After a summer of falling infections and deaths, the autumn has seen soaring cases and new lockdowns imposed in many countries across Europe. In most places, these latest measures are now succeeding in curbing the exponential rise. And there is new optimism about turning the tide of the disease after promising results from three vaccine trials.
Health officials have also warned, however, that a third wave could still hit before the vaccines are rolled out next year. Full immunisation of European countries is not expected to be completed until well into 2021. The WHO’s Covid-19 envoy David Nabarro told Swiss media on 23 November that he predicts a third wave early next year, unless the “necessary infrastructure” is put in place now. Europeans, he said, had “missed building the necessary infrastructure in the summer months after getting the first wave under control”. Nabarro stressed the importance of granular tracing of cases.
The past and present waves are the most important source of information about what happens next. So what does the data reveal about the relative prospects of different countries?
Hospitalisations and death figures show the second wave has peaked in several countries
By 25 November, the number of patients hospitalised with Covid-19 had exceeded first wave levels in Italy, Belgium, Portugal and Czechia. A recent spike in hospitalisations suggests this is probably also true of Poland, although the data there is incomplete.
However, in most countries – with the exception of Poland and Czechia, both of which avoided a pronounced first wave – deaths are currently at a lower level than in March and April.
One study of patients in England published in October found “a substantial mortality improvement in people admitted to critical care with Covid-19”, with the death rate halving between late March and June, indicating rapid advances in understanding how to treat the disease. John Dennis, one of the authors of the study, told the New Statesman that the drastic fall in mortality rates in just a few months was likely due to several factors, including hospital capacity and new treatments becoming available.
“If the threshold for admission to critical care is shifted – meaning on average the people being admitted have slightly less severe forms of the disease – then you’ll obviously get improved outcomes due to a changing patient mix,” Dennis added.
Another British study found that the steroid dexamethasone could reduce fatalities by as much as a third among patients requiring ventilation. According to an email from a spokesperson for the WHO, triaging procedures are also much improved since the first wave, contributing to reduced mortality.
In addition, the average age of people contracting Covid is much lower than it was in the spring in most countries. More young people are becoming infected, pushing case numbers up, but avoiding corresponding rises in death tolls as the disease is far less deadly among the young than the old. Outbreaks in care homes appear to be happening with less frequency than during the first wave, thanks to increased testing of residents and carers.
Are Europe’s new, lighter lockdowns working?
In response to the second wave, many countries imposed second lockdowns in early November. According to the Blavatnik School of Government at the University of Oxford, which produces a lockdown stringency index, most of these are slightly lighter than those imposed in the spring, with many governments notably choosing to keep primary and secondary schools open.
In France, since 30 October, employees have been encouraged to work remotely and citizens must fill out a form certifying a valid reason to be outside, as during the first lockdown. President Emmanuel Macron is about to loosen restrictions, however, allowing shops to open ahead of the holiday period, but warned that many measures will remain in place for at least a further two months.
German politicians have vaunted the country’s “lockdown-lite”, in which bars and gyms have closed but shops have remained open. The measures will remain in place at least until the end of December, with a temporary loosening of rules over the Christmas period allowing limited gatherings and household mixing.
And on 2 December, England’s national lockdown will be lifted and replaced with a tightened regional tier system. People living in the highest tier will not notice much difference, but lower tiers will offer significantly more freedom than the national lockdown, although initially few in England will be living in the lowest tier.
Sweden, long the exception to the lockdown measures seen in the rest of the continent, has in recent weeks imposed more stringent restrictions, banning gatherings of more than eight people. According to the Blavatnik School index, however, constraints here are still the most permissive in Europe.
A key question is whether these lockdowns are being obeyed as stringently as they were in the spring. Many commentators have noted a fraying solidarity compared with the early stages of the pandemic.
According to Google mobility data, movement across the continent fell dramatically with the first wave of lockdowns – by around three-quarters in most countries. Mobility generally remained below pre-pandemic levels over the summer before dropping again this autumn. As yet, however, there has been no return to the severe dip in mobility seen in March and April, with most countries only between a quarter and half down on baseline levels, indicating that new lockdown measures are not leading people to restrict their movements to the same extent as earlier in the year.
With looser restrictions on movement and a general fatigue with the pandemic, this is perhaps to be expected. Workplace mobility has also fallen by a smaller margin compared to the spring, suggesting that some employees who were working from home then are no longer doing so now.
The exception to these trends is Sweden, which attracted significant international attention for avoiding strict lockdown measures during the first wave. Since October, it has seen a drop in mobility equal to the first wave, as ministers were forced to introduce limits on public gatherings to combat a sharp rise in hospitalisations and deaths. There have been no widespread closures of workplaces, though Swedes are advised to work from home where they can.
Case numbers do not tell the whole story
Since the first wave, most European countries have dramatically increased the number of tests they issue. This means that the number of cases cannot be fairly compared, as more infections, especially of asymptomatic and mild cases, are now being caught. On this measure, Portugal and Poland are seeing the highest case rates compared to population out of European countries, with an average of 54 over the last seven days for every 100,000 people, followed by Italy (53) and Sweden (44).
A better metric is the test positivity rate, which gives an indication of whether countries are testing enough, as well as the scale of the outbreak. According to the WHO, a test positivity rate of under 5 per cent of tests indicates that a country has its outbreak under control.
With the exception of Ireland, most European countries are now above the 5 per cent threshold. The numbers in Poland are particularly alarming, with close to half of tests coming back positive (contrasting with official figures). Figures in Czechia, Belgium and the Netherlands have all seen dramatic spikes over the last month, with up to a third of tests returning a positive result.
In the UK, however, a massive investment in testing has meant that it has managed to record lower test positivity rates, along with Spain and Germany.
Should European countries be bracing for a third wave of coronavirus early next year, as Nabarro has warned? Without a speedy vaccine roll-out, systems to test, trace and isolate cases will be the most efficient measure. Some countries, such as Czechia, have made headway in recent weeks, which is reflected in falling hospitalisations and deaths. Spain, Ireland and the Netherlands appear to have achieved a decline in deaths and hospitalisations, and there are early signs the UK is following suit.
The question now is how far the figures can drop before Christmas, and how far travel and social contact over the festive season will push them back up again. The good news for now is that rapid advances in our understanding of how to treat the virus and conduct effective lockdowns mean – so far – the second wave is in most countries proving less deadly than the first.