Europe’s hospitals could soon hit capacity with covid-19 patients

Germany, Europe’s best-resourced nation, risks being swamped even after increasing its intensive care beds by a quarter over the summer. Belgium, which had doubled its intensive care capacity, is now preparing for decisions about which needy patient should get a bed.

“This huge capacity we’ve built gave a false impression of security. It gave a higher buffer, but ultimately it only represents a week when you’re in an exponential phase,” said Emmanuel André, a leading Belgian virologist who has advised the government on the pandemic — and has bitterly criticized leaders for acting too slowly this fall.

In retrospect, the warning signs could be seen as early as July, when cases in Europe started ticking up again after the relaxation of spring lockdowns. In absolute terms, the numbers were still tiny. Spanish emergency room doctors enjoyed a respite, after being hammered in March and April. Italian nurses headed to the beach. Central European leaders — among the worst hit now, but back then largely untouched — gathered at the end of August for a triumphant conference to discuss the post-pandemic era.

But the math for exponential growth is as simple as it is scary. When two coronavirus cases double to four, and four cases double to eight, it doesn’t take long for the numbers to reach the tens of thousands — and beyond.

“An exponential phenomenon starts with very small numbers, and it is not tangible for weeks and weeks and weeks for people out there,” André said. “If you look at the numbers, you have very strong indicators early on that things are going wrong, but it is only at the very end that things explode.”

Europe is now feeling the explosion.

The continent reported 1.5 million cases over the past week, the highest yet during the pandemic, the World Health Organization’s Europe director, Hans Kluge, told an emergency meeting of health ministers on Thursday. Deaths rose by a third in seven days. Occupancy of intensive care units doubled in 17 days leading up to Oct. 25 in countries tracked by the European Center for Disease Prevention and Control.

“Europe is at the epicenter of this pandemic once again,” Kluge said.

A week ago, French intensive care beds were half full. Now, they are more than two-thirds occupied, with more than 3,100 covid-19 patients. When President Emmanuel Macron on Wednesday announced a second national lockdown — something he and other European leaders have sought mightily to avoid — he warned that “at this stage, we know that whatever we do, nearly 9,000 patients will be in intensive care by mid-November, which is almost the entirety of French capacities.”

Top public health leaders echoed his dire message.

“We are going to have two to three extremely difficult weeks for the health-care system,” Jean-François Delfraissy, the head of the scientific council that advises the French government on the pandemic, told France Inter radio on Thursday. “We can’t allow it to crack. We are in a worse situation than in the beginning

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On the front lines of Europe’s surging 2nd COVID crisis: Reporter’s Notebook

I’ve just left the intensive care unit of a hospital in Liege, Belgium. It’s impossible to know of course, but this is quite possibly the epicenter of Europe’s new coronavirus crisis.



a person standing in front of a refrigerator: A health worker standing in an intensive care unit treats a patient suffering from the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
A health worker standing in an intensive care unit treats a patient suffering from the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.

The city of about 200,000 residents nestled in eastern Belgium is at around a 41% infection rate, and the hospital is at full capacity. Intensive care unit numbers have tripled in three weeks. Belgium, which had 100 to 200 cases per day throughout June and early July, is now marking north of 10,000. On Oct. 25, it set a daily record with 17,709.

We stood outside one room — which patients are now forced to share due to overcrowding — to hear the groans of an elderly man who was just admitted. As doctors and nurses attended to him another ambulance swept up outside the window with another case.

MORE: Europe struggling with 2nd surge of COVID-19 case, and it may be worse than the 1st

The doctor guiding us on a tour admitted a chilling fact: health workers here (including himself) are now treating patients knowing they themselves have COVID-19.



a group of people standing in a room: Health workers take care of patients suffering from the coronavirus disease in a recovery room of an operating theatre transformed for COVID-19 patients, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
Health workers take care of patients suffering from the coronavirus disease in a recovery room of an operating theatre transformed for COVID-19 patients, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.



a person taking a selfie in a room: A health worker looks on in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
A health worker looks on in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.

Gallery: These States Just Broke Grim COVID Records (ETNT Health)

It’s an ethical dilemma, but not a choice this doctor could make. He now tests negative, but he said if he and others like him do not continue working, the health system here would go under. The toll on health workers, already exhausted from the first wave, about to be exacerbated by the second.

Why is it so bad? COVID fatigue, he says. Belgium relaxed the measures that had kept the country safe and now are going to pay a price. Lots of testing, yes. But not so much tracing.

MORE: Further restrictions, curfews imposed in Europe as continent fights ‘second wave’ of coronavirus cases

But they have learned some important lessons from the first wave.



A health worker picks up utensils in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
A health worker picks up utensils in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.



a close up of a woman: A woman takes part in a demonstration at the hospital MontLegia, in Liege, gathering employees, and called by the Belgian trade union National Center of Employees, on Oct. 29, 2020 as the country faces a second wave of infections from COVID-19.


© John Thys/AFP via Getty Images
A woman takes part in a demonstration at the hospital MontLegia, in Liege, gathering employees, and called by the Belgian trade union National Center of Employees, on Oct. 29, 2020 as the country faces a second wave of infections from COVID-19.

We came across Florent, a 75-year-old man in the ICU who said

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Europe’s Second Wave of COVID-19 is Being Driven by Two Countries. Here’s Why

covid prague
covid prague

Employees of Czech hospital beds maker Linet check beds to be used in the Covid-19 field hospital on October 20, 2020 in the Linet factory in the village Zelevcice, 30km south-east of Prague. Credit – Michal Cizep/AFP—Getty Images

Europe is clearly in the grip of a second wave of the coronavirus pandemic. In the past week, countries throughout Europe—including Belgium, Croatia, the Czech Republic, France, Germany, Hungary, Poland, Portugal, Slovakia, the U.K, and Ukraine—have all recorded their highest daily caseloads since the pandemic started.

But two of these stand out. As of Oct. 25, Belgium and the Czech Republic are currently reporting about 146 and 115 new daily cases per 100,000 people, respectively, according to TIME’s coronavirus tracker, which compiles data from Johns Hopkins University. That’s dramatically higher than the E.U. average of 33 per 100,000.

The Czech Republic hit a new daily record of 15,258 new infections on Oct. 23; a day later, Belgium set its own record with 17,709 new daily cases. Belgium is now the epicenter of the E.U’s second wave, with the continent’s highest per-capita case rate (besides tiny Andorra). The country also has the world’s third highest number of COVID-19-related deaths per capita after Peru and tiny San Marino.

Experts speaking to TIME say they can’t point to anything specific that has made the Czech Republic or Belgium unique among E.U. states in their handling of the pandemic, instead attributing the rise in cases to a combination of factors, and the relatively arbitrary nature by which a virus spreads through populations.

Increased testing doesn’t fully explain the rise in case numbers

Marc Van Ranst, a virologist from the University of Leuven in Belgium, says the rise in cases can be partly explained by the increase in testing in his country. The number of daily tests has increased from about two out per 1,000 people each day in September to nearly six in recent days.

Testing has also increased in the Czech Republic over the same period, from about one per 1,000 people to around 3.5.

However, that cannot entirely account for the overall rise in cases, because the positivity rate—the share of tests that come back positive—rose in Belgium from around 2% in mid-September to over 18% in late October.

In the Czech Republic, that number soared from around 4% in to nearly 30% in the same period.

Population density may be a factor

Another potential factor for the situations in Belgium and the Czech Republic is their relatively high population densities. “You have to look at Belgium as one big city,” says Ranst. “That’s why in Brussels, where the population density is particularly high, the problem is acute.” For every square kilometer of land in Belgium there are 377 people; in the Czech Republic that number is 137. Compare those to the E.U. average of 112.

Pierre Van Damme, an epidemiologist in Belgium, said the reopening of universities at the end of September, in particular, has been a driver of

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How Europe’s Fight Against Covid-19 Went Awry Over the Summer

In the battle against Covid-19, Europe is looking back at a summer of squandered opportunities.

With the virus suppressed following months of intensive social restrictions last spring, European leaders quickly moved to accelerate the reopening of society to try to spur an economic recovery. But pockets of infection persisted, and few countries had put in place adequate systems to track and lock down local outbreaks. Making matters worse, in several regions infection rates never fell to a level where such systems could work effectively.

The result: A second wave of infections washing across the continent that is proving difficult to manage and poses the risk that Europe will have to live with high infection rates well into next year.

“People assumed the situation was under control but it wasn’t,” said Rafael Bengoa, the co-director of the Institute for Health and Strategy in Bilbao, Spain. “The fire was out but the embers weren’t.”

European nations are trying to strike a middle path, neither fully repressing the virus nor fully opening up their economies, a vast experiment in how to manage a pandemic without infringing too extensively on civil liberties or destroying livelihoods.

Most are now experimenting with localized restrictions in virus hot spots. But the balancing act is set to be sorely tested as public compliance with rules frays and the death toll again climbs. Already some leaders are abandoning the lighter-touch strategy. Ireland’s government recently announced a six-week lockdown.

“It is just very difficult,” said Lawrence Freedman, a professor at King’s College London. “People talk as if there is an obvious policy to follow but there isn’t.”

The race to return to a form of normality fanned the virus. Across the continent universities welcomed back students, the U.K. government subsidized millions of restaurant meals to get people to eat out, newly reopened borders saw tourists flock to night clubs in Spain and beaches in France. With the virus out of sight, people’s behavior relaxed.

“Authorities prioritized the economy over health, thinking that during the summer nothing would happen,” said Saúl Ares, researcher at the National Center for Biotechnology of Spain’s National Research Council.

Today that has left leaders with little option but to reimpose restrictions to slow the virus’s spread. A state of emergency has been declared in France and Spain. Paris is under nightly curfew and Madrid is locked down. People living in Wales are advised to leave the house only for exercise. Face masks have been made compulsory in Italy, even outdoors. Though these restrictions aren’t yet as stringent as the total closures seen earlier this year, they are likely to both dent economic growth and test the morale of populations in the winter months, experts say.

On the whole, European countries are in a better place to handle the pandemic than in March. Testing capacity has vastly expanded and hospitals are better able to treat the sick. Europeans are now accustomed to social distancing and wearing masks in public.

But even Italy, traumatized after the north of

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‘Trench Warfare’ In Liege, Europe’s New Virus Front

Shell-shocked hospital staff, some of whom have tested positive for the coronavirus, are fighting a losing battle in the Belgian city of Liege against Europe’s second wave of Covid-19.

It is the second time that Belgium, a small EU country of 11.5 million people, has ended up as one of the hardest hit by the global pandemic. It has already seen more than 270,000 cases and 10,500 deaths.

And, according to the latest data, Brussels and Wallonia, the French-speaking region of which Liege is a major city, are now the epicentres of Europe’s renewed crisis.

Belgium is experiencing one of the worst second waves of the coronavirus pandemic in the world Belgium is experiencing one of the worst second waves of the coronavirus pandemic in the world Photo: AFP / Kenzo TRIBOUILLARD

This repeat performance brings a quiet rage to those on the front lines in the medieval city’s overwhelmed university hospital CHU Liege.

His hair unkept and eyes weary, Benoit Misset, head of the intensive care unit, weighs each word as he explains the daily onslaught from the silent virus threat.

Everyone fears that Liege will become the next Bergamo, the Italian city where scenes of overcome hospitals heralded a pandemic that was about to engulf Europe  Everyone fears that Liege will become the next Bergamo, the Italian city where scenes of overcome hospitals heralded a pandemic that was about to engulf Europe  Photo: AFP / Kenzo TRIBOUILLARD

“We’re losing. We’re overwhelmed. We’re bitter… because we’ve known this was coming for two months and the decisions weren’t taken in time,” he told AFP.

The hallway of his Covid unit is filled with staff and patients, and rooms are crowding even more quickly than in the first explosion of cases that ran from March until May.

“On Wednesday, we almost reached the number of cases we saw in the first wave,” says Christelle Meuris, an infection specialist and head of the unit.

“We’re afraid that the latest measures will not be enough to flatten the curve. We can see a tsunami coming,” said the doctor, whose unit now has 18 virus patients in its 26 beds.

Two days ago, Liege's university hospital began transferring patients to other Belgian provinces and to Germany  Two days ago, Liege’s university hospital began transferring patients to other Belgian provinces and to Germany  Photo: AFP / Kenzo TRIBOUILLARD

She said she fears that soon each room will have to take two patients, a complicated situation for a virus this contagious.

Everyone is worried that Liege, just a short drive from Germany or the Netherlands, will become the next Bergamo, the Italian city where scenes of overcome hospitals heralded a pandemic that was about to engulf Europe.

About 20 percent of current staff are unable to come to work About 20 percent of current staff are unable to come to work Photo: AFP / Kenzo TRIBOUILLARD

Before entering a patient’s room, Hendrika Abourou, a double-masked nurse’s aide, laces on three overblouses and squeezes her hands into two pairs of gloves, not forgetting her protective glasses.

“Each gesture is calculated. To move the patient, wash him, throw his sheet in a specific bag… We have to think all the time, pay attention to everything,” she explained.

Many of her colleagues did not make it beyond the first wave, giving up hospital work altogether. About 20 percent of current staff are unable to come to work.

“The shortage

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Where Europe’s Second Wave of Covid-19 Is Filling Up Hospitals






Cases per 100,000

in the last 14 days

Belgium has postponed

all non-essential hospital

work to deal with the influx

of new Covid-19 patients.

About a fifth of

Spain’s ICU beds are

already occupied by

Covid-19 patients.

Cases are rising faster in

the Czech Republic than

anywhere else in Europe.

Physicians there fear a

shortage of medical staff.

Belgium has postponed

all non-essential hospital

work to deal with the influx

of new Covid-19 patients.

Cases per 100,000

in the last 14 days

About a fifth of

Spain’s ICU beds are

already occupied by

Covid-19 patients.

Cases are rising faster in

the Czech Republic than

anywhere else in Europe.

Physicians there fear a

shortage of medical staff.

Cases per 100,000

in the last 14 days

Belgium has postponed

all non-essential hospital

work to deal with the influx

of new Covid-19 patients.

Cases are rising faster in

the Czech Republic than

anywhere else in Europe.

Physicians there fear a

shortage of medical staff.

About a fifth of

Spain’s ICU beds are

already occupied by

Covid-19 patients.

Belgium has postponed

all non-essential hospital

work to deal with the influx

of new Covid-19 patients.

Cases per 100,000

in the last 14 days

Cases are rising faster in

the Czech Republic than

anywhere else in Europe.

Physicians there fear a

shortage of medical staff.

About a fifth of

Spain’s ICU beds are

already occupied by

Covid-19 patients.


Source: European Centre for Disease Prevention and Control, New York Times database of cases

LONDON — Poland has turned its largest stadium into an emergency field hospital. The numbers of Covid-19 patients in Belgium and Britain have doubled in two weeks. And doctors and nurses in the Czech Republic are falling ill at an alarming rate.

As new cases of the virus began to increase again across Europe last month, hospitals were initially spared the mass influx of patients they weathered earlier this spring. Some suggested that the virus had become less deadly, or that older, more vulnerable people would be shielded.

But a second wave of serious illness is here, new data released on Thursday shows, making it clear that the pandemic is still dangerous and that adherence to control measures over the next few weeks will be crucial in preventing hospitals from becoming overrun for a second time this year.


Where People Are Sick From the Coronavirus

Country

Patients in hospital per 100,000

Spring peak

% of spring peak

Czech Republic

35

4

882%

Spain

29

Belgium

22

50

43%

Bulgaria

21

6

381%

Poland

21

9

230%

Hungary

18

7

249%

France

16

48

34%

21 European countries

14

31

45%

Italy

13

55

24%

Slovenia

13

6

226%

Croatia

12

9

136%

Slovakia

12

4

285%

United States

11

18

61%

Portugal

11

13

83%

United Kingdom

10

30

33%

Austria

8

12

68%

Ireland

6

18

31%

Luxembourg

5

35

15%

Latvia

4

2

163%

Estonia

3

12

23%

Denmark

2

9

23%

Finland

1

4

23%

Norway

1

6

10%

Iceland

0.3

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