Establishing a novel European hospital surveillance platform in response to a newly emerging infection lessons from the I-MOVE-COVID-19 hospital network

Background: The first signal of a new infection is often severe cases presenting at hospital. Enhanced surveillance of these cases is critical to learning more about disease epidemiology and patient outcomes, but nationallevel surveillance can lack power to draw conclusions. In response to the emergence of SARS-CoV-2, the Influenza-Monitoring Vaccine Effectiveness (I-MOVE) network, founded in 2007, expanded to establish the I-MOVE-COVID-19 Consortium in February 2020. The Consortium’s surveillance objectives included using pooled data to describe clinical and epidemiological characteristics of hospitalised COVID-19 patients across Europe, in order to contribute to the knowledge base, guide patient management, and inform public health response. Methods: Eleven study sites participated in the surveillance, including 23 hospitals across six EU Member States and Albania, and hospitals nationally in England and Scotland. A standardised protocol and dataset for collection was agreed by April 2020. In England and Scotland, data were generated by linkage of routine datasets; other sites used bespoke paper or electronic questionnaires. Data were submitted, pooled and analysed quarterly. Results: Data were received regarding 84,297 COVID-19 patients hospitalised between 1 February 2020 and 31 January 2021. Three surveillance bulletins were published between September 2020 and March 2021, providing key insights into severe COVID-19 at European level. However, the unexpected, overwhelming workload at participating sites, and difficulties securing data protection and ethics permissions, delayed data submissions and presented challenges for timely analysis. Conclusions: Building on an existing network facilitated a novel European multicentre hospital surveillance system to be implemented during a pandemic; however, timeliness was nonetheless problematic. In future, processes could be streamlined e.g. by developing pre-approved template protocols with information governance and ethical approvals in place during the inter- pandemic period.