Intended for healthcare professionals


Covid-19: Austria enters lockdown as cases surge across Europe

BMJ 2021; 375 doi: (Published 19 November 2021) Cite this as: BMJ 2021;375:n2861
  1. Tony Sheldon
  1. Utrecht

Clinicians and public health experts have been urging the public to get vaccinated against covid-19 and have called for clear messages from governments on preventive measures as Europe deals with a surge in cases.

On 19 November Austria imposed a countrywide lockdown and became the first European country to make covid vaccination mandatory, from 1 February 2022. With 1400 cases per million people in the past week,1 the decision to lockdown was a “last resort,” said Wolfgang Mückstein, health minister. Full vaccination rates in Austria remain relatively low at 64%.

Slovakia and Slovenia were the only countries in Europe to record higher confirmed case rates, with seven day averages of 1640 and 1580 cases per million people, respectively. Belgium (1180), the Czech Republic (1170), the Netherlands (1050), and Ireland (890) all recorded high case rates, and slightly lower levels were seen in the UK (581), Germany (540), and France (200).

Maurizio Cecconi, president of the European Society of Intensive Care Medicine, urged people to get vaccinated, as hospitals across Europe showed “a steady pace of mostly preventable admissions.”

Increasing admissions of patients with covid take healthcare staff away from other services, resulting in cancelled screening and operations. Cecconi, a professor of anaesthesia and intensive care at Humanitas University in Milan, Italy, told The BMJ, “Anything that reduces the strength of intensive care beds is causing potential issues somewhere else. You don’t vaccinate only against covid; you do it for this ‘general health’ reason as well.”

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, UK, said that “a winter covid spike is not inevitable.” He noted that case rates across Europe showed a 15-fold difference when Spain and Portugal were compared with some of the Baltic states. Spain, in particular, had shown how to control the pandemic through “decisive government action, clear messaging that the pandemic is not over, and high rates of vaccination,” he said.

McKee feared that countries such as the Netherlands were suffering from mixed messaging, resulting from attempts to minimise inconvenience and return to normal too quickly.

The Netherlands

Hospitals in the Netherlands are near capacity, as latest figures show 205 hospital admissions a day, up from 175 the previous week. Despite 84.7% of adults being fully vaccinated a record number of people tested positive for covid on 18 November: 110 558, up 44% on the previous week.

Ernst Kuipers, professor of gastroenterology at Rotterdam’s Erasmus University Medical Center and chair of the national network coordinating covid admissions, said, “In the past seven weeks admissions have increased sevenfold. The peak has not yet been reached.” He feared that if cases continued to rise hospitals would be forced to choose between treating patients with covid and regular admissions.

Peter Paul van Benthem, president of the Dutch Association of Medical Specialists, warned of “growing concern” among colleagues about not being able to treat patients.

Five hospitals in the southern province of Limburg have written to the health secretary, Hugo de Jonge, warning that the province is close to becoming the first to be unable to admit more patients with covid. The hospitals argued that this would be irresponsible if it meant delaying further admission of oncology patients who had already been waiting for months. “We are at our limits,” they warned.

The proportion of hospitals able to undertake “critical planned care” has fallen from 96% to 88% in a week.

Measures aimed at reducing the “overburdened healthcare sector” have now come into force, aiming to limit daily contact. These include banning spectators from sport events, restricting the number of home visitors a day to four, and advising people to work from home.

Ireland has also imposed new restrictions to curb a surge in covid infections, including proof of vaccination for cinemas and theatres, pubs closing at midnight, and people being urged to work from home.

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