases Recovered Self-isolation Hospitalized On a respirator Deaths
295 998 (+3029*) 16245 (+40*) 1180 14793 9057 291 24
(+1*)
272
(+0*)
A total of 164 people died in this epidemic wave. Most of the deceased had significant comorbidities or were of advanced age. The average age of the deceased in this epidemic wave is 76.5 years. Seventy - six people died on a respirator.
* in the last 24 hours

There are currently 24 testing places in the Republic of Croatia that perform RT-PCR analysis and collect samples. All processed samples enter national Croatian Health Insurance Institute platform, which is accessible to all county public health institutes. County public health institutes submit data about positive cases, sources of infection and hotspots as part of their daily reports to the Croatian Institute of Public Health. The Croatian Institute of Public Health collects information about hotspots, hospital treatment of COVID-19 positive persons, COVID-19 positive patients on respirators and the deceased.
You can find more about the test centers on the link.

Epidemiological indicators on 21 st of September
  • Cumulative 7-day rate for the Republic of Croatia: 30,7/100 000
  • Cumulative 14-day rate for the Republic of Croatia: 64,8/100 000
  • Counties with a cumulative 7-day rate greater than 50/100 000 inhabitants: Virovitičko-podravska, Karlovačka, Ličko-senjska, Požeško-slavonska, Splitsko-dalmatinska
  • Counties with a cumulative 14-day rate greater than 100/100 000 inhabitants: Karlovačka, Ličko-senjska, Požeško-slavonska, Splitsko-dalmatinska
  • Total number of tests in the last week: 34 105
  • Share of positive tests in the total number of tests in the last week: 3,7 %
  • Total number of tests and share of positive tests in total number of tests: 295 998; 5,5 %
  • The number of new cases in intensive care per 100,000 inhabitants in the last 7 days: 0,39/100 000
  • Number of deaths in the last week: 19
  • Total death rate per 1 000 000 population: 66,5/1 000 000

Epidemiological situation in Croatia

Geographical distribution of new COVID-19 cases by counties
In a two-week period from 15th of September to 28th of September all counties recorded new cases of COVID-19 disease. The highest number of new cases are recorded in the Splitsko - dalmatinska County, followed by the City of Zagreb and Zagrebačka County. The lowest number of new cases were recorded in Sisačko - moslavačka and Istarska County. The Požeško - slavonska County also has the highest 14-day rate, followed by Splitsko - dalmatinska and Ličko – senjska County.

Figure 1. 14-day rate by counties

Epidemic by weeks, from 19 th – 31 st week of the epidemic
Table 1 shows the epidemiological indicators by epidemic week. The data shows that one of the most important epidemiological indicators, the rate of confirmed cases, the number of tests and the share of positive ones show a positive trend in the last 5 weeks. The confirmed case rate has been steadily declining since week 27 when it stood at 47.6 to 31,2 at week 31. The total number of tests has been growing continuously for the past 4 weeks, i.e. from the 25 th week, but at 31 st week there was a slight decrease in the number of tests compared to previous weeks. The proportion of positive people in total testing also fell steadily, falling from 12.5 in the 26 th week of the epidemic to 3.7 in the 31 st week.

Table 1. Overview of the number of confirmed cases by weeks, from week 19 th –31st


Table 2 shows a set of indicators related to the severity of the clinical picture and the characteristics of deaths. The table shows that in the last 4 weeks there has been an increase in the average age of cases and the number of cases on the respirator, which corresponds to previous findings that older people are more likely to develop more severe clinical forms and higher mortality in older age groups. The death rate in the last 3 weeks shows stagnation.

Table 2. Overview of patients on respirator and deaths by weeks, from week 19th – 31st


Table 3 shows the incidence of the 7-day rate in the two last weeks with a limit of 50/100 000 inhabitants, which in some countries is taken as one of the criteria in assessing the epidemiological situation. In most counties, the 7-day rate is generally stable or slightly declining.

Table 3. Overview of 7-day incidence rates per 100,000 population in the last week


Clinical aspects - Hospitalizations and severity of clinical picture for the period 22.9.-28.9.2020.
Figure 2 shows the relationship between the daily number of confirmed cases and the daily number of hospitalized cases. Number of hospitalized cases per day ranged between a minimum of 16 and a maximum of 37, while the share of hospitalized cases in the total daily number of confirmed cases ranged from 9.9% to 33.3%.

Figure 2. Overview of the daily number of confirmed and hospitalized cases (15.9.-21.9.)

Figure 3 shows the proportion of hospitalized in the total number of weekly cases. Of the total number of confirmed cases in a given weekly period, 15.2% were hospitalized, which is an increase compared to last week's 13.2%. In the same period, 16 people were put on a respirator, which makes 1,3% of the total number of confirmed cases.

Figure 3. Relation of the total number of confirmed and hospitalized cases (22.9.-28.9.)

The graph in Figure 4 shows that the slope of the curve of confirmed cases is followed by the curve of cured cases, while the curve of active cases, in addition to some ascending, shows stagnation in certain periods related to the continuation of the first wave of the epidemic in Croatia. In the last 2 weeks the curve of active cases shows a declining slope.
Figure 4. Movement of the total number of cases, recovered, deceased and active number of cases from 18.6.- 28.9.

Age-sex distribution of COVID-19 deaths
A total of 165 people died in this wave of epidemics. Most of the people who died had significant comorbidities or were of advanced age. The mean age of the deceased in this wave of epidemics is 76.5 years. Seventy - six people died on a respirator.
An overview of the situation is given in Table 4 and Figure 5.
 
Table 4. Distribution by age and sex of the deceased people in the continuation of the first wave of the epidemic
AGE GROUP 40-49 50-59 60-69 70-79 80-89 90-99 100+
MEN 3 16 24 55 35 11 1
WOMEN 2 0 16 31 51 27 0

Figure 5. Age and sex distribution of deaths from COVID-19 in the period 29 th June – 28th of September 2020

Deaths for the period 22.9.-28.9.2020.
 
In the last week, 19 people died, of which 14 (73.7%) were on a respirator. The distribution by age and sex in the last weeks is shown in Table 5, and by counties in Table 6.
 
Table 5. Distribution by age and sex of persons who died in the last week
AGE GROUP 50-59 60-69 70-79 80-89 90-99
MEN 3 2 2 4 0
WOMEN 0 3 6 5 1

Table 6. New patients and deaths in the last week and total deaths
County Number of new cases in the period
22.9.-28.9.
Incidence of new cases in the last 7 days on
100 000 inhabitants
Number of deaths in the period
22.9.-28.9.
Total number of deaths Total mortality rate at
1,000,000 inhabitants
CITY OF ZAGREB 198 24,6 4 43 53,4
BJELOVARSKO-BILOGORSKA 32 29,7 0 1 9,3
BRODSKO-POSAVSKA 25 17,8 1 5 35,7
DUBROVAČKO-NERETVANSKA 45 37,1 1 13 107,2
ISTARSKA 11 5,3 0 13 62,3
KARLOVAČKA 62 53,1 0 2 17,1
KOPRIVNIČKO-KRIŽEVAČKA 16 14,9 0 16 148,5
KRAPINSKO-ZAGORSKA 56 44,7 2 4 31,9
LIČKO-SENJSKA 26 57,5 0 1 22,1
MEĐIMURSKA 30 27,3 0 26 0,0
OSJEČKO-BARANJSKA 58 20,9 0 5 93,8
POŽEŠKO-SLAVONSKA 62 91,4 1 7 73,7
PRIMORSKO-GORANSKA 122 42,9 3 5 24,6
SISAČKO-MOSLAVAČKA 13 8,7 0 70 33,6
SPLITSKO-DALMATINSKA 231 51,6 3 7 156,2
ŠIBENSKO-KNINSKA 18 18,0 0 3 69,9
VARAŽDINSKA 13 7,8 0 9 18,0
VIROVITIČKO-PODRAVSKA 40 53,2 2 16 119,6
VUKOVARSKO-SRIJEMSKA 63 40,8 0 8 103,6
ZADARSKA 32 19,0 1 18 47,6
ZAGREBAČKA 100 32,3 1 43 58,2
TOTAL 1253 30,7 19 1 66,5












Hotspots

Continental Croatia
In the last week, new cases were recorded in all counties of continental Croatia, mostly in the City of Zagreb, Zagrebačka and Vukovasko - srijemska County. The highest 7-day rates on 28 th  of September were recorded in Požeško - slavonska, Virovitičko - podravska and Karlovačka County. A new grouping of patients was recorded in Vukovasko - srijemska County and is associated with masses and family celebrations related to the reception of the sacraments. In Krapinsko - zagorska County, sick people continue to be recorded, as well as their contacts related to larger groupings at the workplace and related to weddings in Međimurska County. Smaller groupings were recorded in the City of Zagreb and Požeško – slavonska County and are related to players of sports clubs. In Krapinsko - zagorska County were also related with a small number of patients. Grouping related to the public event was recorded in Osiječko -baranjska County, and with a private celebration in Virovitičko - podravska County. In the home for the elderly in the Sisačko - moslavačka County, a part of the wards and employees of the home fell ill. Part of the sick people are cases imported from abroad and there is a large proportion of contacts of sick people.

Coastal Croatia
Cases of ill persons have been recorded in Coastal Croatia like in all counties as well. The highest number of patients was recorded in the Splitsko - dalmatinska, Primorsko - gorskanska and Dubrovačko - neretvanska County. The highest 7-day rate on 28 th of September was in Ličko - senjska, Splitsko - dalmatinska and Primorsko - gorskanska County. A significant jump in the number of patients occurred in the Primorsko - gorskanska County after the disease spread to the residents of the home for the elderly in that county, and by the time this report was written, 66 people from that institution had fallen ill. The situation in the Splitsko - dalmatinska County is still stable, no major groupings have been recorded and most sources of infection in sick people are related to the workplace and there was one smaller grouping recorded in the sports club. In addition to the above-mentioned home for the elderly in the Primorsko - gorskanska County, a larger group of patients is associated with weddings in the Ličko - senjska County. A significant proportion of patients are contacts of previously recorded cases.
 
Age-sex distribution of patients in the last week
 
In the previous week, a total of 1,254 people fell ill - approximately the same number of females (51.8%) and males. The same distribution by sex is present in most age groups, except in the age groups under the 7 years, where is the smallest number of patients, and in the age group 66+, in which women predominate (60.7%).
 
By age groups - the least affected were children, 138 (11%). Of the children, the youngest patients were younger than 1 year, a total of 3. The most affected were children of high school age, a total of 69.
 
Adults made the largest share in the total number of patients last week, i.e. 874 (69.7%). The share of elderly patients is 19.3%.

The distribution of patients by age did not change significantly compared to last week, except for the increase in the elderly from 13.3% to 19.3% and a slight decrease in the number of cases in children from 13.4% to 11%.
 
The full view can be found in Figure 6 and Table 7.

Figure 6. Distribution of patients in the last week by age groups

Table 7. Age and sex distribution of patients in the period 15.9.-21.9.2020
Category Age group Number of cases men Share of men (%) Number of cases women Share of women (%) Total by age groups and categories Share of age groups and categories in the total number of cases (%)
Kids 0 3 100,0% 0 0,0% 3 138 0,2% 11%
1-6 18 72,0% 7 28,0% 25 2,0%
7-10 5 45,5% 6 54,5% 11 0,9%
11-14 14 46,7% 16 53,3% 30 2,4%
15-18 28 40,6% 41 59,4% 69 5,5%
Adults 19-30 102 47,4% 113 52,6% 215 874 17,1% 69,7%
31-40 94 51,6% 88 48,4% 182 14,5%
41-50 109 52,4% 99 47,6% 208 16,6%
51-65 137 50,9% 132 49,1% 269 21,5%
Elders 66+ 95 39,3% 147 60,7% 242 242 19,3% 19,3%
TOTAL   605 48,2% 649 51,8% 1254 100

Measures
Measures to maintain physical distance, maintain hand hygiene and disinfection are still in force. Also, it is mandatory to wear face masks or medical masks indoors for all health workers and professionals, employees who work in social care system and the ones who work in hospitality facilities.

Headquarters decisions in the previous week:
  • Decision about the introduction of necessary epidemiological measures for the area of ​​Krapinsko -zagorska County (September 25, 2020)
  • Decision amending the Decision about the introduction of necessary epidemiological measures for the area of ​​Virovitičko - podravska County (September 25, 2020)
  • Decision amending the Decision about the introduction of necessary epidemiological measures for the Zagrebačka County (25 September 2020)
  • Decision about the introduction of necessary epidemiological measures for the area of ​​the Municipality of Đulovac (September 25, 2020)
  • Decision about the introduction of necessary epidemiological measures for the area of ​​Sisačko - moslavačka County (September 23, 2020)
  • Decision amending the Decision about the introduction of necessary epidemiological measures for the area of ​​the Splitsko - dalmatinska County (September 23, 2020)
  • Decision about the necessary measure of limiting the working hours of catering facilities in the category "Bars" (September 22, 2020)
  • Decision on repealing the Decision about the introduction of necessary epidemiological measures for the area of ​​the City of Otočac (September 22, 2020)
 
CIPH recommendations
  • Guidelines for the prevention and suppression of the COVID-19 epidemic for social service providers in the social welfare system - ver. 9 (28/09/2020)
  • Recommendations for the prevention of COVID-19 infection during professional art performances, cultural programs and events - ver. 4 (27/09/2020)
  • Exercise of the right to vaccination against influenza with payments (25/09/2020)
  • Criteria for testing for SARS-CoV-2, termination of isolation and quarantine - Consolidated revised recommendations on priorities for testing for SARS-CoV-2, handling of contacts, completion of isolation and quarantine ("self-isolation") (21/09/2020)
  • Terms of use of school sports halls by external users (22/09/2020)

Recommendations and measures on global and EU level

Europe
On 10 th of August 2020, ECDC released an updated version of the risk assessment:
 
ECDC has additional documents and information available: https://www.ecdc.europa.eu/en and https://www.ecdc.europa.eu/en/covid-19-pandemic
The number of cases and the 7-day cumulative incidence of COVID-19 confirmed cases worldwide can be found on the ECDC dashboard: https://qap.ecdc.europa.eu/public/extensions/COVID-19/COVID-19.html
 
Austria
Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz – https://www.sozialministerium.at/Informationen-zum-Coronavirus/Neuartiges-Coronavirus-(2019-nCov).html
 
Netherlands
Government of the Netherlands - https://www.government.nl/topics/coronavirus-covid-19
National Institute for Public Health and the Environment - https://www.rivm.nl/en/novel-coronavirus-covid-19

Germany
Rober Koch Institut - https://www.rki.de/DE/Home/homepage_node.html
 
Slovenia
(gov.si) – https://www.gov.si/en/topics/coronavirus-disease-covid-19/
National Institute for Public Health – Slovenia - https://www.nijz.si/en
 
United Kingdom
gov.uk – https://www.gov.uk/coronavirus
NHS - https://www.nhs.uk/conditions/coronavirus-covid-19/
 
World
WHO provides comprehensive information and documents
WHO COVID-19-Dashboard: https://covid19.who.int/ and https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update i Weekly Surveillance Report: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports and https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/weekly-surveillance-report
 
Sources of information
https://www.hzjz.hr/
https://zdravlje.gov.hr/

Information about the global epidemiological situation
More about COVID-19 in other countries can be found and learned on the ECDC website: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases. The WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Health Policy have at their disposal the COVID-19 Health System Response Monitor (HSRM). There is information available about European countries and ways to respond to this epidemic. The focus is on health systems and public initiatives: https://www.covid19healthsystem.org/mainpage.aspx