Home Brussels Get ready for an endless coronavirus winter

Get ready for an endless coronavirus winter

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This is the new normal.

Hospitals crowded with the vaccinated and not. Riots in the streets. Masks in the Christmas markets — if they’re open at all.

After several months of rolled-back restrictions caused cases to rise, people saw what “living with the virus” looked like. And they didn’t like it.

Then come the inevitable policy reversals: mask mandates and lockdowns, even in highly vaccinated areas, to stave off catastrophe in the winter months. And people don’t like that, either.

The hard reality: The coronavirus vaccines are medical miracles, but they’re not infallible. And with the predominance of the highly contagious Delta variant, relatively lax restrictions and large minorities of the population declining to be jabbed, the pandemic is back in full force across Europe.

Germany hit an all-time record number of weekly infections on Wednesday, at a weekly rate of more than 400 per 100,000 people. It’s juggling its own overcrowded ICUs in the south and east while taking in Dutch patients on its western border. The Netherlands, Belgium and Ireland are struggling to process PCR tests, while low vaccination coverage in Eastern Europe has fueled brutally high death rates.

Current vaccination levels around the EU are “insufficient to limit the burden of COVID-19 cases and hospitalizations over the winter months,” said the European Centre for Disease Prevention and Control Director Andrea Ammon on Wednesday. Public health measures should be “applied now,” she said — and could still be needed at Christmas if things don’t improve.

The latest wave is a reminder, public health experts say, that there’s no telling when bare-faced, indiscriminate mingling can return in earnest.

“Whenever you lift measures, this virus is learning how to cheat us,” said Walter Ricciardi, a top adviser to the Italian health ministry. With the Delta variant, far more transmissible than the original version, neither vaccines nor social distancing can do the job alone.

“Unless we use all the weapons together in a rational way, we will never [get back] to normal, at least in the short term,” Ricciardi said. “We will have to spend the next two, three years like this, you know, with a sequence of pandemic waves.”

Back in lockdown

Austria proved the days of universal stay-at-home orders are not yet over. Chancellor Alexander Schallenberg said he opted for a 10-day lockdown not just to save the health system but to prompt Austrians — a third of whom refuse to be vaccinated — to sit and think about their choices.

In an interview with POLITICO, he spoke of “creating an opportunity… in the sense that we want to get out of this vicious circle of confused waves and lockdown discussions.”

In case people don’t seize that opportunity on their own, Austria’s vaccine mandate is planned for February 1.

Even in Portugal, where virtually everyone eligible has been fully vaccinated — more than 86 percent of the population — “it is crucial to ensure that the right message is communicated to the population,” said Sofia Ribeiro, a doctor and public health specialist working on the country’s front lines since April 2020: “The pandemic is not over yet.”

Portugal’s rates of transmission, hospitalizations and deaths are on the rise, prompting officials to float the possibility of putting restrictions back in place.

That’s just eight weeks after Lisbon’s vaccines coordinator, Henrique Gouveia e Melo, said the country achieved “nearly herd immunity” with a campaign that studiously avoided politicizing the jabs.

For the vaccinated — many of whom believed the pandemic was over, at least for them — the return of restrictions is a “cold shower,” said Antwerp Mayor Bart de Wever. Presumably, that’s less acutely uncomfortable than the water cannons blasted at some of the 35,000 protesters in Brussels on Sunday. Police opened fire at a similar demonstration against new Dutch measures in Rotterdam, sending three to the hospital.

Antwerp’s region, Flanders, boasts eight in 10 people vaccinated — including 96 percent of those over 65. Yet it joined the rest of Belgium last week to impose new indoor mask rules and four-day-a-week telework as ICUs came under strain. 

Vaccinated but infectious

At the core of the problem is a statistic that can appear misleading: Some 70 percent of those recently in Flanders hospitals were fully vaccinated.

That’s largely the result of the far larger number of people who have received the shots — the unjabbed are getting ill and dying at far higher rates — but it’s also evidence that the vaccines don’t provide foolproof protection, especially in the face of the Delta variant and waning immunity, with many in Western Europe having been vaccinated some six months ago.

And it points to the fact that even if everybody were to be vaccinated, there’s the risk that the pandemic would still pose a problem — at least to the elderly or otherwise vulnerable.

Because vaccinated people are less likely to get infected in the first place, they’re less likely to spread it. However, the Delta variant is dampening some of the vaccines’ benefits.

“The available evidence indicates that the currently available vaccines reduce transmission less for the Delta variant compared to Alpha,” the ECDC said in a new risk assessment Wednesday.

Mix in cold weather that brings people inside and the start of flu season (which can overload a health system even in normal times) and that’s a recipe for disaster.

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The danger is doubly grave when there are big pockets of people not fully vaccinated — which is why politicians are spending so much effort trying to expand coverage.

Even when the general lockdown lifts, the unvaccinated will remain grounded, Schallenberg said. He couldn’t say when that would change: ICU burdens are the “red line.”

As Germany also debates a vaccine mandate, some regions are making daily life difficult for the unvaccinated, including requiring proof of shots, recovery or a negative test to use public transportation.

And with signs that vaccination alone isn’t enough, countries are tightening criteria for the immunity passes that many require for entry to restaurants, nightclubs and other places where masking isn’t practical.

Modeled on the EU Digital COVID certificate for cross-border travel, most coronavirus passes are used to prove people have been vaccinated, recovered, or recently had a negative test. But there are moves to limit use of the latter option, either by requiring more accurate PCR tests over antigen, or by cutting out the test option completely.

In the Netherlands, an advisory panel estimated that in high-risk environments, where only the vaccinated and recovered are allowed to enter, the risk of infection is 50 percent lower than versus when testing is also an option, and the risk of hospitalization is 82 percent lower. (Broadly, however, there’s little data so far about how well vaccine passes work.)

In response to the waning immunity, the European Commission is expected to propose taking boosters into account in the EU-wide COVID certificate.

Boosters offer a note of hope for those with stale immunizations, restoring efficacy back to that initial two weeks after the second dose. The big question mark is whether the third dose will also lose potency after a few months. However, Marco Cavaleri, the European Medicines Agency’s head of vaccines strategy, told reporters Wednesday that boosters drive antibody levels up much higher than the initial course, putting the potential for longer protection “in a very good place.”

Political catch-22

In the meantime, for politicians, the pandemic’s resurgence presents an unwelcome balancing act.

An ECDC overview of studies about restrictions, including masking and lockdowns in Europe (which has yet to be peer-reviewed), notes a catch-22: These measures work best when implemented early — but also when they have solid backing from the public. That means officials are stuck with the challenging task of convincing people to take new precautions even when things aren’t that bad.

That conundrum is especially clear in places like Portugal, where — ahead of elections in January that could see the end of Prime Minister Antonio Costa’s six-year tenure — the government is under pressure to soften proposed measures amid criticism from the opposition. Likewise, French President Emmanuel Macron will have to make a complicated calculation ahead of his bid for re-election in April.

The U.K. government makes the opposite case about timing. Amid heavy criticism, Prime Minister Boris Johnson declared “Freedom Day” on July 19. Lockdowns ended, masks became optional and anyone could walk into a crowded pub. Cases soared in the summer, but now the Delta wave seems to have died down ahead of the regular winter rush in the National Health Service, according to some British scientists.

Just across the Irish Sea, Irish Deputy Prime Minister Leo Varadkar expressed optimism that lockdowns wouldn’t be needed thanks to the Republic’s high vaccine coverage.

Notably, however, no lockdowns doesn’t necessarily mean normalcy. A key adviser said Sunday that if everyone cut their social contacts by 30 percent, that would shrink the incidence.

That’s not a straightforward ask ahead of the Christmas season.

Ultimately, even in a place as heavily vaccinated as Portugal, it’s still too early to predict when life will return to something resembling the old normal, said Rebeiro.

“Living in uncertainty for such a long period of time is certainly difficult for all of us,” she said, “but we must keep observing precaution.”

For political leaders, the risk is that public opinion will mutate even faster than the virus.

Matthew Karnitschnig, Helen Collis, Douglas Busvine, Carlo Martuscelli and Cornelius Hirsch contributed reporting.

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.

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