Europe’s Deadly Second Wave: How Did It Happen Again?

0
139

4,0003,0002,0001,000MarchAprilMayJuneJulyAug.Sept.Oct.Nov.Dec.April 94,081 deathsNov. 284,082 deathsCovid-19daily deathsSpring waveFall wave

Source: New York Times database. Chart represents the seven-day moving average of deaths in the 27 European Union member states in addition to the United Kingdom, Iceland, Liechtenstein and Norway.

By early June, scarred and battered, Europe was emerging from the depths of its fight against the coronavirus pandemic.

Strict lockdowns in most countries had lifted health care systems off their knees, just as the United States and others were fighting record caseloads. The weather was warming up, the European Union was encouraging borders to reopen and Europeans were desperate for a break.

They paid dearly for it.

A devastating second wave has forced reluctant governments back into lockdowns or restrictions and inflicted new scars on European economies. The optimism of the summer is gone, replaced with the realization that loosening precautions led to thousands of deaths just months before vaccines may arrive.

We now know that the second wave in Europe has become deadlier than the first. Nearly 105,000 people died of Covid-19 in November in 31 countries monitored closely by the European Centre for Disease Prevention and Control, surpassing April’s total, official data shows. About as many people are dying in Italy each day as when Bergamo was the center of the world’s attention.

And in most countries, daily deaths are jumping higher this fall than ever before.

Where the second wave was deadlier than the first

Daily deaths per 100,000 people

Exceeded spring peak

Below spring peak

Far below spring peak

21Czech Rep.GreeceCroatiaPolandSlovakiaBulgariaSloveniaHungaryMaltaLithuaniaLatviaAustriaRomaniaIcelandPortugalCyprusLuxembourgEstoniaGermanyItalyBelgiumFranceNetherlandsSpainU.K.DenmarkSwedenNorwayFinlandIreland

Source: New York Times database. Charts represent the seven-day moving average of reported deaths. Liechtenstein not shown. Countries far below spring peak include those whose highest daily deaths in the fall were 30 percent or less than in the spring.

Western European countries such as Italy and Belgium, which were hit hard the first time, are suffering nearly as badly now. Portugal is doing even worse. Some countries, including Germany, have done roughly the same, while others have done somewhat better, including Britain. Norway, Ireland and Finland have done best of all.

But most notably, nearly every country in Central and Eastern Europe — which as a region largely skirted the first outbreak — is now seeing alarming spikes in cases and deaths. Dramatic springtime scenes of sick western Europeans stranded on stretchers outside packed hospitals are now playing out in Bulgaria and elsewhere in eastern Europe.

In the spring and again in the fall, the coronavirus waves reached deadlier peaks in Europe than in the United States, adjusted for population — although Europe’s current epidemic has begun to level off, and the surging American epidemic may soon overtake it.

How did Europe, home to the world’s richest club of nations, find itself back in the claws of a disastrous second wave of the pandemic, after having wrestled back the first?

Rush to Reopen

It was April 14, deep in the first round of lockdowns, when the president of the European Commission delivered a dreaded message: The summer vacation, a sacred European tradition and the economic lifeblood for many countries, might need to be cancelled.

A week later, without explanation, she made a 180-degree turn. “I think we will find smart solutions to have some vacation,” Ursula von der Leyen told Portugal’s SIC TV channel. “I am positive about summer vacation.”

Around the same time, the Commission, the European Union’s executive branch that tries to coordinate policy for the 27 members, unveiled its “roadmap to reopening,” suggesting to national governments how to slowly, cautiously resuscitate social and economic life.

On paper it looked measured: phased reopening of schools, retail and other activities coupled with stepped-up testing and tracing as well as mask-wearing and distancing.

But most European governments moved much faster than the Commission recommended. Some, especially along the continent’s southern rim, took big risks to admit tourists in July, in a bid to rescue millions of tourism jobs. And the E.U., eager to reestablish its fundamental function as free-movement zone, encouraged countries to reopen internal borders, even as it continued to block outside travelers.

More than four million people visited Spain in July and August, often with no requirements to test or isolate when they arrived or returned home. While only a fraction of the normal number, it gave the virus plenty of opportunities. Tourists held parties in private villas in the Mediterranean, limiting the effectiveness of government restrictions, which often applied only to formal venues.

A couple dancing at the Angel of Peace monument in Munich in April.Laetitia Vancon for The New York Times

Research shows that these decisions — swift internal reopenings with nominal restrictions, coupled with cross-border travel — were at the root of the second wave.

In Belgium, which suffered severe first and second waves, people returning home from holidays abroad weren’t tested, and quarantine demands were not enforced. Cases began to grow exponentially in September.

“While millions of Belgians were returning from holidays including in hotspots such as Spain, mass tourism was a hidden incubator outside the country for a lot of Belgians,” said Emmanuel André, the country’s Covid-19 taskforce chief during the first wave.

Genetic research illustrates the impact of such policies. Dr. Emma Hodcroft, a molecular epidemiologist at the University of Bern, in Switzerland, together with her colleagues, identified a prominent variant of the virus that seemed to have originated or gained a major foothold in Spain by late summer.

That variant, Dr. Hodcroft said, accounts for 60 to 80 percent of all second wave cases in the United Kingdom and 40 percent of Swiss cases, and is noteworthy in other countries, including Belgium. The research indicates that people who traveled to Spain and became infected with this particular variant, took it back to their home countries in their thousands, and it spread from there.

Beyond the holiday season, a false sense that rapid reopenings would lead to rapid economic gains led many governments to adopt policies that backfired.

“Europeans wanted it all,” said. Prof. Devi Sridhar of the Edinburgh University Medical School. “In Europe people are still wondering ‘Is it worth it, should we protect people or the economy?’,” she said, adding that experience shows this is a false dilemma.

Economic forecasts from Europe indicate that the small gains made during the summer months have been wiped out in the second wave, as the spike in economic activity coinciding with the summer months quickly plummeted. Overall, the E.U. economy is predicted to shrink by more than 7 percent this year.

By late October, Ms. von der Leyen, the European Commission president, acknowledged the mistakes.

“Obviously the exit strategies were partly too fast and measures were relaxed too soon,” she said.

Sleepwalking Into the Second Wave

Signs of the second wave were appearing in many European nations by mid-August, when cases, still low, began to grow at an alarming pace. But, in some cases, politics took precedent.

As cases began to spread in the Czech Republic in the second half of August, the country’s tracing system became overwhelmed, said Dr. Pavel Plevka, a virologist with Masaryk University in the city of Brno. By October, about one in three tests came back positive, he said, a big warning sign.

But life went on as normal. With elections scheduled for Oct. 3, the government carried on as if nothing had changed, and it only pushed for a lockdown after the polls closed.

A Covid-19 testing facility in Prague in October.Laetitia Vancon for The New York Times

The impact has been devastating. The Czech Republic suffered fewer than 500 deaths in the first wave of the outbreak but has recorded more than 8,000 deaths in the last three months, in a country of fewer than 11 million people. It’s one of the worst outbreaks in the world.

“I have friends who had to work night shifts because of sick coworkers, they had no vacations, they worked and worked,” said Dr. Petr Smejkal, the chief of infectious diseases and epidemiology at the Institute of Clinical and Experimental Medicine in Prague. “They saw things they’ve never seen in their lives.”

Hospitals in Central and Eastern Europe have been hit hardest in the second wave

Daily Covid-19 patients per 100,000 people

Sources: European Centre for Disease Prevention and Control; European Commission’s Joint Research Centre; National health departments. Data shown for 24 European countries that provide daily occupancy data to the ECDC.

Mixed messages, misinformation and a relaxed attitude were spreading in Central and Eastern Europe throughout the summer, experts say.

“I am glad we are less and less afraid of this virus, of this epidemic. You don’t have to be afraid of it anymore,” Mateusz Morawiecki, prime minister of Poland, said as he urged voters to July polls. “All of you, especially the elderly, don’t be afraid, let’s go and vote,” he added.

Today, Poland faces a severe second wave that is straining its hospitals to the breaking point.

Aneta Afelt, an expert in the geography of health at Warsaw University, said that the country implemented a strict lockdown before the first wave hit, and people complied. But then the messaging changed.

“Politicians were saying that the virus has weakened and the pandemic is over, and maybe it didn’t even exist. That put people in doubt, and led to a growing group of people who doubt the virus, its origins and consequences,” Ms. Afelt said.

Most hospitals in Central and Eastern Europe were spared in the spring. Fewer than 10 patients per 100,000 people were hospitalized with Covid-19 on a given day in April in the Czech Republic, Bulgaria, Hungary and Poland. But in the fall, their hospitals have become some of the worst hit.

On Nov. 30, nearly 1 in 1,000 Bulgarians was in the hospital with Covid-19, a rate higher than ever recorded elsewhere in Europe or in the United States.

Hesitant Lockdowns, and the Third Wave

Even as the second wave began wreaking havoc in multiple European countries, governments waited to push ahead with restrictions.

Second wave lockdowns were slower and softer than those in the first wave, experts note, and in many cases they have not been strictly enforced, curbing their effectiveness, even as societies suffer economic losses and disruption. A collective exhaustion with new restrictions made it harder to get widespread support and compliance.

Masked pedestrians in Brussels in September, where some stores are reopening.Dmitry Kostyukov for The New York Times

“There was a certain hesitancy to reintroduce the measures after the summer, because we all knew what they meant in terms of the economy and society,” said Bruno Ciancio, the head of disease surveillance at European Centre for Disease Prevention and Control.

“That hesitancy didn’t really pay off. When you reach the levels that you see now, you have to go back to those measures anyway, but the price you pay is very high in terms of hospitalizations and deaths,” he added.

The few countries that did move fast saw great benefits. Denmark, Finland, Iceland and Norway have kept the second wave at bay. Ireland has recorded fewer than 300 deaths since September 1, just 15 percent of its first wave total, after a tough and early second national lockdown.

How deaths in the first wave compare to the second

Peak deaths per 100,000 people Country First wave Second wave Second wave as % of first
Czech Republic 0.10 1.97 2,011%
Greece 0.05 0.93 1,950%
Croatia 0.08 1.45 1,733%
Poland 0.08 1.33 1,622%
Slovakia 0.03 0.47 1,483%
Bulgaria 0.14 1.97 1,428%
Slovenia 0.19 2.34 1,207%
Hungary 0.14 1.42 1,031%
Liechtenstein 0.38 3.01 800%
Malta 0.09 0.71 800%
Lithuania 0.08 0.58 713%
Latvia 0.06 0.35 588%
Austria 0.24 1.21 495%
Romania 0.23 0.85 367%
Iceland 0.16 0.44 275%
Portugal 0.31 0.75 241%
Cyprus 0.08 0.14 171%
Luxembourg 0.73 1.18 161%
Estonia 0.21 0.29 142%
Germany 0.33 0.41 123%
Italy 1.36 1.21 89%
Belgium 2.92 1.98 68%
France 1.64 0.93 57%
Netherlands 0.89 0.49 54%
Spain 1.91 1.00 52%
United Kingdom 1.42 0.73 52%
Denmark 0.28 0.12 43%
Sweden 1.05 0.42 40%
Norway 0.16 0.06 38%
Finland 0.25 0.05 19%
Ireland 1.45 0.14 9%

But experts fear that the makings of a third wave are already lurking in some European societies as they prepare for the holiday season.

In the United Kingdom, the authorities are temporarily relaxing measures to permit up to three families to come together, even as they advise caution. Elsewhere, like in Belgium, rules are hardly being relaxed, but stores are reopening to accommodate holiday shoppers. Authorities are also debating whether skiing resorts should reopen, in a déjà vu of the beach holiday debates.

Dr. Hodcroft in Switzerland and other experts say the ski resorts could pose a grave health risk.

“My worry is that we’ll pay for Christmas parties in January and February lockdowns,” said Professor Sridhar of Edinburgh University. “Unless we see massive behavioral change, we are going to see January and February lockdowns,” she added. “The virus doesn’t care it’s Christmas.”