By Aneta Zachová, Barbara Zmušková, Benjamin Fox, Bogdan Neagu, Charles Szumski, Clara Bauer-Babef, Eleonora Vasques, Goranka Jureško (Jutarnji list), Julija Simić, Krassen Nikolov, Maria de Deus Rodrigues (Lusa), Oliver Noyan, Pol Afonso Fortuny, Sarantis Michalopoulos, Sebastijan R. Maček (STA) and Thomas Lehnen
Feb 10, 2022
While the spread of the Omicron variant has led to record-high infection rates across Europe, many governments are scaling back restrictions and declaring that the end is in sight. But the reality is that some states are still suffering from disproportionately high mortality rates.
The data gathered by our partners across Europe suggests that the rapidly approved COVID vaccine cannot be a panacea and some countries need to do their homework when it comes to the modernisation of healthcare systems. Many analysts in Brussels suggest that the Recovery Fund offers a huge opportunity in this regard.
As an example, Athens and Sofia experienced a dramatic increase in COVID-related deaths compared to their population.
Both countries reported more than 2,300 deaths each due to COVID, while the rest of Europe saw mortality rates fall.
Germany, with a population ten times Greece and Bulgaria, registered just 2,256 COVID-related deaths in January.
In the case of Bulgaria, EU sources attributed the high mortality rate to poor vaccination and health infrastructure.
According to official ECDC figures, Bulgaria has the lowest level. of vaccination rates, with just 29.3% of the population fully vaccinated and only 9.1% having received a third dose. Sofia has a maximum capacity of 1,200 ICUs.
Neighbouring Romania reported 1,273 deaths in January, and the vaccination rates are no better: Just 42% of the population has been vaccinated, while 8.2% has received a third dose.
In the case of Greece, among the first to impose lockdowns, the Commission is puzzled, as 68.9% of the total population is fully vaccinated while 45.4% of citizens have also received a booster.
What the government says
According to the government, the high number of deaths are attributed to the ageing population.“89% of deaths are over 60 years old and are in people with comorbidities,” said Deputy Minister of Health Mina Gaga.
Gaga also emphasised how COVID deaths are calculated compared to the rest of Europe. “For whatever reason, a person comes to the hospital, even a car accident, or a heart attack, and gets tested positive in the hospital, we count it as a COVID case”.
Contacted by EURACTIV, a government source explained that the Delta variant – which is more fatal – dealt a severe blow to the health system.
“Delta variant insists […] and this creates a lot of problems”, a government source said, adding that people infected with Delta may stay for months in ICUs while admissions with Omicron are few.
The same source said that by the end of February the public health system is expected to “take a breath” with a lower number of deaths.
Lack of GPs, specialised ICU staff
For the Greek opposition, several factors have led to this deadlock. One of them is the absolute lack of primary care (GPs) at the pre-hospital level.
“In the period 2017-2019 we managed to set up 127 local health units (with GPs) that were not utilised in this pandemic […] the government did not even set up a telephone medicine protocol for the sick, to monitor their health status, the oxygen level and urge them to go to the hospital if needed”, told EURACTIV Stamatis Vardaros, health policy advisor to the President of Syriza Alexis Tsipras.
“Almost all severe cases go to the hospital quite late, and unfortunately, lives are lost because insufficient and timely care is not provided,” he said.
Vardaros, who is also former deputy secretary-general of the health ministry, added that COVID clinics had been staffed with non-specialised doctors. “For example, we had gastroenterologists on duty in covid clinics”.
Regarding ICUs, he said the quality of care and health standards had dropped dramatically. An ICU needs four nurses and a doctor. In one night, the beds were doubled, and therefore there was not the necessary staff to manage the ICUs.
He also referred to a recent leaked study conducted by leading epidemiologists Sotiris Tsiodras and Theodoros Lytras who found that out of the 3,988 deaths examined, 1,535 were “attributable” to not being in an ICU when they should have been, due to the high load of intubated COVID-19 patients.
Last but not least, he also said the private sector did not participate equally in the care of COVID incidents. “The private sector did not take over and continues to not take on the difficult cases”, he concluded.
Spain reported 4.830 deaths out of 47.5 million in January, with the mortality rate standing at 1.46%. The percentage of COVID related patients in the ICUs ranged between 19-23% of the total ICUs capacity. So almost a quarter of ICUs is exclusive for COVID related cases.
Portugal registered 950 COVID-related deaths. The country has no ICU exclusively dedicated to COVID. Hospital beds, whether regular or ICU, are turned into COVID units according to the needs.
Italy, with a 59 million population, reported 9,095 deaths.
Slovenia reported 244 in January, but in February, deaths related to COVID are nearing twenty on average daily. As in Portugal, there are no ICUs specifically dedicated to COVID patients. They activate additional ICU beds as needed, depending on the state of the pandemic. At the peak, during previous waves, there were around 280, which means basically all ICU beds were occupied by COVID patients.
In Croatia, 1,254 citizens died from COVID in January, or an average of 35 per day. Unfortunately, this trend continued in February, with 267 citizens dying in the first five days. The reason for the high mortality rate is the low number of vaccinated people, especially those over 60, and the fact that many infected people seek medical help too late.
Croatia has 795 intensive care units in hospitals that are converted into COVID intensive units, but not completely, to take care of emergency patients not related to COVID.
Neighbouring Serbia had a total of 890 COVID-related deaths.
Slovakia reported 1,185 COVID-related deaths in January. The country has 129 standard ICU beds, 364 “oxygen high-flow technology” beds, and 333 artificial ventilation beds.
In the Czech Republic, 894 COVID-19 related deaths were recorded (28 average daily). In total, there are 4,481 ICU beds in the country. There are no given numbers of ICUs exclusively dedicated to COVID cases, but 3,583 beds have the necessary equipment for severe COVID-19 cases treatment (HFNO, ventilators).
In France, the average number of daily COVID-related deaths was 259 in January, while a month ago, it was 393.
In 2019, there were 19,600 beds in intensive care units. But there are no ICUs officially exclusively dedicated to COVID-19 cases. Analysts in Paris estimate that the death rate will decrease as the peak of the fifth wave has been reached combined with high rate of vaccination as 78% of the total population is fully vaccinated.
Last month, Germany reported 2,256. Occupied intensive care units are 19.086; free stand at 2988 while free COVID-specific intensive care units are 1,276.
In the UK, there were 5,797 deaths from COVID in January, while the average number of patients in ICU was around 700 per day for the same month.
The Netherlands reported 275-300 deaths in January while Belgium 661.
Sweden reported 775 deaths in January, while 364 patients were in ICUs.
Denmark registered 479 deaths in January with 356 patients in ICUs.
Looking at the data from across Europe, comprising mortality, vaccination rates, and the capabilities of hospitals, it becomes apparent a conversation is needed about healthcare infrastructure.
With governments pushing for a return to normality and efforts focusing on vaccination, lessons should be learned and preparations made before Europe has to face another pandemic.
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