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.
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.
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.
We came across Florent, a 75-year-old man in the ICU who said he wanted to speak to us. Back in March, he
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
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
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.
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.
“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.
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.
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.