The new coronavirus wave appears to be dividing European countries into two leagues: those that, in spite of the uptick in infections, are keeping their hospitals under control, and those that aren’t. The data suggest that the places with more than 75 to 80% of their total populations are vaccinated are better resisting this new rise in cases. Others, meanwhile, with just 10 percentage points fewer in terms of immunizations, have had to resort to drastic measures given the imminent collapse of their healthcare centers. That said, the numbers from some countries, such as Belgium – which has vaccination rates similar to those of Spain – and the strength of the new wave (with the reach of the newly detected variant, omicron, still to be determined), suggest that caution is needed given the rise in hospitalizations in certain Spanish regions. In Aragón and Navarre, for example, the number of hospitalizations due to Covid-19 has doubled in the last month.
Infections on the continent have started rising at different times and at different speeds. In the Baltic countries, Bulgaria and Romania, cases seem to have peaked and are falling according to the dynamic that has been seen at other times during the pandemic. In Slovakia, Slovenia, Austria and the Netherlands, new positives have risen to levels that have not been seen in the last two years. Germany has also registered a record in infections and the volume of Covid patients has once again affected the normal running of healthcare centers. In Spain, Italy and Denmark, cases have risen later and for now, are doing so at a lower velocity.
In recent months, the number of hospitalizations has been an even more important indicator, given that the vaccines are preventing serious illness and infections alone do not reflect the genuine magnitude of the wave. This figure is worrying in some countries. In Bulgaria, for example, the situation is critical: 100 of every 100,000 inhabitants are hospitalized due to Covid-19 – practically double the figure in the worst moment of the pandemic in Spain after last Christmas. In Slovakia and Slovenia, which are headed toward a peak in terms of cases, hospitalizations have been growing for weeks and are currently at 45 per 100,000 inhabitants. These numbers are close to those of the worst moment in that country too, seen during last winter.
Also showing worrying trends are Slovakia (55 hospitalizations per 100,000 inhabitants), Czech Republic (49) and Poland (44). In the Netherlands, Denmark, Italy, Portugal and Spain, hospitalizations are also growing, although apparently at a slower speed. In none of these countries has the incidence of hospitalizations exceeded 10 per 100,000 inhabitants so far.
In this scenario, what role are the vaccines playing? Poland and Denmark represent a good example. The incidence of new infections is similar, but Polish hospitals are seeing six times more Covid-19 patients than those in Denmark. It is likely that the extraordinary capacity of Denmark to detect nearly all of the cases that there are (the country has a positivity rate of 2.4% compared to 24% in Poland) is having an influence, but the difference in vaccine coverage in these countries is also a factor: in Denmark, 76% of the population has received two doses; in Poland, the figure is barely 50%.
This pattern is clear in other countries: the higher the vaccination rate, the lower the incidence in hospitals. This can be seen in the following graph: countries such as Slovakia, Slovenia and Hungary, with roughly 50% of the population vaccinated, have a higher number of hospitalizations than countries with greater coverage such as the Netherlands and Belgium, which have already inoculated more than 70% of inhabitants.
It should be noted that these countries with fewer vaccinated residents have suffered larger waves of infections (as indicated by the size of the point on the graph), and this has caused a higher number of hospitalizations. But it is also true that in countries with similar numbers of cases, hospitals have suffered more where there is a lower vaccination coverage, something that can be observed when France and Denmark are compared.
Enric Álvarez, a researcher at the Computational Biology and Complex Systems group in Barcelona, explains that “in countries with 75% or more of the population vaccinated it appears that incidence rates close to 1,000 cases per 100,000 inhabitants over 14 days are not being reached, something that is occurring in countries with 10 points fewer, such as Austria, Slovakia and Slovenia. On the opposite side is Denmark, which is [the country that Spain] is likely to most resemble.”
For now, it is clear that the countries with more people vaccinated have emptier hospitals, given that people are experiencing less-serious cases of Covid-19. As epidemiologist Óscar Zurriaga explains, “it might not appear to be a huge difference, but going from 65% to 80% vaccinated is millions of people, a huge amount of citizens. What’s more, they are not always distributed by age in a homogenous way like in Spain – this allows for the circulation to not be focused in particular age groups.”
Spain – below on the right in the graph above – is a good example of this relationship. But there are exceptions, such as Belgium, which with 75% of the population vaccinated has the same number of hospitalizations per 100,000 inhabitants as Austria. That’s to say, if the incidence doubles, there is inevitably a rise in the number of patients in hospitals.
The vaccine alone is not enough to explain these differences. Firstly, because its effectiveness is reduced with time. “There are a number of different scenarios for the fall in effectiveness,” explains Álvarez. “If the vaccines continue with a descending trajectory when it comes to slowing transmission, it is clear that the situation in terms of infections and hospitalizations can rise once more.”
Seasonal behavior is also important: places where the cold weather arrives first, such as in central Europe, are seeing people spending more time indoors, and it is easier for infections to happen there. And finally, as Ortiz points out, “the relaxation of measures, which has taken place much faster in other countries, has had a massive influence in some infection curves.”
The gradual relaxation of these restrictions in Spain no doubt has also had an influence on the fact that its situation is far from those of other European countries. What’s more, the high vaccination coverage could be avoiding a new wave of hospitalizations.
Even so, the situation is one of tense calm and in recent weeks the data has gotten worse in the majority of Spain’s regions, which are in charge of their coronavirus restrictions, healthcare systems and vaccination programs. In Aragón and Navarre, hospitalizations have doubled in the last four weeks. In Catalonia, in the last week the incidence data has worsened among those aged between 60 and 80, something that has caused a significant increase in hospital occupation.
“The fact that there are regions that are rising is the proof of something that we already knew: the vaccine is not enough to eliminate transmission,” Zurriaga explains. “That is why it is not convenient to rely on the third dose for everything: if it stopped transmission, it would be a key factor, but this is not the case. Three concepts continue to be key: ventilation, masks and vaccines.”
Even taking these rises in the indicators into account, the situation is far from what it was a year ago. Catalonia, for example, has an incidence of cases that is comparable to that of October 2020, more than 220 cases per 100,000 inhabitants over the last 14 days. At that time, with rising infection rates, the region was reporting more than 1,500 Covid-19 patients. Now that figure is practically half, at 720. The Basque Country had 520 patients at the time, with a curve that is similar to the one it has now, but currently has just 224 coronavirus patients, which is less than half.