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10 November 2020

Why has Belgium been so badly affected by Covid-19?

The country, which has the highest coronavirus death rate in the world, has suffered from a lack of trust and coordination between different regions and cultures.  

By Dave Keating

Much like the UK, Belgium has seen a new national lockdown replace a confusing and uncoordinated localised response to rising Covid-19 cases.

The home of EU institutions has been hit hard by both waves of coronavirus. In the spring, the country had the highest Covid-19 death rate in the world. Now, with a rate of 1,443 cases per 100,000 people over the past 14 days, it has the highest rate of infections in Europe. Hospitals are being overwhelmed, admitting 680 coronavirus patients each day, and, on Monday 2 November, non-essential shops and businesses were shuttered again.

“We’ve lost control,” the Belgian health minister Frank Vandenbroucke warned last month, predicting a “tsunami” of infections.

There are some obvious reasons why Belgium has been so badly affected: it is one of Europe’s most densely populated countries and is a crossroad of cultures at the centre of the EU.

But this doesn’t entirely explain the problem. The neighbouring Netherlands, also densely populated, was lightly affected earlier in the year, though it is experiencing a more severe second wave. Instead, another reason the county has struggled to keep the virus under control is a phenomenon that’s affected the whole of the EU during the virus crisis: a lack of trust and coordination between different regions and cultures.

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Regional splits

Belgium, often called “a country in name only”, has been steadily federalised over the last 60 years, split into three regions: Dutch-speaking Flanders, French-speaking Wallonia and theoretically bilingual – but mostly Francophone – Brussels. In the first wave, the wealthier Flanders region was the hardest hit of the three, with deaths in care homes particularly high. Now, it is Francophone Wallonia and Brussels that are suffering most.

As the federal government refused to increase restrictions in September, despite rapidly rising cases, the minister-president of the Brussels region decided to take matters into his own hands. Bars were closed and gatherings were restricted in the capital. Wallonia followed suit. But in Flanders, which surrounds Brussels and is where many of the city’s workers live, things remained open.

Eventually measures had to be harmonised, and the federal government announced a full national lockdown on 30 October, one similar to the shutdown imposed from March to May. But regional differences remain. Brussels has a curfew from 10pm to 6am, for instance, yet in Flanders, the curfew is from midnight to 5am.

The timeline of a regional approach replaced by a national lockdown has been familiar through both waves of the pandemic, says Sascha Marschang, the director-general of the European Public Health Alliance. It has been witnessed in Germany, France and Spain, he says, adding: “We had to learn again that more localised situations weren’t working.”

The same formula was applied in the very first days of the pandemic, when Italy first tried to contain its northern regions, only to quickly extend the restrictions to the whole country after an exodus from north to south. A similar pattern is now playing out in the UK.

[See also: Why are we locking down again? Because England didn’t learn from Europe’s mistakes]

Aside from the confusion, it is simply difficult for people to see themselves locked down while their neighbours are not, says Marschang. This applies not just within countries, but also among them. “The differences between regions and countries have made people uncomfortable; to see that they’re locked down, but in Sweden people are free to sit out on a patio somewhere.”

Where Belgium has perhaps helped itself, however, has been in the quality of its national-level communications. During the summer, while policy decisions wer left to the regions, Belgium’s caretaker prime minister Sophie Wilmès became the communicator-in-chief. “How Covid is communicated is as important as the measures that are taken,” says Marschang, who thinks the nation has fared better than its neighbours in this respect. “It was neither hype-based like in the UK, or trying to play it down like in other countries.”

Hospital fears

Belgium’s lockdown, scheduled to last until 13 December, is very similar to that of England. The big difference is that Belgian schools are closed, though this has been achieved by extending school holidays. It’s the result of a classic “compromis à la Belge”, in which the Flemish wanted to emulate the Netherlands’ softer approach and the Walloons wanted to emulate France, where people are required to carry permission slips when making trips outside.

The fear for a tiny country such as Belgium, however, is that the country’s hospitals will become overwhelmed. Unlike in larger nations, Belgium does not have much flexibility to transfer patients around, says Marschang. Its 2,000 ICU available beds is a relatively large amount for a country of 12 million – but more than half of those are now occupied, and some hospitals are at breaking point. Often patients do not want to be transferred to a part of the country where they cannot speak the language.

Philippe Devos, the president of the Belgian Association of Medical Unions, has said the situation in Liège, in Wallonia, is “catastrophic”. He told the Belgian broadcaster RTBF last week that between a fifth and a quarter of medical staff are currently sick or in quarantine. Meanwhile, hospital staff across the country have been protesting about the extreme conditions they are working in. 

[See also: Postcards from Planet Covid]

The European Commission has proposed a data-sharing system through which patients could be more easily transferred to different hospitals in other EU countries based on current capacity. But cooperation between EU member states during this pandemic has been slow-going. The lack of coordination between Belgium’s regions has, in this way, made the country a microcosm of the situation in the EU as a whole. Though the Commission has tried to coordinate, it has limited power to do so in the area of health policy, which is made at national level.

“Up until now, EU member states have not been prepared to take joint decisions on health,” says Marschang. But this is being revised. “We don’t need to all shut down at the same time,” he says, explaining that there could be a nuanced system in which a nation will have to enter a certain lockdown phase depending on the conditions in the country. He adds: “But you have to apply the same system to determine that in every country.”

Dave Keating is a Brussels-based journalist and senior writer for Energy Monitor