Not out of the woods: COVID cases rising in Western Europe

Santa won't be getting his traditional welcome in the Dutch city of Utrecht this year. The ceremonial head of Carnival celebrations in Germany's Cologne had to bow out because he tested positive for COVID-19. And Austria is planning a lockdown on unvaccinated people in two hard-hit regions.

Nearly two years into a global health crisis that has killed more than 5 million people, infections are again sweeping across parts of Western Europe, a region with relatively high vaccination rates and good health care systems but where lockdown measures are largely a thing of the past.

The World Health Organization said coronavirus deaths rose by 10% in Europe in the past week, and an agency official declared last week that the continent was "back at the epicenter of the pandemic." Much of that is being driven by spiraling outbreaks in Russia and Eastern Europe—where vaccination rates tend to be low—but countries in the west such as Germany and Britain recorded some of the highest new case tolls in the world.

While nations in Western Europe all have vaccination rates over 60%—and some like Portugal and Spain are much higher—that still leaves a significant portion of their populations without protection.

Dr. Bharat Pankhania, senior clinical lecturer at Exeter University College of Medicine and Health, says that the large number of unvaccinated people combined with a widespread post-lockdown resumption of socializing and a slight decline in immunity for people who got their shots months ago is driving up the pace of infections.

Thanks largely to vaccination, hospitals in Western Europe are not under the same pressure they were earlier in the pandemic, but many are still straining to handle rising numbers of COVID patients while also attempting to clear backlogs of tests and surgeries with exhausted or sick staff. Even the countries experiencing the most serious outbreaks in the region recorded far fewer deaths per person over the past four weeks than the United States did, according to data from Johns Hopkins University.

The question now is if countries can tamp down this latest upswing without resorting to stringent shutdowns that devastated economies, disrupted education and weighed on mental health. Experts say probably—but authorities can't avoid all restrictions and must boost vaccination rates.

"I think the era of locking people up in their homes is over because we now have tools to control COVID—the testing, vaccines and therapeutics," said Devi Sridhar, chair of global public health at the University of Edinburgh. "So I hope people will do the things they have to do, like put on a mask."

Many European countries now use COVID passes—proof of full vaccination, recovery from the virus or a negative test result—to access venues like bars and restaurants. Pankhania warned that the passes can give a false sense of security since fully vaccinated people can still get infected—though their chances of dying or getting seriously sick are dramatically lower.

But restrictions don't go much further these days, although the Dutch government is reportedly planning a partial lockdown and German lawmakers are mulling legislation that would pave the way for new measures. Austrian Chancellor Alexander Schallenberg announced Friday that unvaccinated people in two regions will only be able to leave home for specified reasons starting Monday, and he is considering implementing similar measures nationwide. But he has said he doesn't want to impose the restrictions on those who got the shot.

Austria is seeing one of the most serious outbreaks in Western Europe, along with Germany, which has reported a string of record-high infections in recent days.

"We have a real emergency situation right now," said Christian Drosten, the head of virology at Berlin's Charite Hospital, which has started canceling scheduled surgeries.

Duesseldorf's university hospital said earlier this week that its ICU is full, though many facilities are struggling more with staff shortages than bed space.

Drosten said Germany must increase its vaccination rate of 67% further—and fast. But officials have balked at ordering vaccine mandates and want to avoid any blanket lockdowns.

Health Minister Jens Spahn indicated that Germany could improve its often lax enforcement of COVID pass requirements.

"If my vaccination certificate is checked more often in one day in Rome than it sometimes is in four weeks in Germany, then I think more can be done," Spahn said recently.

The Netherlands is in a similar bind: The country announced the highest daily tally of new cases since the pandemic began Thursday, hospitals are warning the situation could get worse, but officials are reluctant to clamp down too hard. Amid these concerns, organizers in Utrecht said they couldn't in good conscience bring tens of thousands of people together to greet Santa at the annual Sinterklaas party beloved of children.

Cities in Germany, by contrast, went ahead with outdoor Carnival celebrations this week—but the head of Cologne's party, Carnival Prince Sven I., canceled public appearances after testing positive.

In the United Kingdom, which lifted remaining restrictions in July and has seen big spikes as well as dips in cases since, Prime Minister Boris Johnson insists the country can "live with the virus." The government will only reimpose restrictions if the health service comes under "unsustainable" pressure, he says.

Spain, once one of Europe's hardest hit nations, perhaps offers an example of how the risks can be managed.

It has vaccinated 80% of its population, and while face masks are no longer mandatory outdoors, many people still wear them. While infections have ticked up slightly recently, Rafael Bengoa, one of Spain's leading public health experts, said that given the high vaccination rate, "the virus won't be able to dominate us again."

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Several countries are hoping that pushing harder on immunizations will get them there. Germany plans to re-open vaccination centers across the country to speed booster shots. France is also pinning its hopes on booster doses while urging holdouts to get their first shots. Italy is also expanding its booster program as numbers edge higher.

Pankhania says that no single measure will control the pandemic.

"To really control it, it has to be multi-layered ... avoid crowds, avoid poorly ventilated places, be immunized, wear your mask," he said.

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