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Tuesday, October 20, 2020

Europe’s new Covid-19 wave, explained

Students walk past a safety sign in Oxford. Covid-19 cases have been rising in England and across the European continent. | Steve Parsons/PA Images via Getty Images

Some countries with the fastest-spiraling outbreaks may soon have to go back into lockdown.

VIENNA — With new Covid-19 cases rising exponentially across the European continent, leaders are once again turning to social distancing mandates and business closures to halt the spread of the coronavirus.

There are curfews across England and France, limits on drinking in the Czech Republic and Belgium, and stricter mask requirements in Italy and Switzerland.

Here in the Austrian capital, where people can be seen panic-hoarding toilet paper again, Chancellor Sebastian Kurz has warned of a “challenging autumn and winter” ahead. The country’s new anti-virus measures include limits on the size of gatherings, while one particularly hard-hit town in the Salzburg area, Kuchl, has shut down.

So far, the restrictions stop short of country-wide stay-at-home orders, where people’s movements are curtailed and non-essential businesses close. But already, local governments in several countries — including Austria, Germany, and the UK — have imposed targeted lockdowns, just as they did in the spring, and health officials in countries with the fastest-spiraling outbreaks are warning of more to come.

“How could we possibly be here again?” Clare Wenham, an assistant professor of global health policy at the London School of Economics and Political Science (LSE), asked of the UK, where the death toll from Covid-19 is among the highest in the world. It’s because “the government didn’t spend the last six to eight months investing and getting a good track, trace, and isolate system in place.”

Christina Animashaun/Vox

For months, scientists and global health experts warned that European governments must build up coronavirus testing and tracing capacity, put in place strict quarantine and isolation measures, ready hospitals for Covid-19 patients, protect the elderly and vulnerable, and, for god’s sake, get people to wear masks. Taking these steps, said Anthony Costello, a professor of global health at University College London, avoids “the bluntest weapon to control the epidemic” — the lockdown.

Yet, with few exceptions, leaders did not adequately prepare. Instead, there was complacency and denial. When social distancing measures slowed coronavirus spread over the summer, politicians lifted restrictions quickly in an effort to restart economies. They then failed to heed the warnings of scientists and doctors — that small upticks in infections would eventually culminate in an exponential growth in cases, followed by increases in hospitalizations and deaths. (A grim, similar pattern developed in the US.)

In the absence of stricter anti-virus measures now, Hans Kluge, the World Health Organization’s regional director for Europe, warned last week, daily mortality rates from Covid-19 could reach “levels 4 to 5 times higher than what we recorded in April.” And what makes this wave even more challenging than the last: People have already endured the pain of lockdowns once. They’re tired of the pandemic, and leaders in some cities and states are even fighting back against federally imposed measures. If pandemic restrictions are abandoned, the new wave in Europe might rival the severity of the last one.

Europe’s new coronavirus wave, explained

The springtime lockdowns around the world came with a level of economic, psychological, and social pain we haven’t seen since the Second World War. Millions of people saw their lives dramatically shift: They changed how they work, lost jobs, or risked their health to carry on. They stayed away from loved ones, died alone, and delayed funerals. They put off weddings, canceled holidays, and kept their kids home from school.

These sacrifices, at least in the short term, appeared to pay off: By early summer, the first coronavirus wave was largely under control, and related hospitalizations and deaths were falling back down. But shortly after leaders began to lift the pandemic restrictions, people started socializing again, and, in many places, the virus started to move.

“This idea was you lift all restrictions, and we’ll have our life back,” Devi Sridhar, chair in global public health at the University of Edinburgh, told Vox. “But in no scenario do you lift restrictions and does life go back to how it was pre-Covid.”

In September, the new daily case counts in many European countries surpassed those reported during the first peak of the pandemic. You can see the trends in this chart from Our World in Data:

Our World in Data

To be sure, you can’t “take the numbers today and place them on top of the earlier curve and assume it’s the same thing,” as Flavia Riccardo, a researcher at the Italian National Institute of Health, told Vox in September. That’s because this new peak can — in part — be explained by more robust testing across the continent: Health authorities in many countries are simply testing more than they were in March, when tests either weren’t available or the indication for testing was limited.

But the expansion of testing doesn’t fully explain what’s happening. As you can see in the next chart, the daily share of positive tests began increasing in July from a summer low. This means health officials in many countries didn’t keep up with the predictable, post-summer increase in demand for testing — and therefore aren’t finding where new pockets of disease are spreading. In other words, they’ve lost control of their epidemics.

Our World in Data

Also worrying: Covid-19 hospitalizations are rising across Europe again. It took a while to see hospitals fill up: the uptick in cases over the summer first affected mostly younger people who are less susceptible to severe disease. But by September, that younger group had spread the virus to their older friends, colleagues, and relatives. And by mid-October, Covid-19 hospitalizations and ICU admissions were either high (at a quarter of the spring pandemic peak) or had increased compared to the previous week in 20 countries in Europe, according to the ECDC. And with more hospitalizations and ICU admissions, come more Covid-19 deaths.

Our World in Data

As you can see in this chart, the deaths per million so far are nowhere near the last peak. “Although we record 2 to 3 times more cases per day compared to the April peak, we still observe 5 times fewer deaths,” the WHO’s Kluge noted in an October 15 update.

The doubling time for hospital admissions has also slowed down in Europe: it’s “still 2 to 3 times longer” than it was in the spring, Kluge said. And, thanks in part to improved treatment approaches, people have better odds of surviving when they are admitted to a hospital. According to the Financial Times, in March, people over the age of 70 had a 50 percent chance of living; by August, that number climbed to 74 percent.

Still, the increases in deaths have sparked renewed fears that the new wave is going to overwhelm hospital systems again — and once they’re overwhelmed, doctors will have a tougher time keeping patients alive. (At the height of Italy’s epidemic last March, doctors were forced to ration care while the army was drafted to help move corpses piling up in the outbreak’s epicenter.)

To stave off these nightmare scenarios, broader lockdown becomes inevitable. The simple math of Covid-19 explains why. As Tom Inglesby — the director of the Johns Hopkins Center for Health Security — explained on Twitter: “We have had [ten times] the numbers of Covid deaths as compared to influenza last year, and that is with huge social distancing, masking and restrictive policies in place. Without those things in place, the numbers of Covid deaths would have been many, many times higher.”

Or, Sridhar told Vox in September, “If you see hospitals filling up and ICU beds full, [politicians will] have no choice but to implement some kind of lockdown unless you want your health system to collapse... You can’t have people dying in hospital doorways because they can’t get access to oxygen.”

That’s why countries are imposing social distancing measures anew — and why there may be more to come soon.

Europe’s new measures

Let’s take a brief look at new measures in some of Europe’s coronavirus hotspots, sorted here by countries with the highest incidence in new cases over the past two weeks. They range from mask mandates and curfews, to lockdowns:

Barbara Gindl/APA/AFP via Getty Images
An empty market square in Kuchl, near Salzburg, Austria, on October 17.

Most of these restrictions are more limited than the national lockdowns we saw in the spring — but they may be followed by stricter measures. And the most troubling part is that this was both predictable and preventable.

The first lockdowns were supposed to buy countries time to avoid more pain

Just about everyone who has been watching this pandemic closely warned that, as the first set of lockdowns lifted and people started mingling indoors after the summer, we’d see cases rise again.

But it wasn’t inevitable that cases would rise this much in Europe. To understand how the new wave could have looked different, let’s contrast the German coronavirus situation with what’s happening in the UK.

Our World in Data

Germany, which has consistently had a lower case and death rate than much of Europe, used the early days of the pandemic wisely: It quickly locked down, scaled up testing capacity, established a contact tracing network, made masks mandatory, empowered local health authorities to tailor policies to meet their local needs, and put in place a system for isolation and quarantine of confirmed and suspected cases. When local outbreaks have begun to grow swiftly, leaders reacted with localized lockdowns.

From the beginning of the pandemic, health authorities and politicians also listened to scientists, adapting policies as the evidence evolved. Most recently, for example, the government in the southern state of Bavaria gave schools money to improve classroom ventilation ahead of the winter.

These measures didn’t bring Covid-19 cases to zero. And when states across Germany relaxed social distancing measures this summer, cases started creeping back up — and they could still spike further. But the country’s epidemic is so far growing at a slower rate compared to the rest of Europe, and on a per capita basis, the outbreak in Germany is still milder.

What’s more, the systems in place should also help Germans stay on top of where the virus is spreading, and more quickly snuff out new outbreaks when they arise.

That’s what’s happened in South Korea, which launched a mass testing, tracing, and isolating program — powered by surveillance technology — even before their first major outbreak. The country is now reporting only 50 new cases per day and their numbers have stayed low for months.

“Lockdowns only make sense if they’re followed by testing and tracing,” Steven Hoffman, director of York University’s Global Strategy Lab, summed up. “Otherwise you’ve endured a painful experience without any longevity in its benefit.”

Indeed, countries that didn’t use the lockdown, and post-lockdown, period as effectively are now faring worse in the second wave. Look at the UK — with one of the fastest-growing outbreaks in Europe. Like the US, the UK government repeatedly failed to heed the advice of scientists and establish an effective testing, tracing, and isolating protocol.

For months, they waffled over whether to require face masks. After the summer, testing shortfalls meant thousands of people couldn’t access Covid-19 diagnostics when they wanted to. Today, most people still don’t get their test results in a timely manner (in England, only 10 percent get results within 24 hours). This means people with the virus may be going about their daily lives, potentially spreading to others, before they know they’re positive.

There’s also little follow-up or support to ensure people actually isolate and quarantine, said University College London’s Anthony Costello. “In the progressive European countries like Germany, and in South Korea and China, [the government] would pay your salary when you isolate. And if you’re not working, there’s a proper sickness benefit,” he said. Britain has no such program.

Scientists “have been saying testing, tracing, isolating hasn’t been working here. The testing was wrong, the tracing was wrong,” Costello added. “I’m realizing now nobody listens.”

Europe’s new coronavirus wave is a devastating, political failure — especially for the poorest and most vulnerable

Make no mistake: The quasi-lockdowns in place already, and stricter measures possibly to come, are the result of a political failure. “It was understandable that countries imposed lockdowns in the initial weeks when countries first got hit and were quickly overwhelmed,” Adam Kamradt-Scott, a global health professor at the University of Sydney. “But six months on, countries should have sufficient systems in place to undertake the necessary contact tracing and have a range of other measures they can use to limit the spread of the virus, rather than looking to hard lockdowns as the answer.”

The lack of those systems is a failure that the public will have to keep paying for, said LSE’s Clare Wenham. “Unless governments crack [testing, tracing, and isolating], we’re going to see these endless cycles of lockdowns every four to five months. There’s no other way.”

Wiktor Szymanowicz/NurPhoto via Getty Images
Hundreds of hospitality workers take part in a demonstration in Parliament Square in London on October 19.

In some cases, governments may not be able to revert to spring-style closures. The highest court in Austria, for example, determined the March and April ban on entering public places, and a tiered rollout for shops reopening according to their size, was partly unconstitutional. Similar legal battles are unfolding at the city and state level in other countries in Europe.

But with disease spread out of control, economic activity may contract even without government lockdowns because people may start to voluntarily restrict their movements, according to an analysis from the International Monetary Fund. “When we looked backward at the economic impact of the pandemic in the first half of the year, it’s true that lockdowns contributed to the economic contraction,” said Damiano Sandri, an IMF analyst who has been studying the impact of the virus. “But economic activity also contracted because people got scared and didn’t go out as they would otherwise when infections increased.”

In other words, the social and economic toll of the pandemic isn’t only caused by lockdowns. “The damage is also done if you get a strong wave of infections,” Sandri added, “and people start dying.”

In either scenario, businesses would have to restrict their hours or shutter altogether this winter. More people will lose wages or lose their jobs. And the economic toll of the pandemic has already been devastating — the worst recession since the Second World War. “The worst outcomes for governments are the repetitive lockdown,” Wenham added. “It’s better to be in one lockdown longer and have one economic shock than have these rolling shocks for two years.”

As the cold weather sets in across the Northern Hemisphere, people will have to stay away from their loved ones again. Parents will have to juggle work and child care, or choose between the two, again. The sick and elderly will have to endure another bout of isolation and loneliness, in some cases, gasping their last breaths alone.

Or maybe pandemic fatigue will deepen, the public will resist new measures, and virus cases will soar.

Researchers have been busy calculating the health and social toll of the first round of coronavirus lockdowns. Cancer screenings dropped off dramatically in multiple countries. Domestic violence soared, as did childhood malnutrition and mental health problems. More people suffered heart attacks at home, delaying life-saving visits to emergency rooms.

These are only the effects we can quantify right now, said Steven Woolf, a family medicine and population health professor at Virginia Commonwealth University, who has been tracking the rise in mortality from non-Covid-19 causes in the US.

Woolf expects, in the years ahead, we’ll find there was a lot more devastation than is currently visible: such as a surge in deaths from chronic conditions — such as diabetes, congestive heart failure, and HIV — as a result of Covid-19 disruptions in health care. The pandemic could also bring a “spike in overdose deaths” from loneliness and addiction services disruptions, and a long-term toll on childhood development.

“Decades from now, researchers may be talking about the ‘pandemic generation,’” Woolf said, “and some of the health effects they tolerated because they grew up in the midst of this.”

This will be especially true for the poorest and most vulnerable among us. Covid-19-related job losses, and even infections and deaths, have disproportionately affected the poor and minority groups around the world. Blunt tools like city- or nationwide lockdowns only exacerbate those impacts, York’s Steven Hoffman said.

“It’s easy for some people to lockdown, particularly when they’re able to work from home. It’s far more difficult for those working in the service industry, who can’t work from home and might be living paycheck to paycheck,” Hoffman added. “The story of this pandemic is that it’s been a grand revealer for the inequalities in our society.”

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