Europe is now fighting a second wave of the coronavirus
Credit: Bloomberg
"Almost all the indicators are on the rise," warned Sophie Vaux, an epidemiologist and programme director at Santé Publique France last week; the virus was once again in an "ascendant phase", its spread “exponential”.
Looking at the data for our nearest continental neighbour, Ms Vaux’s analysis is hard to fault. A&E admissions linked to suspected Covid cases rose by 21 per cent in France last week. Hospitalisations were up 34 per cent and intensive care admissions rose by 40 per cent nationwide.
As one might expect, the death toll was also up. It rose 25 per cent on the week, with 332 deaths recorded in French hospitals and retirement homes, according to data published on Friday.
That Europe, including the UK, is now fighting a second peak of Covid 19 there can be no doubt. But the health and economic outcomes will — just as they always have — depend largely on government policy and our collective behaviours.
As Professor Chris Whitty, the Chief Medical Officer for England, pointed out on Monday: “If we do too little, this virus will go out of control and we will get significant numbers of increased direct and indirect deaths, but if we go too far the other way, then we can cause damage to the economy which can feed through to unemployment, to poverty and to deprivation, all of which have long-term health effects."
Professor Chris Whitty said on Monday the UK must react to increasing infections carefully
Credit: No10 Downing Street
The latest data from the European Center for Disease Control (ECDC) underlines the challenge at hand as we enter winter with the virus resurgent.
By the end of week 38 of the outbreak (September 20), the 14 day case counts across Europe had been climbing for 63 days. It averaged 94 confirmed cases of the virus per 100,000 of the population, far above the limit of 20 the UK placed on foreign travel destinations only two month ago.
High case levels (at least 60 per 100 000) or sustained increases were reported in a total of 20 countries including Austria, Belgium, Croatia, Denmark, Estonia, France, Holland, Hungary, Ireland, Luxembourg, Norway, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the UK.
Hospital and/or ICU admissions due to Covid-19 had increased in Austria, Czechia, Denmark, Estonia, France, Greece, Hungary, Latvia, Portugal, Slovakia and Slovenia, and high (at least 10 per million) or sustained death rates were observed in four countries — Bulgaria, Croatia, Romania and Spain.
These and other data contain several pointers for the UK in the months ahead. One is that we are likely still trailing much of Europe by several weeks and a second is that a spike in cases will still lead to hospitalisations and deaths if left uninterrupted.
It is no coincidence that the countries reporting higher 14 day average death counts by September 20 — Bulgaria, Croatia, Romania and Spain — were all among those first to report a second rise in new cases more than two months ago.
Already in the UK the numbers are ticking up. Hospital admissions have been rising steadily for several weeks now and there are signs that deaths too are rising.
Data for Universities Hospital Trust Birmingham, for instance, shows that on September 11 it had 72 covid patients on its wards, seven of whom were in ICU. On Friday it had 124 Covid in patients and 18 in intensive care. In the two week interim, it recorded 22 Covid deaths.
Another lesson from the European data (one that could have been taken from Florida and the sun belt states of the US in the early summer) is that cases start in the young but don’t stay there for long.
The ECDC data now show “high levels or sustained increases” in confirmed Covid cases among those over 65 in 17 countries including Austria, Ireland, Luxembourg, Malta, Portugal, Romania, Spain, Sweden and the UK.
The same pattern was almost certainly true of the first wave of the virus in the spring but was not picked up because testing was more limited.
If there are positives to be drawn from the trends in Europe they come largely from the variation beneath the high level data, suggesting that mitigation policies and health care capacity has an impact.
For instance, while the ECDC data shows that on average 22 per cent of reported Covid-19 cases end up in hospital and 9 per cent of them are transferred to intensive care beds, the variance between countries for these two data points is 3–63 per cent and 0-62 per cent respectively.
Coronavirus Spain Spotlight Chart — Cases default
Even with the incidence of the virus, there remain huge differences between countries. Germany has kept cases per 100,000 below 30, while in Spain it is over 300, for example.
Another positive outlier for the moment at least is Italy. Hit horribly hard in the initial outbreak, it has performed relatively well since. New Cases, at around 1,500 a day, are up but opposition to social distancing and mask-wearing remains muted.
What was advertised as a “national” anti-mask protest in Rome a few weeks ago ended up a “gathering barely large enough to fill a modest-sized piazza” and compliance with the rules remain strong, reports our Rome correspondent.
The same is broadly true in Germany where the population is said to have adopted Britain’s wartime spirit of "Keep calm and carry on". While Boris Johnson’s government has issued dire warnings and changed course repeatedly, the message from Chancellor Angela Merkel has been steady and measured.
This appears to have had an impact. A month ago, the two countries were on a similar course with rapidly rising infections but while in Britain cases have since rocketed, Germany has again flattened the curve — for the moment at least.
At the other end of the spectrum, there is huge concern in Spain that the second wave could be every bit as destructive as the first. Experts fear that if it continues the new spike, combined with the onset of seasonal flu, could cause a collapse in the health system and lead to further lockdowns that will cripple an already weak economy.
In Germany, the population is said to have adopted Britain’s wartime spirit of 'Keep calm and carry on'
Credit: REUTERS
As is the case in the UK, doctors and others blame poor communications between the central government and the regions, the overly rapid lifting of restrictions on bars and nightclubs and summer tourism for the difficult position the country now finds itself in.
While there is broad consensus on the need for caution and continued social distancing across Europe, one thing that the existing data can not tell us is how the virus will behave in winter. This is the greatest known unknown and the possible googly experts fear most.
Will the virus react with other viruses that circulate in winter to become more virulent? Will dryer air allow it to spread more efficiently? Might the frail become more vulnerable as the cold sets in? Will the infectious dose people are exposed to rise as we huddle indoors and close the windows? Might a larger dose once again push up the death rate?
These are the things keeping Prof Whitty and experts across Europe awake at night. We will only know the answers with certainly by spring.
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