As coronavirus infection rates slow in several countries, Europe asks: what next?

Data suggest that new cases and deaths related to COVID-19 may be beginning to plateau in some European countries, with some set to begin easing their lockdown measures next week. In a sign that the pandemic can affect anyone, the UK Prime Minister Boris Johnson was taken into ICU after a week of displaying COVID-19 symptoms. After being treated using oxygen and CPAP, he had improved enough by the afternoon of April 9 to return to a regular hospital ward, before being discharged on Easter Sunday.

Meanwhile, new cases and deaths continue to surge upwards in the USA and particularly New York City and State, which now has more cases than any individual country outside America.

Despite the high death toll, European countries are now actively looking to ease their restrictions, following in the footsteps of China which this week finally allowed people to leave Wuhan, the epicentre of the original outbreak. The first countries to allow some elements of normal life to return will be watched closely by all other countries.

Key developments in selected individual countries worldwide are summarised below:

Austria

Austria has so far avoided a huge outbreak, with 350 deaths and 13,945 confirmed cases. The Chancellor Sebastian Kurz has this week announced a step-by-step lifting of restrictions, which will begin with small retail shops allowed to open after the Easter weekend on Tuesday, April 14. Everyone will need to wear a mask on public transport, in supermarkets, and in the stores that are due to reopen.

Should this phase be successful, the economy will continue to reopen in two-week stages. At the end of April, larger stores and malls will be able to reopen, followed in May by restaurants and bars. Despite national debate on the issue, schools are likely to remain closed.

Denmark

Like Austria, Denmark went into lockdown relatively early. The country closed its schools, day centres, restaurants, cafes, gyms and borders, on 11 March. The result has been 6,174 confirmed cases and 273 deaths so far.

The Prime Minister Mette Frederiksen has announced that schools and daycare centres will open on Wednesday 15 April, which has met significant protests by some parents. She said: “This will probably be a bit like walking the tightrope. If we stand still along the way, we could fall and if we go too fast it can go wrong. Therefore, we must take one cautious step at a time.”

Gatherings of more than 10 people will remain banned until at least 10 May, and larger gatherings will not be permitted until August.

Norway

With 6,459 cases and 124 deaths so far, Norway believes it has the virus mostly under control. Norway’s largest mobile phone operator, Telenor, is collaborating with the Norwegian Institute of Public Health to help them track the spread of the virus. This data will help the country monitor the effects of easing restrictions, and predict outbreaks in any region of the country.

The Norwegian Prime Minister Erna Solberg has announced that various emergency restrictions will be relaxed after Easter. Kindergartens will open again from April 20, and schools for the youngest age groups from April 27.  Some small businesses—including hair salons—will be permitted to reopen on a date later in April. A controversial ban on staying in so-called holiday cabins and other homes outside a person’s main residence will be lifted from April 20.

Czech Republic

Another country making positive noises about its control of the novel coronavirus is the Czech Republic, which has recorded 5,905 cases and 132 deaths. It has allowed some non-essential shops to reopen, including bicycle, DIY and craft shops, and hopes to gradually lift other anti-coronavirus measures soon. In shops that have reopened, customers and staff must wear facemasks and stay two metres apart from each other.

Czechs have also been allowed to resume some outdoor sports and to run and cycle without a facemask, and the government plans to permit people to leave the country from Tuesday, April 14,  if they have “reasonable grounds” for the trip and go into quarantine for a fortnight when they return. Officials say meetings will be held over this Easter weekend, with a decision expected on whether more shops will be allowed to resume trading next week.

Spain

Spain remains one of the worst affected countries in the world, with 16,972 confirmed deaths and 166,019 cases related to COVID-19. However as with some other countries, the death toll does not include people that have died at home or in care residences, so is likely to be far higher. Despite the grim overall numbers, daily deaths have followed a recent downward trend, although on Easter Sunday they actually increased to 619 from 510 on Saturday. On Friday, 605 deaths were reported, with 683 on Thursday and 757 on Wednesday.

Spain will allow certain non-essential workers to return to work after the Easter weekend and will recommend use of face masks while out in public and especially on public transport. The government is also appealing to companies to be flexible on working hours to stretch out the busiest travel times and avoid congestion on buses and trains and in stations.

Despite these positive discussions, Spanish Prime Minister has extended the Spanish national ‘state of alarm’, which gives the government emergency powers, to April 26, and will likely ask parliament to extend it again to May 10.

Italy

Reports suggest Italy may be about to extend its lockdown measures until May 3, with Prime Minister Giuseppe Conte saying the county is not ready to lift restrictions yet.

However, there are clear indications that the lockdown is having the desired effect: daily rises in new infections have slowed dramatically, down to around 2-3 per cent in the last few days, a fraction of the regular 20-25 per cent at the peak of the crisis. The country has now seen 19,468 deaths of people with COVID-19, and 152,271 confirmed cases.

The Prime Minister may allow a tiny number of businesses to reopen when existing restrictions expire on April 13, such as book and stationery stores as well as lumber companies and factories that make agricultural machinery. The government and scientists reportedly view these as businesses with the least amount of human interaction. Some media say this is largely a symbolic gesture.

USA

The United States is now the new centre of the global COVID-19 pandemic. It has passed two unpleasant milestones of half a million cases and 20,000 deaths. As of Easter Sunday, there have been 529,951 cases and 20,608 deaths related to COVID-19. New York State alone now has more cases than any individual country outside of America, with more than 180,000 cases. However, New York’s death toll of 8,627 still lags well behind that of Italy and Spain. In a clear sign that the pandemic is raging out of control in New York City, photos have emerged of workers in full protective suits placing coffins into a mass grave.

Dr Anthony Fauci, Director of the US National Institute of Allergies and Infectious Diseases (NIAID) has estimated that around 60,000 Americans will die with COVID-19, down from a previous estimate of 100,000 to 200,000. On Easter Sunday, he suggested that the United States may have a ‘rolling’ return to normal with different restrictions lifted at different times in different regions.

US President Donald Trump has told America to prepare for several very difficult weeks. However, he also continues to give conflicting messages, suggesting that America should be open for business again at the end of April despite surging unemployment and public concern around the spread of the virus.

UK

The UK was left reeling when on March 27, the Prime Minster Boris Johnson, Health Secretary Matt Hancock and Chief Medical Officer Prof Chris Whitty were all taken ill with COVID-19 symptoms. While Whitty and Hancock recovered, Johnson was admitted to hospital on April 5 and spent 3 nights in intensive care before returning to a normal ward and being discharged from hospital on Easter Sunday to recover at home. Scotland also faced a small crisis when its Chief Medical Officer Dr Catherine Calderwood was forced to resign after being photographed breaking her own quarantine regulations to visit her second home.

The UK currently has 84,279 confirmed cases and 10,612 people who have died with COVID-19. While numbers of daily deaths are expected to increase for several days, the latest data suggest that numbers of new cases of COVID-19 and patients entering ICU are increasing at a steady pace rather than going up sharply. Officials are hopeful that this, combined with increased to ICU capacity nationwide and the opening of several new emergency hospitals, will mean the country can cope with the worst part of the pandemic. However, some experts are predicting that the UK will be the worst affected country in Europe in terms of numbers of cases and deaths.

The lockdown is likely to be extended to the end of April. The UK will carefully observe the lifting of restrictions in other countries, and is also in a desperate race to increase its testing capacity to match that of other countries such as Germany. It is not clear yet when an antibody test to show if someone has had the infection will be ready.

Germany

Germany is still seeing a low number of deaths in relation to confirmed cases and the size of its population. The country has seen 125,452 cases and 2,871 deaths. The apparently lower death rate is thought to be linked to mass testing, meaning that many people with mild symptoms are counted in Germany’s figures that have not been counted in the data of other countries.

The lockdown restrictions including a ban on gatherings of more than two people are currently in place until April 19. The Federal Government and 16 State Governments will review the lockdown next week. Chancellor Angela Merkel has asked Germans to be patient despite being cautiously optimistic about the spread of the epidemic. She said restrictions would be lifted slowly and reviewed every two to three weeks. She said: ‘I don’t want to take such a big step that it throws us back completely and we find ourselves once again with an exponential rise.’

Brazil

While cases and deaths related to COVID-19 begin to soar in Brazil (almost 21,000 cases and more than 1,100 deaths), and also across South America, Brazil’s President Jair Bolsonaro is appearing more and more isolated. Despite social distancing and closedown of businesses being introduced by State Governors, Bolsonaro has defied them with nationally televised addresses asking people to ‘get back to work’ and saying that ‘some people will die, that’s life.’ During the Easter weekend, he has again been pictured meeting members of the public.

He has also fought publicly with his own Federal Health Minister Luiz Henrique Mandetta, who has supported social distancing measures and refused to endorse use of the drug hydroxychloroquine for early treatment of COVID-19, since as there is not yet evidence that this will be effective.  A clinical trial of hydroxychloroquine is ongoing in Brazil but has so far detected no signals of efficacy.

The Brazilian people are overall far more supportive of Mandetta than of Bolsonaro, and there are increasing calls for Bolsonaro to resign due to his poor handling of the crisis.

Tony Kirby