Indian Council of World Affairs

As the European Union (EU) continues to build a roadmap to recovery, several measures have already been taken at the national level to meet the challenges presented by the pandemic. This paper attempts an overview of responses. It will identify the reasons why certain countries have faltered in their response, while their counterparts have fared better. While analyzing the response of the European countries, the paper tries to answer four main questions - a) what went wrong in many countries?; b) what some countries did right?; c) can herd immunity be an answer for the pandemic?; and d) is there a comprehensive approach towards the lifting of lock-down in Europe?

What went wrong?

From an analytical point of view, there are four main reasons why many of the European countries buckled under the pressure of the coronavirus pandemic.

First was the slow response of the certain governments’. This was visible in Spain, Italy, the UK, and France which registered the maximum number of cases in Europe. In all these countries, the governments under-estimated how quickly the virus could spread. For example, the first trigger of the spread of the virus for Spain was a football match on 19 February 2020 in Milan, Italy which was attended by almost 2500 persons.This region emerged as a key hotspot that escalated the number of infections in the Lombardy region. This was further aggravated when 3000 people flew to Liverpool for another football match on 11 March 2020. The second trigger was the Women’s Day parade in Madrid which was attended by over 120,000 women. Between the last week of February and mid-March, Spain had already reached the stage of community transmission. Similarly in the UK, in the initial stages of pandemic, the Johnson government did not take proactive measures to contain the virus spread. The lack of decision making and urgent response by the government led to an exponential rise of confirmed cases and a critical shortage of medical equipment. The government also did not adhere to the WHO advisory and decided to stop tracing and testing contacts of virus-infected patients.

Second was the non-cooperation from people in initial stages. The lack of public support in the initial stages aggravated the crisis. It was only after dissemination of information and with the measures getting stricter that movement of people was curtailed^[i].The initial measures taken by the Italian government on 7 March 2020 to lock-down the Northern Italian regions led to an exodus of people from North to South to avoid limits on movement. This resulted in the rapid spread of the virus. Further, instead of taking a systemic approach towards the crisis, the Italian government issued a series of measures and decrees incrementally increasing the restrictions, which were then implemented in the entire country.

Third reason was the older demography. As Italy has the second oldest population in the world, the number of death reported is also higher. The demography of the country is in favour of older population with 23% of the population over the age of 65. The country is facing above-average mortality rate at 4% due to the virus primarily because the average age of coronavirus patients who have died is 81.^[ii] In other countries, there was under-reporting of deaths from old-age care homes which were ill-equipped to manage the pandemic resulting in higher fatality numbers. In Spain, its elderly care system came under severe pressure as it was unprepared and understaffed. With reports of older people found abandoned or dead, the government had to send in the Army to run and disinfect these care homes. The older people represent almost 24% of the total deaths due to coronavirus complications here.^[iii] Similarly in France, the government came under criticism regarding the number of fatalities in the old-age care homes. According to official data, “at least 9973 people have died from COVID-19 in the country's nursing homes since early March”^[iv]. Although the government has “launched screening tests for the vulnerable people, putting priority on the elderly, the disabled, the most vulnerable and professionals who accompany them, in establishments and at home”^[v], it has been called too little, too late. The UK government was also under criticism due to reports that it was under-reporting deaths. There are reports that the number of deaths reported could be almost 15% higher. This is because of “a combination of delayed reporting of deaths, and the fact that those who died in nursing homes and private residences are not included in official figures”.^[vi]

Fourth was the fragility of the health-care sectors. This was visible all across Europe as many countries were caught off-guard at the speed of the spread of the virus. As the governments failed to place measures at the earliest, they also failed to perceive that their health-care systems were at risk of becoming overwhelmed. In the initial phases, the governments were unable to build rapid tracing and testing networks, stockpile the PPE, medical supplies and equipment – which proved to be a critical failure to bolster the health-care system. Their unpreparedness further led to diffused reactions such as stopping the export of medical equipment, followed by shutting of borders and disrupting trade. For example, the decision to stop the exports of face masks by Germany^[vii] had caused outrage in Austria and Switzerland. This was further exacerbated as several member states put restrictions on the exports of medical equipment, in violation of the EU single market. Although, EC President Ursula von der Leyen appealed to the member states to share medical supplies, so far no country has responded comprehensively^[viii].

What some countries did right?

While the entire European continent presents a bleak picture in terms of confirmed cases and death, a few countries took proactive measures to mitigate the impact of the virus. Their policy frameworks were formulated based on their respective strengths and weaknesses. One country that stands out for its approach in fighting the pandemic is Germany. The decision of the government to perform aggressive testing and tracing limited the number of unreported cases as compared to other countries.^[ix] Germany implemented strict measures to tackle the crisis and was the first country to develop COVID-19 tests. Their private sector companies moved quickly to mass manufacture the test kits which helped the authorities to conduct widespread testing.One major difference between Germany and other countries’ is that the healthcare sector in Germany tested people with even mild symptoms so that they could be effectively quarantined. The country plans to conduct almost 500,000 tests per week and “Germany's federal institute for vaccines said it has given the go-ahead for clinical testing of a potential COVID-19 vaccine developed by the Mainz-based company Biontech.”^[x] This has been supplemented by the increase in the number of ICUs and ventilators. The German strategy of aggressive testing and tracing and bolstering of healthcare sector, has meant that the country did not face any shortage of medical equipment or pressure on its hospitals.

Second, Portugal, which learned from its neighbour and formulated its approach accordingly.Unlike in Spain and Italy, the general population followed the government’s recommendations. It detected its first coronavirus case on 2 March 2020, almost a month after they were detected in other European countries. This gave the government time to introduce relevant counter-measures to mitigate the impact.In this interval Portugal was able to reinforce its healthcare sector which had been the victim of austerity in the aftermath of the 2008-09 financial crisis. The government declared a state of emergency on 18 March 2020 putting the country under lock-down to slow the spread of virus. Another reason for success was Portugal’s centralised government system, which allowed the rapid implementation of policy decisions unlike some other countries of the region. While the virus spread has slowed, Prime Minister Costa has said that it is too early to think about the relaxation and lifting of the measures, despite the economic costs.^[xi] Thus, despite promising results, it is still early to evaluate the effectiveness of Lisbon’s response to the crisis.

Third, is Greece which implemented the lessons learned from years of austerity.“Having gone through another crisis ten years ago, Greek people realised that sacrifices early on will give us better results later on. And we created a consensus, a wider consensus, and people feel that by working together in solidarity we can deal with this”^[xii] – this statement of Greek Prime Minister George Papandreou represents the core of Greece’s fight against coronavirus. So far Greece has reported 2918 confirmed cased with 179 deaths (as on 3 June 2020) as compared to 233515 confirmed cases with 33530 deaths in Italy. With a total population of approximately 60 million, Italy recorded 386.4 confirmed cases per 100,000 population and 55.5 deaths per 100,000 population and on the other hand, with total population at approximately 10 million, Greece recorded27.2 confirmed cases per 100,000 population and 1.7 deaths per 100,000 population.[xiii]The stark difference between the two countries is because Greece started taking measures to contain the virus early like street patrols, deployment of drones to check and enforce a ban on the movement of individuals and took several steps to bolster its public health care system. It increased the number of ICU beds from 565 to 910 by the end of March^[xiv] and reached an agreement with the private health care sector to share the burden, whereby the private hospitals took patients with non-corona ailments, reducing the burden on the public-sector hospitals. The Greek government also gives daily briefs to its population, keeping them updated regarding the measures taken and the measures they need to take to mitigate the impact.

Fourth, is the Visegrád Four (Poland, Czech Republic, Hungary and Slovakia) which have reported fewer number of coronavirus cases as compared to the rest of the continent. These governments were able to act quickly and institute several measures as compared to their western counterparts. By early to mid-March Hungary (11 March), Czech Republic (12 March) and Slovakia (16 March) declared a state of emergency and implemented aggressive social distancing and closed all their schools and universities, while declaring nationwide lock-downs. Poland also implemented these strategies without a declaration of state of emergency. Poland and the Czech Republic banned public meetings of more than two people and, in Slovakia and Czech face masks were made mandatory for every citizen in a public place. All four countries raised their internal borders restricting the cross-border movement and implemented mandatory 14-days quarantine for citizens returning from abroad. This was one of the most crucial steps taken by the V4 government to control the spread of virus because these countries have maximum cross-border movement. Within EU, Slovakia’s share of cross-border movementis 5.5%, Hungary 2.3%, Poland 1.8%, and the Czech Republic 1.6%. Curtailing this free-movement between borders emerged to be the key step that helped mitigate the impact of the pandemic. Another reason why these countries pushed for aggressive policy decisions was the risk posed to their respective health care infrastructure. According to OECD data on healthcare spending by the V4 countries, Czech Republic spends 6.2% of its GDP followed by Slovakia with 5.3%, Hungary at 4.6% and Poland with 4.5%, which are well under the EU average of 10%.^[xv]

Herd Immunity versus Lock-down impact

Herd Immunity is understood as the resistance to the spread of a contagious disease within a population. It can happen in two ways: first, many people contract the disease and in time build up a natural immune response to the disease. Second, people are vaccinated against the disease to achieve immunity. As countries were imposing travel restrictions and lock-downs, the Herd Immunity approach was adopted by two countries – the UK and Sweden. Although the UK started with the idea in the early stages of its fight with the pandemic and then gave it up, it is Sweden which has taken this approach forward.

Sweden is the only Nordic country that has not yet closed its schools, public places or introduced rigorous rules for social distancing. Spearheaded by Chief Epidemiologist Anders Tegnell, Swedish policy towards mitigating coronavirus impact appears to be based on voluntary restrictions rather than forced measures. He has advocated a strategy to “allow the virus to spread slowly without overwhelming the health system.” The argument in favour of this approach is based on the idea that the priority is to protect the high-risk sections of the society while keeping the economy going. This Swedish exceptionalism comes from the idea or belief that the Swedes follow recommendations of the state and that there was no need to legally implement any further measures. Social isolation is only being recommended for the older and vulnerable population and only some are working from home. Swedish government has banned gathering of more than 50 people, visits to care-homes are suspended and people have been advised to avoid restaurants and bars. However, this approach is not without any criticism. The Swedish scientific and medical community hascirculated a petition urging the government to take more stringent measures to control the spread of virus^[xvi] as the number of confirmed cases and deaths is highest among the Nordic nations, highlighting the failure of the government’s approach. The government was granted additional powers on 16 April 2020 to approve health emergency bills without going to the Parliament, so far it has not come out with any substantial policy change.

Although, the Swedish response was not perfect and has been criticised, a case can be made out for the approach. It has in some ways succeeded in enhancing the immunity of the population to the virus. Its healthcare sector is not over-burdened, intensive care units are not over-run and the virus curve appears to be flattening. As it becomes clear that the efforts to control the spread of infection had limited impact with large percentage of people being infected, it becomes necessary for the people to enhance their immunities. This is also crucial because maintaining lock-downs for a long period is unsustainable. These lock-downs have virtually paralysed the economy - putting millions of people out of work and leaving many to struggle for basic requirements like food and medicines. According to an OECD report^[xvii], the economic and social cost of lock-downs are very high, it suggests that “France, Germany, Italy, Spain, the UK, will see their economies shrink by more than 25 percent within a year. Unemployment is rising to levels unheard of since the 1930s - fuelling political backlash and deepening social divisions.”^[xviii] As countries move out of the lock-down and scientists learn more about this virus, there is a growing realisation that living with this virus will be a new normal until the vaccination is made available for mass consumption.

Coming out of Lock-down – A Common Approach?

Despite the EU coming out with its policy on the lifting of lock-downs, the member states largely re-opened their societies according to the severity of the infections. Austria and Denmark were the first countries to ease the lock-down in Europe. Although several restrictions and social-distancing norms remain in place, these two countries allowed opening of outdoor sports, gathering of up to ten people, schools etc. Germany started easing lockdown on 20 April 2020 with small shops allowed to function. German lifting of lockdown is dependent on its 16 federal states which decided to open schools, shops of all sizes. It was also declared that Bundesliga matches would resume, with the first match of the season held on 16 May behindclosed doors. Spain declared a four-step strategy of lifting the restrictions on 4 May. Religious institutions would open from 11 May. Under the plan, terrace bars and restaurants would open from 11 May - they can work at 50% capacity from 10 June onwards. It also allowed for partial opening of schools for examination from 26 May. Cinemas, exhibitions, concerts etc. will be open from 26 May with only 30% capacity.[xix]

France also started its first phase of lifting of lockdown on 11 May - the plan divides France into two zones – red and green. While minimal activities are allowed in the red zones, in the green zones, schools for primary education opened on 11 May and for age-group 11 to 15 will open from 18 May. Gatherings of up to ten people are allowed and all shops, except for shopping centres in Paris, bars and restaurants, can reopen. Italy imposed the most stringent lockdown in Europe with even a ban on walking 200 mtrs away from home. However, a number of restrictions were relaxed in May 2020 with people allowed to travel longer distances, however, travelling between states is still prohibited. The country allowed the take-away services to resume, with full dine-in service from 1 June onwards. The Churches can hold masses from 18 May, and more shops would be allowed to function with strict social distancing measures. However, schools will remain closed until September 2020. The Netherlands government also took tentative steps towards relaxation of measures. Starting from 11 May it allowed elementary schools to reopen. However, the ban on bars and restaurants will remain till 20 May and on large-scale events till 1 September 2020.

Prime Minister Boris Johnson announced a range of measures for lifting of restrictions on 10 May 2020. The new approach has seven elements – “first, people who cannot work from home should be encouraged to go to work; second, new guidelines for businesses on making workplaces secure will be published; third, people should avoid public transport if possible; fourth, people should wear cloth face masks in enclosed spaces; fifth, there are no limits on outdoor exercise as long as social distancing is observed; sixth, people can drive to outdoor spaces; seventh, the UK could move to Phase 2 no earlier than 1 June, when there will be a phased reopening of shops, a return for some pupils to school”.[xx]  The idea behind this step as highlighted by the Prime Minister was “stay alert” which replaced the earlier message of “stay at home”.

These countries are but few examples of how Europe is easing out of lock-down. What is common in their approaches is that they are taking tentative steps towards the lifting of restrictions with the phased reopening of their economies and social life. In the first phase, emphasis is placed on schools and shops with social venues and restaurants given a secondary place. The governments are also cautious of the fact that rapid re-opening of the economic and public life could reverse the gains of the last two months and would see a rise in infections. So far, the policies appear to be member-state driven depending on the situation on ground and particularities of each country.

Assessment

Elaborating on the Spanish Flu pandemic of 1919, George A. Soper^[xxi] wrote, “The pandemic which has just swept round the earth has been without precedent… there have been epidemics almost as widespread, but they have been less deadly…never before has there been a catastrophe at once so sudden, so devastating and so universal. The most astonishing thing about the pandemic was the complete mystery that surrounded it. Nobody seemed to know what the disease was, where it came from or how to stop it. Anxious minds are inquiring to-day whether another wave of it will come again”^[xxii]. COVID-19 pandemic can truly draw a parallel with these lines today. The intensity and the rapid spread of this crisis have led to the realisation that the countries are unprepared to handle the severity of the pandemic.

The responses of the European countries are a case in point. Their health-care systems are under severe pressure with a lack of essential medical equipment and support structures. It was only a few countries that were able to curb the spread of the virus due to early lock-downs, aggressive testing and tracing of infected individuals, and bolstering their health-care sector. However, this does not stand true for most countries which in the initial crucial phases did not put in appropriate measures leading to a rapid increase of infections. These varied responses will affect the overall steps taken to stop the spread of the virus across the continent.

The lifting of the lock-down in many countries of Europe has raised the spectre for the second wave of infections. The EU has called on its member states to gradually lift the restriction and augment the capacity of their surveillance systems to control the spread of the virus. Countries that have lifted the lock-down have already started experiencing this second wave, such as Germany. According to a report by Robert Koch Institute,country’s disease control agency released on 10 May 2020, the infection rate in Germany had risen to 1.13 from 0.65^[xxiii], i.e. an infection rate of over 1.0 depicts more people are contracting the virus than those who already have it, pointing towards the expected second wave of infections over the summer. This has prompted the Merkel government to declare that the “emergency brakes” on the lockdown would be implemented if the authorities feel that the situation is going out of control. This has also created concerns in other countries regarding the potential wave of new infections, with experts almost unanimous in their projections that the number of cases would rise as more restrictive measures are lifted. But the debate remains over how this second wave would be as compared to the first- will it be more devastating, or are countries better prepared to contain the virus now. The first phases of the virus raised four questions addressed in this paper, countries have to now address their responses not just for the second potential wave but also for the long term future as people adjust to the ‘new normal’ of social distancing and restricted movements.

*****

Dr. Ankita Dutta, Research Fellow, Indian Council of World Affairs.
Disclaimer: Views expressed are personal

End Notes

^[i]The Washington Post,18 March 2020 https://www.washingtonpost.com/politics/2020/03/18/italians-adapted-quickly-pandemic-rules-that-may-be-good-news-europe/, Accessed on 25 April 2020

^[ii]Why is Italy’s Coronavirus Outbreak so bad, Time, 10 March 2020, https://time.com/5799586/italy-coronavirus-outbreak/, Accessed on 23 March 2020

^[iii] COVID-19 Mortality Rate in Spain for March 2020, Statista, https://www.statista.com/statistics/1106425/covid-19-mortality-rate-by-age-group-in-spain-march/, Accessed on 23 April 2020

^[iv] Dashboard for COVID-19 Data, Government of France, 24 April 2020, https://dashboard.covid19.data.gouv.fr/, Accessed on 22 April 2020

^[v]Le Monde, 6 April 2020, https://www.lemonde.fr/planete/live/2020/04/06/coronavirus-l-attestation-numerique-pour-les-deplacements-doit-etre-disponible-lundi_6035676_3244.html?highlight=1187532329, Accessed on 22 April 2020

^[vi]The Guardian, 30 March 2020, https://www.theguardian.com/world/2020/mar/30/covid-19-deaths-outside-hospitals-to-be-included-in-uk-tally-for-first-time, Accessed on 20 April 2020

^[vii]Reuters, 4 March 2020, https://www.reuters.com/article/health-coronavirus-germany-exports/germany-bans-export-of-medical-protection-gear-due-to-coronavirus-idUSL8N2AX3D9, Accessed on 24 March 2020

^[viii]Euronews, 16 March 2020, https://www.euronews.com/2020/03/16/ursula-von-der-leyen-tells-eu-countries-to-share-medical-supplies, Accessed on 23 March 2020

^[ix] Why Is Germany's Coronavirus Death Rate So Low?, Time Magazine, 30 March 2020, https://time.com/5812555/germany-coronavirus-deaths/, Accessed on 22 April 2020

^[x]DW, 22 April 2020, https://www.dw.com/en/coronavirus-as-it-happened-germany-plans-to-start-testing-vaccine/a-53204428, Accessed on 23 April 2020

^[xi]Politico, 14 April 2020, https://www.politico.eu/article/how-portugal-became-europes-coronavirus-exception/, Accessed on 24 April 2020

^[xii]Euronews, 23 April 2020, https://www.euronews.com/2020/04/23/europe-should-learn-from-greece-in-the-fight-against-covid-19-says-former-pm-papandreou?utm_source=newsletter&utm_medium=en&utm_content=europe-should-learn-from-greece-in-the-fight-against-covid-19-says-former-pm-papandreou&_ope=eyJndWlkIjoiYmY1NTMxOWUxMjQxZjhjZWFkZmFmM2IxNTg3MjJkNjQifQ%3D%3D, Accessed on 25 April 2020

[xiii]COVID-19 situation update for the EU/EEA and the UK, as of 3 June 2020, ECDC, https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea, Accessed on 4 June 2020

^[xiv] Greece Has an Elderly Population and a Fragile Economy. How Has It Escaped the Worst of the Coronavirus So Far?, Time Magazine, 23 April 2020, https://time.com/5824836/greece-coronavirus/, Accessed on 25 April 2020

^[xv] Data on Health Spending, OECD, 2019, https://data.oecd.org/healthres/health-spending.htm, Accessed on 25 April 2020

^[xvi]The Guardian, 30 March 2020, https://www.theguardian.com/world/2020/mar/30/catastrophe-sweden-coronavirus-stoicism-lockdown-europe, Accessed on 24 April 2020

^[xvii]Tackling Coronavirus – Contributing to Global Efforts, OECD, 22 April 2020, https://www.oecd.org/coronavirus/en/, Accessed on 13 May 2020

^[xviii]Evaluating the initial impact of COVID-19 containment measures on economic activity, OECD, 14 April 2020, http://www.oecd.org/coronavirus/policy-responses/evaluating-the-initial-impact-of-covid-19-containment-measures-on-economic-activity-b1f6b68b/, Accessed on 13 May 2020

[xix]Euronews, 29 April 2020, https://www.euronews.com/2020/04/29/coronavirus-spain-reveals-four-stage-plan-to-de-escalate-from-covid-19-lockdown, Accessed on 13 May 2020

[xx]The Guardian, 10 May 2020, https://www.theguardian.com/uk-news/live/2020/may/10/uk-coronavirus-live-boris-johnson-to-announce-covid-19-alert-system, Accessed on 13 May 2020

^[xxi] Major George A. Soper was Sanitation Engineer with Department of Health, USA. His area of specialty included study of typhoid fever epidemics. He was also the managing director of American Cancer Society from 1923 to 1928.

^[xxii] George A. Soper (1919), The Lessons of the Pandemic, Science, 49(1274), pp.501-506

^[xxiii]Coronavirus Disease 2019 (COVID-19) Daily Situation Report for Germany, Robert Koch Institute, 10 May 2020, https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-05-10-en.pdf?__blob=publicationFile, Accessed on 13 May 2020