Offline: Europe and COVID-19—struggling with tragedy

Abstract

The Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, USA, publishes weekly reports on progress to control the COVID-19 pandemic in Europe. They make grim reading. The latest iteration, dated Nov 19, predicts that daily deaths from COVID-19 will continue to rise in the coming weeks, reaching a peak of over 7000 deaths per day around mid-January. Hospitals will be stretched to breaking point from December through to the end of February. COVID-19 is currently the second leading cause of death in the region—29 858 weekly deaths (ischaemic heart disease killed 44 253 people across Europe during the same period). The effective reproduction number, R, remains above 1 in most countries. There is still a large susceptible population—IHME estimates that only 7% of Europeans have been infected with the coronavirus so far. European publics remain resistant to public health advice. Mask use is less than 50% in Sweden, Norway, Denmark, Finland, the Netherlands, Belarus, Bulgaria, Croatia, and Latvia. Europe is struggling with tragedy. But the crisis Europe faces is not only about health—it is about politics too. There is a sense of desperation among political leaders. One example: Belgium. This country is the headquarters to the EU and North Atlantic Treaty Organization. It is the symbolic heart of Europe. But of equal symbolic significance, Belgium has now risen to the top of the Johns Hopkins Coronavirus Resource Center's mortality league table. The country has suffered 133 deaths from COVID-19 per 100 000 population (for comparison, the US figure is 77). This ruinous situation has plunged Belgian politicians into despair. Belgium's parliament has established a Special Commission to examine the origins of the pandemic and to understand better how to manage it. I took part in one evidence session they held last week. A dozen or so politicians met virtually and raised questions that uncovered fear and bewilderment about how they have reached this point of breakdown. “What do you think European countries should do to prepare for the next pandemic?” “Do you consider that the reaction by the WHO and the recommendations that it disseminated during the initial months of the crisis were sufficient and appropriate?” “Could the alarm have been raised earlier?” “Was there a tendency to play down the epidemiological situation?” This urgent search for answers led parliamentarians to look for someone to blame. “Did European leaders overestimate or underestimate the outbreak of this virus?” “In your opinion, where and when did things go wrong in Belgium?” The first case of COVID-19 in Belgium was reported on Feb 4 and the first death took place on March 11. A lockdown was instituted on March 18 and lasted until May 4. The virus surged back. A second lockdown was imposed on Nov 2 and will last at least until Dec 13. Clues to explain the high mortality in Belgium are evident. Political chaos as competing party factions sought power. A breakdown in trust between government and the people. Poor coordination between regions. But the responsibility does not only lie at the national level. I voted against Brexit. I hope that one day a new generation of more internationalist political leaders will inspire public support for rejoining the EU. In solidarity, therefore, we should ask: when facing the greatest peacetime threat in its history, why didn't the EU do more to ensure collaboration, learning, and collective action among countries? The European Centre for Disease Prevention and Control (ECDC), based in Stockholm, Sweden, is the agency dedicated to supporting national governments on health issues. COVID-19 tested its competence. And, sad to say, the ECDC stumbled. It was unable to coordinate country action. It could not convene national leaders to synchronise responses. It was too silent, too invisible, and too weak. When it did speak, it was ignored. The scenarios set out by IHME are not without hope. The rate of rise of new cases across Europe is slowing. Expanding mask use from the current average of 67% to 95% could avert 221 000 deaths by March 1, 2021. Improvements in clinical care have reduced infection fatality rates by 30%. But the coming winter will be hard. Those dark nights will leave ample time for European leaders to reflect on the gap between the ideal of Europe and its reality.