World Health Organization Regional Director for Europe, Dr Hans Kluge, highlights concerns over a winter wave of COVID-19.
Speaking at an emergency meeting of ministers of health from the World Health Organization’s (WHO) European region, WHO Regional Director for Europe Dr Hans Kluge expressed concern over the latest epidemiological data and projected rates of COVID-19 infections throughout the 53 Member States of the European region over the winter of 2020. The projections were drawn up by researchers at the Institute for Health Metrics and Evaluation (IHME), an independent global health research centre at the University of Washington in the US and one of many modelling groups with which the WHO has partnered on COVID-19.
“Europe is at the epicentre of this pandemic once again,” Dr Kluge told the assembled ministers. “At the risk of sounding alarmist, I must express our very real concern and convey our steadfast commitment to stand beside you and support you as best we can. I convened this meeting to present an opportunity for you to express your most serious concerns and for us to collectively reflect and share experiences. I feel the seriousness of the situation warrants it: although the projections are sobering, they also demonstrate modelling on the effectiveness of strategies that can help us to reduce the foreseen negative impact on our populations and our health systems.”
COVID-19 cases rising again
In the final week of October, Dr Kluge explained, the European region as a whole registered its highest weekly incidence of COVID-19 cases since the beginning of the pandemic; with more than 1.5 million cases reported across Europe over the course of seven days. The total number of confirmed cases has rose from seven million to nine million in just two weeks, and Europe has now exceeded the 10 million-case milestone.
A significant majority of European nations have reported ‘very high’ 14-day incidences of more than 200 cases per 100,000 population, and a third of reporting countries have recorded 10 or more hospitalisations for COVID-19 per 100,000 population – a level which has not been seen since the peak of the ‘first wave’ in spring 2020. Meanwhile, as rates of transmission have begun to outpace the capacity of many countries’ testing systems, the number of people who have tested positive for COVID-19 rates is reaching new highs: a majority of European countries are now reporting with positivity levels higher than 5%.
Dr Kluge noted that rates of mortality have also taken a sharp ascent, increasing by 32% across the European Region in the last week. The virus has gone from being predominantly spread among young and healthy populations, as was the case for much of the summer, to infecting older and at-risk populations at a troubling rate. Rises of this nature in ‘all-cause’ mortality act as an early signal that the affected countries are at risk of receding into significant excess mortality.
Lockdown as a potential solution
With a number of European countries introducing local or regional lockdown measures as a means of addressing the spread of COVID-19 without taking on the deleterious economic and logistical implications of a full-scale national lockdown, the focus of many countries has been on determining at what point national lockdowns will again become inevitable. “The key question that many countries are asking is whether or not to lock down; and when does a lockdown become necessary?” Dr Kluge explained. “We know that lockdowns at the scale of those seen earlier this year will cut community transmission and give the health system much needed space to recoup and scale up so that it can attend to severe COVID-19 cases and provide essential health services – but we also know that full lockdowns will propel mental healthcare demand and spur an increase in domestic violence while decreasing hospital attendance for chronic conditions, resulting in premature deaths from those conditions.
“The indirect impact associated with people falling into financial hardship and turning to social security would result in further economic impact and extend economic recovery time. Given these realities, we consider national lockdowns a last resort option because they bypass the still-existing possibility to engage everyone in basic and effective measures. So-called lockdowns need not mean what they meant in March or April.”
As a whole, national authorities have been expressly reluctant to introduce lockdown measures of the scope and scale seen earlier this year. The social, economic and wellbeing impacts of the first set of national lockdowns – whereby non-essential businesses and schools were closed, movement and social interaction were restricted, and in a number of European countries citizens were only permitted to leave their homes for a certain period of time – are still being felt. Job losses have been high; hospitals are facing a growing backlog of patients whose treatment or surgery has been postponed; mental health crises have seen a drastic increase.
“We can take action that makes a difference and saves lives while maintaining livelihoods,” Dr Kluge said. “Modelling by IHME suggests that the systematic and generalised wearing of masks at a rate of 95% from now may save up to 266,000 lives by 1 February across our 53 Member States in the European region. The data also suggests that encouraging people to work from home where possible, restricting large gatherings and proportionately shutting down places where people gather can go a long way to preserve lives and livelihoods. On the other hand, we are also confident that children and adolescents are not considered primary drivers of COVID-19 transmission. Therefore, school closures are not considered to be an effective single measure and should continue to be a measure of last resort.”
COVID fatigue and worker burnout
Dr Kluge went on to draw attention to the phenomenon which has become known as ‘COVID fatigue’, which refers to a sense of weary hopelessness on the part of a public faced with a long-form pandemic with no real end in sight. The constant state of underlying stress incurred by the pandemic, alongside the exacerbation of people’s individual worries over health, money, mortality, childcare, relatives and the sudden drastic shrinking of many people’s social spheres, can trigger trauma responses. Key among these, for the purpose of understanding COVID fatigue, is an attitude of apathy or indifference towards the virus, which is particularly prevalent among younger people who are not themselves at high risk of infection.
“We cannot underestimate the impact that COVID-19 fatigue is having on the wellbeing of our communities and the effectiveness of our ongoing responses,” Dr Kluge cautioned. “We need to engage citizens to help us create solutions. It’s important that we communicate to manage expectations in the coming season with empathy. Any actions that we take need to be viewed in terms of their effectiveness in slowing down transmission, but also in terms of their negative impacts. Effective communication using credible data projections and solutions based on science can help us to engage individuals, families and communities to support our efforts to control the pandemic as we head into a difficult winter.”
While citizens in all walks of life have reported experiencing an understandable degree of burnout, Dr Kluge clarified, the impact of the COVID-19 pandemic on healthcare workers has been particularly severe. Physicians, nurses and other clinical staff have found themselves working long hours with a reduced workforce, isolated from families and loved ones, and seeing patients and colleagues die at unprecedented rates.
“While in March the critical limiting factors were intensive care units, ventilators and personal protective equipment, today the single issue of greatest concern is the health workforce,” he said. “Our health workforce is exhausted; people are burning out. We have no COVID-19 response if we do not care for our healthcare and essential workers: their needs and wellbeing must be prioritised. These are exceptional times and they require decision-makers to go an extra mile in supporting the workforce, for example, by compensating their unused leave or allowing them to carry this leave to the next calendar year, and by providing additional support services to them and their families, including psychosocial support or childcare. Our systems require adaptation.”
Given that the rapid transmission of COVID-19 means it carries high potential to overwhelm countries’ testing and contact tracing facilities, Dr Kluge said, the limited resources available need to be focused towards areas where they are most needed: “When we can no longer ramp up testing and tracing at scale, we need to assess where to focus our resources. Adapting testing and tracing so that they are used in a targeted way for maximum impact, focusing on the events that trigger highest spread within communities, may become necessary, but we cannot give up on these critical systems.”
Dr Kluge went on to highlight the impact of a heavy focus on COVID-19 on non-COVID services and treatments, saying: “While supporting an already-stretched health system, we must try to maintain a dual-track health system to minimise the effects of ongoing COVID-19 responses. Adequate resourcing, both human and capital, stronger referral mechanisms and alternative service delivery platforms (digital) can all help us to achieve this goal. We need to understand how close our health systems are to being overwhelmed, and here is where we need to improve the quality of the data available. In turn, this will enable us to improve the modelling scenarios.”
The necessity of hope
Dr Kluge concluded: “It is time to draw on our reserves to communicate empathy and gratitude – gratitude to communities, to our health and essential workforce, to the general public, for their courage and resilience. People need hope. At the heart of this is understanding, honesty and transparency. We entered this pandemic together, we bear the hardship together, and there is no doubt in my mind that we will triumph together.”