key: cord-1010903-jbe5ys5b authors: Müller, Markus title: The start of the Austrian response to the COVID-19 crisis: a personal account date: 2020-06-12 journal: Wien Klin Wochenschr DOI: 10.1007/s00508-020-01693-y sha: 09c831f0f3d5a1880fac3461782037c266d440ec doc_id: 1010903 cord_uid: jbe5ys5b nan tact traced, (c) all community-acquired pneumonia (CAP) cases in Vienna hospitals should be screened for SARS-CoV-2. On the same day, I made contact with the Austrian Government via a Parliamentarian of the Green Party, which was responsible for the Ministry of Health in a coalition with the Peoples Party. From an administrative point of view, Austria was in a vulnerable position, as the new government was in office only until January 2020 and the National Sanitary Council, whose term had expired on 31 December 2019, had not been re-established. The position of the National General Director for Public Health had been removed by a previous government and never been reinstalled and the pandemic plan dated back to the emergence of H5N1 and H1N1 and focused on influenza. On 24 February I was asked by the Austrian Ministry of Health to suggest a panel of experts who could advise the Minister of Health. On 28 February this advisory council was introduced to the public and first pursued a COVID-19 containment strategy. The first case of COVID-19 in Austria was reported on 25 February and on 27 February the CAP screening initiative reported a first COVID-19 case in a Vienna Hospital intensive care unit (ICU). On 28 February the WHO published a report of the WHO-China joint mission on COVID-19 providing further details on the outbreak in China, including fatality rates and asymptomatic carriers [8] . At the beginning of March, the effective reproduction number (Reff) of COVID-19 infections in Austria was around 3.0, the doubling time around 2 days and the daily increase around 40%. It was clear from the beginning that the available data from China were probably prone to substantial reporting bias but despite the question of the individual risk profile, different modelling approaches showed that a synchronized appearance of severe cases would probably also overwhelm the Austrian capacities, which was in line K The start of the Austrian response to the COVID-19 crisis: a personal account main topic with a report from the Imperial College [9] . An unanswered question was an "iceberg" of asymptomatic infections. which was reported to range from 1% to 40% or even 86% [2, [10] [11] [12] [13] . In line with reports on a destabilizing situation in northern Italy [14, 15] and a cluster of COVID-19 cases in skiing resorts in Tyrol it became clear that SARS-CoV-2 had reached the level of community transmission. It was therefore advised to switch from containment to mitigation, level 2 according to the ECDC RRP5 (Rapid risk assessment -Outbreak of novel coronavirus disease 2019 : increased transmission globally -fifth update) [16] , and to focus on social distancing similarly to the Swiss approach. On 10 March the Medical University implemented mandatory distance learning for all students to protect its large teaching hospital, the Vienna General Hospital. On the same day, the government and the Parliament unanimously implemented the first steps of a number of measures, which led to a ban of public events, travel restriction closing of schools, universities, restaurants, most businesses on 16 March. Following the first announcement of measures in Austria, Reff was reduced from above 3.0 to below 0.7, which enabled a gradual lifting of restrictions. From 14 April Austria, together with Denmark, was the first European country to lift first restrictions, at the beginning with the opening of shops, followed by restaurants and schools. Mandatory wearing of face masks in defined situations was introduced in line with emerging reports on likely effectiveness of masks [17, 18] . The Austrian strategy, which was legalized by Austrian COVID Act was initially supported unequivocally by all parliamentary parties and the public; however, a shift in public opinion could be observed from the beginning of April onwards, which was also seen in other countries worldwide. The initial UK, Dutch and US attempts to pursue herd immunity were never broadly considered in the public opinion, but alternative strategies were advocated, notably the softer Swedish approach and the crisis management was reproached for its strategy nationally but taken as a role model internationally [19] [20] [21] . A further study of the Imperial College estimated that the Austrian interventions had led to a reduction of fatalities by approximately 50% and estimated an infection rate in the population of 1.1% (0.36-3.1%), which was largely in line with later random samples [21, 22] . First assessments of different national strategies to cope with SARS-CoV-2 in the early phase noted that: "Germany and Austria stand out as nations that adopted aggressive and early control strategies compared with Italy, France and Spain, which implemented similar measures, including lockdown, but later in their epidemics", and that, "so far, Germany and Austria have, per capita, seen a fraction of the deaths from COVID-19 of these other countries" [22] . Funding Open access funding provided by Medical University of Vienna. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. World Health Organization. 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