Employees of Czech hospital beds maker Linet check beds to be used in the COVID-19 field hospital on Oct. 20, 2020 in the Linet factory in the village Zelevcice, 30 km 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 transmission in the country. As students typically go home on the weekend, “they then expose the infection to their parents, driving transmissions among the 40 to 60 plus age group. These are the people entering the hospitals,” he says.
Jan Pačes, a virologist from the Czech Academy of Sciences, notes that cases in the Czech Republic began to soar shortly after schools were reopened on Sept. 1. “The rise in new infections in September were reported mostly among young people, and now it has reached higher ages,” he says. Within the first two weeks of reopening, 144 out of the country’s approximately 11,000 schools (kindergartens, elementary, secondary, and higher vocational schools) reported cases of coronavirus, according to official data cited in Kafkadesk. An estimated 30% of new infections were caught from people mixing in their homes, according to Pačes.
What happens when you don’t listen to health experts
Experts also say the governments did not heed advice from public health officials about the need to reintroduce restrictions when the number of cases were rising at the end of summer and in early autumn.
Olga Loblova, a Prague-based sociology research associate at the University of Cambridge, said the Czech government dismissed advice from public health experts at the end of summer, a move “that is now proving inadequate.” At the end of August, as new infections began to rise, Prime Minister Andrej Babis overruled a decision by then-Czech Health Minister Adam Vojtech that would have made the wearing of face masks mandatory in public places and schools. Babis later admitted that ignoring the advice may have been a mistake, during a press conference on Sept. 21; the country recorded 1,474 new cases that day.
Vaces says the Czech senate elections, the first round of which were on Oct. 2 and 3, and the second on Oct. 9 and 10, may have led the government to postpone new measures, noting that strict measures were introduced after citizens cast their votes. On Oct. 12, the authorities banned events bringing together more than 10 people indoors and 20 people outdoors were banned, and ordered high schools and universities to switch to online learning. Pubs, bars and restaurants were closed and gatherings were limited to six people on Oct 14. A week later, Babis reintroduced the strict face mask mandate that had been in place in the spring, requiring everyone to wear masks outside of their homes. “These measures should have been introduced earlier. There is now too much of the virus around to use the same methods that we used in the spring,” says Vaces.
In Belgium, some public health experts opposed the government’s decision to ease coronavirus prevention measures, including no longer mandating masks in most outdoor places from Sept. 23, when the country reported 1,661 new confirmed cases. “The most surprising” decision, says Van Damme, “offered everyone the possibility to have close contact with five other people, and these five can change every other month. That was really the wrong relaxation.” In addition, on Oct. 1, the government reduced the period of time people were required to quarantine if they were potentially exposed to the virus or have tested positive from two weeks to one.
Implementing adequate testing and tracing systems before lifting restrictions was crucial to helping stop the spread of coronavirus. “That’s basically the answer. But only a few countries have done this, like Finland, Taiwan and South Korea,” says Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine. Creating an effective test and trace system has been a struggle for some countries in Europe, including Belgium and the Czech Republic.
In the Czech Republic, only one in five users who test positive self-report their status on the contact tracing app eRouška (“eFacemask”), the government’s chief hygienist, Jarmila Rážová said on Oct. 16, according to local media. (The chief hygienist declares and implements measures to protect public health). The Minister of Health said that 6 million people would need to download the app for maximum effectiveness, but so far only 1.2 million people are users, according to local media on Oct. 16.
The Czech Republic’s contact tracers—local groups of people who get in touch with those who may have been exposed to an infected individual—have been overwhelmed by the spike in cases. For example, Prague’s chief hygienist Zdeňka Jágrová, who oversees local public health measures, told reporters on Sep. 4 that contact tracers working for the city—the country’s most populous metro area—have been unable to track all the contacts.
Belgium’s team of 2,000 contact tracers likewise have been unable to keep up with its rise in new infections. In mid-September, local media reported that the staff had only contacted half of the people who tested positive in the capital of Brussels. The government recently brought in a track-and-trace app, “Coronalert,” so far downloaded by more than 1.6 million people in a population of 11.5 million, to bolster contract tracers’ efforts.
The efforts to reverse course
Like many other European countries, both Belgium and the Czech Republic are now taking restrictive measures to stem the spread of the virus and prevent their healthcare systems from being overwhelmed. In addition to closing bars, cafes and restaurants, and banning cultural events in some areas, Belgium has suspended all non-urgent surgeries for a month to free up hospital capacity for coronavirus patients.
The Czech Republic ordered bars and restaurants to close, and most schools to move to remote learning from Oct. 14, and is closing non-essential stores from Oct. 22. The country is building capacity to care for a massive rise in COVID-19 patients; hospitals are cutting other types of care, while the government has started building a makeshift hospital in the capital Prague and has made preliminary agreements with bordering Germany that their hospitals will take Czech patients. The government said that it might impose a full lockdown in two weeks depending on the results of the current restrictions.
However, it may be too late to avoid a catastrophic second wave. Lockdowns at this stage are, says McKee, an “indication of policy failure, of not having driven the numbers down enough in the first wave and not putting in place a well-functioning test and trace system.”