By mid to late May, Europe had tamed the first wave of the coronavirus, but not eradicated it. Had Europe opted to pursue elimination of the virus, a second wave could have been avoided. But, on the whole, governments let down their guard. And then, complacency kicked in. Restrictions were substantially eased over the summer and into early autumn. Subsequently, as the weather cooled in September, people returned indoors to bars, restaurants, offices, and homes where the virus could easily spread.
In the past 10 days, the European Union (E.U.) has overtaken the U.S. in terms of new coronavirus cases per capita. Europe’s regional director of the World Health Organization (WHO), Hans Kluge, has said that there has been an exponential increase in daily cases across all of Europe, including the U.K. and non-E.U. countries, with the continent now reporting a 7-day average of more than 1,200 deaths a day.
While all of Europe is experiencing the effects of a second wave of coronavirus infections, there are major differences in impact and response across individual countries.
The figure below shows that Europe’s coronavirus resurgence is being led by several countries that also headed the first wave, including Belgium, France, Italy, the Netherlands, and Spain. But, the second wave also includes several countries that had been spared for the most part during the initial March onslaught, such as Poland and the Czech Republic.
The level of confirmed infections is presently much higher than in March and April in many European countries. This is partly owing to more testing than during the first wave. But, the alarming rise in test positivity – now double-digit percentages in many European countries – suggests the intensity of the spread of the contagion is strengthening. Hospitalizations and intensive care unit occupancy are steadily increasing, with a number of jurisdictions - for example, the region in and near Liège in Belgium, and the metropolitan Rotterdam area in the Netherlands - already reporting healthcare system capacity issues.
Belgium stands out as an especially poor performer, not only during the first wave, but now it’s experiencing a dramatic rise in new daily cases; nearly an 80% increase in one week. Hospitalizations have also gone up, with currently more than 3,500 people in hospital with Covid-19. Belgian officials warn that if daily new cases continue to rise at the same rate, Belgium will fill its capacity of 2,000 intensive care beds by mid-November.
In several countries, such as the Czech Republic, the second wave is far worse than the first in terms of all three key indicators: Cases, hospitalizations, and deaths.
Other nations, like Spain, demonstrate that while numbers of new daily cases are worse than in March and April, hospitalizations and deaths are not as high as they were at their peak in the first wave.
A few European countries have been able to maintain relatively steady control over the situation in both the first and second waves. The figure below shows that Denmark’s second wave of daily new cases is relatively short-lived and muted, so far. Its strategy of test (third highest rate in Europe behind Iceland and Luxembourg; and 2.2 times the U.S. rate), isolate, and contact trace that it began implementing in March, appears to be working throughout the crisis. Furthermore, the death rate in Denmark, measured in deaths per million inhabitants, continues to be more than five times lower than its neighbor, Sweden.
Overall, Europe’s second wave is worse in terms of daily new cases, but this hasn’t (yet) translated into aggregate hospitalizations and deaths that exceed the numbers seen in the first wave, though in many countries numbers of hospitalized Covid-19 patients are already nearing 60% of the peak levels last March and April. The three growth curves – cases, hospitalizations, and deaths – exhibit distinct slopes, with hospitalizations less steep, and deaths somewhat flatter still. An important caveat is that death is a lagging indicator. Many who die from Covid-19 spend more than four weeks in hospital. So, it is premature to draw definite conclusions about the trajectory of the deaths curve. A fourth curve to keep an eye on is excess all-cause mortality. Across most of Europe excess deaths are rising again.
Notably, in the U.S. the observed pattern thus far is that the second peak (focused on the sunbelt states during the summer) and now ascending third wave (concentrated in the Midwest and Northern Plains) is hardest in areas previously less impacted; while across Europe the second wave seems to be affecting many of the same hard-hit areas that were struck during the first wave. There are a few conspicuous exceptions to the rule, including Italy’s Southern provinces which had largely escaped Covid-19, and are now being hit hard as well.
As with the second apex that primarily impacted the sunbelt states in the U.S. over the summer, the discrepancy between curvature in the case and death curves can be traced to numerous factors. More testing may be at the top of the list, especially as it pertains to a younger demographic and those with mild or no symptoms. Indeed, the median age of those testing positive is at least 30 years lower than of people who contracted the virus in March. Older age is a critical risk factor that is positively correlated with a greater degree of severity of symptoms as well as death. Also, we may attribute fewer aggregate deaths during the second wave to the availability of number of comparatively effective treatments.
Since last week, European countries have re-introduced varying levels of restrictions, though so far most jurisdictions, with the exception of Ireland and the Czech Republic, are resisting the kinds of draconian lockdowns imposed in March. The impact of Europe’s second wave of coronavirus infections is being felt differently across different countries. Accordingly, policy responses have differed.
The raft of measures taken by European governments includes limits on gatherings outside households, mask and physical distancing mandates, closing of non-essential businesses, bars, and restaurants, and even curfews in some locales.
Until now, the Czech Republic has implemented the most restrictive set of measures, which includes the closing of schools for at least three weeks. The Netherlands and Germany have imposed what they’re calling a “partial lockdown” that comprises a shuttering of bars and restaurants (except takeout) but does not include schools. Other countries like the U.K. and Italy have tightened opening times of restaurants, imposed local partial lockdowns, set stricter limits on gatherings, and further expanded mask requirements. These measures are intended to stave off full lockdowns. It’s unlikely these softer measures will preempt the need to impose harsher steps in the very near future.
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