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COVID-19 in Europe
The Current State of the COVID-19 Pandemic in Europe: A December 2020 Update

Released: December 11, 2020

Expiration: December 10, 2021

Jens D. Lundgren
Jens D. Lundgren, MD, DMSc
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The novel coronavirus disease (COVID-19), caused by SARS-CoV-2, is now widespread throughout the world and continues to spread at an exponential rate. As of this writing, 70.9 million people have been infected with SARS-CoV-2 worldwide and 1.6 million people have died due to COVID-19. The situation in Europe has waxed and waned since the beginning of the pandemic in March 2020, with most places falling into relative chaos at the start as lockdown measures were initially instituted, followed by reasonably low levels of transmission and the corresponding easing of some restrictions during the summer period. Unfortunately, we saw a surge beginning to happen in Spain starting in August, which became more widespread across Europe in October and November. Here is my take on the current state of the COVID-19 pandemic in Europe as we head into winter and what we may be able to expect in the coming months.

Current Status of the COVID-19 Pandemic in Europe
According to the European Centre for Disease Prevention and Control, which compiles data from all EU countries as well as Iceland and Norway, most of Europe is currently experiencing high levels of SARS-CoV-2 transmission. As in other parts of the world, transmission is being driven primarily by the younger population who are clearly experiencing pandemic fatigue, with obvious spillovers to the older, more vulnerable part of the population, leading to hospital admissions. Unsurprisingly, some of the most affected locales are larger cities where the population density is very high, particularly cities where people are living in very small apartments such as in central and southern Europe.

Mitigation strategies across the continent vary and have been variably effective. Since the primary mode of transmission is community transmission, most countries have instituted measures such as physical distancing, virtual learning to some degree, reducing the number of people who are allowed to meet in public spaces to 10 or fewer, mask wearing, and even limiting the number of people who meet privately. Most public places, however, are trying to remain open in comparison with the spring, albeit with the requirement of far fewer people. In areas where transmission has been exceedingly high, however, such as in Madrid in October, public places have been ordered to close. Finally, it is currently quite difficult to travel throughout Europe, with varying levels of restrictions depending on which countries you are originating from and travelling to. This topic is currently one of much debate since many believed these restrictions were logical when the transmission rates were very high in one place and low in another, but with nearly universally high rates, limiting this migration may not make as much sense.

Two notable, and encouraging, differences can be observed, however, regarding the state of the pandemic in the spring. First, in drastic contrast to the spring, testing rates are generally very high throughout the continent—and are exceedingly high for some countries. The country of Denmark, for example, has the highest COVID-19 testing rate in Europe and is testing approximately 300,000-400,000 people per week, which amounts to 6% to 8% of the population that is tested weekly. One notable exception, however, is Poland, where testing rates are so low that it is not possible to estimate incidence rates. The second encouraging trend is that, for patients who are admitted to the hospital, the in-hospital duration seems to be shorter and more people are surviving post hospitalization. There is ongoing discussion of why we are seeing these improvements in prognoses, but this can probably be explained, at least in part, by the availability of medicines and healthcare provider experience in treating COVID-19.

What May the Future Hold?
The projection in Europe is that the current trend of high rates of SARS-CoV-2 transmission will probably continue, at least for the foreseeable future. There is great concern, as in other continents, about the upcoming holidays and multigenerational gatherings at Christmas parties, for example. Therefore, we project that we are not coming out of this second wave anytime soon.

Fortunately, the European Medicines Agency has scheduled decision meetings for the 2 COVID-19 mRNA vaccines in later stages of development for late December 2020/early January 2021 and is simultaneously preparing for the rollout of the vaccines. Uniquely, the 27-member states of the European Union have agreed to join forces and negotiate purchase of vaccines by the European Commission, as opposed to doing so as individual member states, which is the normal procedure. This has really turned out to be very successful and will undoubtedly expedite the rollout of the vaccines. However, vaccine quantities will be limited in the first quarter of 2021, and therefore, there have been many discussions about prioritization. As in other places, Europe is likely to focus on vaccinating the most vulnerable populations first, such as the older population and frontline workers, followed by accelerated access in the second and third quarters.

Finally, it will be very interesting to see what happens after the first quarter of 2021. We project that, regardless of vaccine coverage, there will be a reduction in transmission in the second and third quarters of 2021 as was seen in the summer of 2020. Therefore, the real “stress test” for the rollout of vaccinations will be during the fourth quarter of 2021. At that time, if we have actually built immunity in the population, we should not see the same levels of transmission and associated healthcare crises that we are currently facing.

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