Analysis: As Europe sees new daily cases of Covid-19 reach more than six times their March/April high, the limits of living with Covid-19 are becoming evident, Marc Daalder reports
A massive and sudden surge in Covid-19 cases in Europe has forced much of the continent back into lockdown.
On Thursday morning, New Zealand time, both Germany and France announced new restrictions. Germany will close all bars, restaurants, cinemas and other recreational workplaces for the month of November, while France is reentering lockdown – although with plans to leave schools and some offices open.
For Europe more broadly, the World Health Organisation says the continent makes up more than half of last week’s cases and has seen deaths increase by a third over the past seven days.
The significant resurgence of Covid-19 amidst wealthy countries that have had months to prepare for it shows the inherent limits of living with and managing low levels of the virus in the community.
“The experience in those countries really confirms what our assessment has been right from the beginning: It is something of a binary process, our relationship with the pandemic,” Michael Baker, a professor of public health at the University of Otago, Wellington, and one of the architects of the elimination strategy, told Newsroom.
“The middle ground is not particularly viable or sustainable. That’s why people like myself have really advocated for elimination as a much more sensible approach, because everything else is mitigation. You’ve either got a control approach or elimination.”
Baker cautioned against reading too much into case numbers when compared with earlier in the pandemic. Although Europe has reported a record high of 238,000 daily new cases – more than six times as many as the peak number of cases in the first wave – an April 4 high mark of 37,800 – testing capabilities across the continent have become far more robust in recent months.
Germany, for example, averages three times as many tests today as at the peak of the earlier outbreak. Nonetheless, it is clear that a serious wave of infections is occurring.
Looking at testing numbers alone, the positivity rate – or percentage of tests that come back positive – is beginning to rise in European nations. In Germany, one in 33 tests come back positive. In France, Spain and Italy, one in 10 do. In Belgium, a fifth of Covid-19 tests return a positive result, despite Belgium conducting more tests per capita than all but 12 other countries.
Look too towards hospitalisations and the evidence of a severe outbreak becomes apparent. In the United Kingdom, some 10,000 people are in hospital with Covid-19, including 900 on ventilators. Already, half of France’s ICUs are occupied by patients with Covid-19 and the country’s president Emmanuel Macron said ICUs will reach capacity by mid-November.
Deaths are also beginning to creep upwards. Europe reported 1700 new deaths on Tuesday – the highest since May 9. Although deaths tend to lag behind case numbers, there are also signs that this latest wave of infection could be less lethal because countries have done a better job of protecting vulnerable populations, particularly rest homes.
“You can minimise the harm by putting a lot of effort into protecting vulnerable groups. But there’s a price for that in terms of the quality of life they have. To keep the virus out of aged care facilities might mean not seeing their family and friends for a long period,” Baker said.
Elimination, suppression, herd immunity?
Nonetheless, the return of Covid-19 to Europe shows the flaw in the suppression approach undertaken by the continent. In the lead-up to global lockdowns in March, a groundbreaking paper from the Imperial College London found that regular lockdowns would be needed to suppress the virus and prevent mass death.
The alternative, a mitigation approach which relied on public health tools like social distancing, testing and tracing would lead to a quarter of a million deaths in the United Kingdom and 1.1 million in the United States.
Countries the world over – including New Zealand – quickly pivoted to a suppression approach, locking down and severely depressing virus numbers. Those that acted quickly enough in the timeline of their own outbreaks, and went hard enough, were able to essentially eliminate the virus. Most of the rest at least went hard enough to reduce the virus to a very low prevalence in the community.
As the northern hemisphere moved to summer, many countries decided to pivot back towards mitigation, hopeful that beefed up contact tracing and testing systems, as well as widespread mask-wearing, would be sufficient to avoid a resurgence without having to return to lockdown.
Yet, even in the countries with the most robust public health systems, that approach appears to have failed. Germany famously contact traced its original outbreak and identified a single salt shaker as the likely culprit for early transmission. Nonetheless, its system clearly hasn’t been up to the task of fighting off a major resurgence.
“I think it’s become more obvious over time that countries that have got far more technological resources and infrastructure than New Zealand have not been able to control it in a sustainable way. In the Asia and Pacific region, countries you’d think would be really struggling, that have had this goal of elimination, have done much better,” Baker said.
For him, there are three viable options. Those with the opportunity to eliminate should continue to do so. Those without can decide between on-again off-again lockdowns in a bid to suppress the virus – and resulting deaths – or laxer restrictions and the mass death that accompanies it.
The notion that letting Covid-19 rip through a community could be a shortcut to herd immunity has been thoroughly debunked. In recent days, Sweden’s chief epidemiologist Anders Tegnell, often championed by herd immunity advocates as an ally to their cause, told a German newspaper the strategy is immoral.
“Striving for herd immunity is neither ethical nor otherwise justifiable,” he told Die Zeit.
“In addition, there has been no infectious disease in history in which herd immunity has completely stopped transmission without a vaccination beforehand. And that won’t happen with Covid-19 either.”