In Europe there are contradictory strategies in motion. Each country decides for itself how it tests its citizens, how it prevents contagion and how it manages medical supplies. “Cooperation is essential,” warn the experts, but is anyone listening?
In Europe, countries have adopted contradictory strategies to combat the Coronavirus Covid-19, taking individual approachs to testing, preventing contagion and managing medical supplies. This is despite the experts warning that “cooperation is vital.”
When the 12 Chinese doctors and nurses arrived at Malpensa airport in Milan, Italy last Wednesday, 18 March, along with 17 tons of medical equipment (clothes, masks, ventilators) they were carrying a large banner. On it was written a phrase in Italian, by the Roman philosopher Seneca: “We are waves of the same sea, leaves of the same tree, flowers of the same garden.”
The idea is simple. In Italy as in China, and everywhere in the world, Covid-19 is spreading fear and anxiety, killing thousands of people and threatening our way of life. As a pandemic, declared by the WHO on 11 March, it does not care about national borders and the consequences are severe in all European countries.
“We are waves of the same sea, leaves of the same tree, flowers of the same garden”
But so far, instead of international coordination, or strategic cooperation between states, the fight against the spread of the disease seems to be decided on a case-by-case scenario. Not only that, countries are adopting protectionist measures (export bans, the closure of borders) and in some cases, even taking measures that appear contradictory.
The message on the Chinese doctors’ flag in Italy was that we should all cooperate. But that is not happening in Europe right now. Although the EU is a common market without borders, it has no say on health issues. That is decided through national policy according to the treaties.
So far, European countries have taken different approaches on such important ways of containing the virus as: testing the population; managing supplies of medical equipment and health care approaches. Early on in the crisis, there was even the question of whether the best way to prevent the spread of the virus was through isolation or, on the contrary, “group immunity”. Although the group immunity strategy, notably adopted by the UK, but also the Netherlands, was soon shown to be unworkable.
The closing of borders, for example, is a common measure today throughout Europe. But the EU’s health agency, the European Centre for Disease Prevention and Control (ECDC) explains to Investigate Europe that it is a wrong move: “The available evidence therefore does not support the recommendation of border closures which will cause significant side effects and social and economic disruption in the EU“.
For the ECDC, “cooperation is key to all cross-border health threats, including Covid-19”.
“You have to try to be as uniform as possible to face an epidemic in Europe,” said Roel Coutinho, former director of the Center for Infectious Disease Control in the Netherlands in a TV interview. In the field of public health, each country now has its own policy, which, he says, is confusing.
“Cooperation is essential,” warn the experts
To understand the problem caused by this lack of cooperation, it is necessary first of all to see how each country in Europe is collecting data on the spread of the disease.
WHO Director Tedros Adhanom Ghebreyesus has said the “key word is test, test, test”. But that does not mean “mass testing” – WHO deputy director Raniero Guerra explained – because “it would be scientifically and logistically useless”.
At the moment, no one seems to know how many tests are being done, and there is no clear common strategy for testing and comparing the data. There are two reasons for this: tests are scarce (and cannot yet reach the entire population) and are expensive (15 euros).
In Italy’s national strategy, according to the Istituto Superiore della Sanità (Higher Institute of Health) is to test only people with symptoms of pneumonia or those who have been in contact with infected people. But some Italian regions are opposed to this and are following a different path.
At the moment, no one seems to know how many tests are being done, and there is no clear common strategy for testing and comparing the data. There are two reasons for this: tests are scarce, and expensive
Germany, Portugal and the Netherlands have until last week been testing people with symptoms who have had contact with infected people or have returned from infected areas. Now they are extending testing to people that need hospitalisation and people over 70 that show symptoms. Until last week France was testing only severe cases of symptomatic people. Some countries, such as Greece, is not doing extensive testing, but are are testing mainly older citizens, partly for fear of running out of tests.
In the UK, community testing stopped on Friday 13, with testing limited to those already in hospital. This approach has been criticised by the WHO, with Tedros Adhanom Ghebreyesus comparing it to “fighting a fire blindfolded“.
But the situation is even worse if we ask a simple question: what is the best way to prevent the virus from spreading in communities?
Most European countries have decided to close public spaces, such as schools, and recommend voluntary isolation. The Netherlands explicitly referred to this idea, but has established a mixed package to fight the spreading. Even the UK, very much an outlier early one, has now adopted this policy.
In the UK, community testing stopped on Friday 13, with testing limited to those already in hospital. This approach has been criticised by the WHO, with Tedros Adhanom Ghebreyesus comparing it to “fighting a fire blindfolded”
“Experimental” and “dangerous”
In a speech to the Dutch nation on Monday 16 March, Prime Minister Rutte explicitly mentioned the words “group immunity” and explained the concept – which argues that transmission of the virus can help create immune defenses in the population. Many citizens have criticised this approach. The Netherlands is however also taking various mitigation measures (self-isolation, school closure, social distancing, remote working, closing bars, gyms and restaurants, travel cancellations and restrictions) in combination with the immunity approach. In the Netherlands, shops are still not required to close and most factories are still working. The official policy is to postpone a “total lockdown” for as long as possible.
The WHO has warned against relying on immunity, saying that testing cases and isolating infected people should be the top priority, followed by social withdrawal and increased medical capacity.
The UK’s initial strategy relied on ‘group immunity’ and was strongly criticised by many, including the WHO and leading scientists, and was described as ‘experimental’ or simply ‘dangerous’. The outcry increased when Imperial College London shared a study that put the UK on a trajectory to “a catastrophic epidemic” with up to a quarter of a million deaths and the health service overwhelmed.
This caused an immediate change of course, and on March 16 Prime Minister Boris Johnson advised against travel and non-essential contacts. But as with the Netherlands this was advisory, and it was left to companies themselves to take the initiative and it was not until March 20, along with the announcement of school closures (but not for children of key workers or vulnerable children) that gyms, bars and restaurants were also advised to close. Finally on March 23 the UK was placed essentially into lock down.
The “nudge theory”
While most countries reacted quickly after the steep rise of cases in Italy, others decided to wait and see. The reason why it was so slow to close schools or ban large meetings in the UK was for the fear that “fatigue” can set in, meaning people will tire of following the rues and find ways round them – just as the infection is reaching its peak.
The UK government’s strategy is influenced by “nudge theory”, an idea popularised by behavioral economist Richard Thaler and political scientist Cass Sunstein. If the effectiveness of social distancing measures is time-limited, the best logic, according to this theory, seems to be to reserve these measures for when we are closer to the peak of the epidemic.
As we can see, everything seems to be contradictory in the countries’ reaction to the Covd-19 crisis. Let us now look at the management of medical equipment.
Some countries have a shortage of alcohol, masks, ventilators, gloves or cleaning products. In Poland, a local online shop was selling masks for 100 euros, a practice that is now prohibited. While some countries already produce masks on a regular basis, most import them from China. France, Germany the UK have asked industry to start producing medical equipment. In the Netherlands and Belgium, prisoners are now producing masks. Some people are making masks themselves at home, though experts say these are not medically useful and may create a false sense of security.
Some countries have a shortage of alcohol, masks, ventilators, gloves or cleaning products
So far, according to our research, it is only Italy and Spain that are running out of ventilators for people needing assisted respiration. But other countries, such as the UK (about two weeks behind Italy) are already foreseeing huge problems. The UK’s health service has just 5,000 respirators for a population of more than 66 million people.
Dräger in Germany is working 24/7 to produce 10,000 fans commissioned by the government. Meanwhile, in March Germany had imposed a ban on exports of medical supplies to all other European countries – even without any ventilator or mask shortages.
On the night of Sunday 8 March, Italian Prime Minister Giuseppe Conte announced there would be a lock down the north of Italy. Almost 16 million people were immediately put into quarantine, the first time this has happened in post-war European history. Three days later, on 11 March, the Italian government closed the entire country in a strict lock down.
But the day after the announcement of the first lock down, (Monday 9 March) Ursula von der Leyen went to the press room of the European Commission in Brussels to take stock of her first 100 days of work.
The Commission President first opted for a statement on the excellent work the EU institutions had done in the Greek border crisis with Turkey. Only after this was the virus mentioned. Shielding Europe from migrants was the main focus of her statement, while the virus which was already spreading with enormous pace, had to take second place. Von der Leyen later admitted that this was an error in an interview with the German newspaper Bild: “I think all of us who are not experts initially underestimated the virus”.
But the knowledge of the danger the pandemic posed was available in the EU all along. The European Centre for Disease Prevention and Control (ECDC), based in Stockholm, Sweden, started working with the Italian authorities in January at the start of the outbreak, and has published six Covid-19 risk assessments to date. But national governments have simply not listened to this peripheral agency, whose reports are not binding.
The ECDC is one of the two agencies created by the European Union to support (not replace) national governments on health-related issues. “It has existed since 2005, is based in Stockholm, and supports states by providing data, guidance and risk analysis on diseases and epidemics,” explains Massimo Gaudina, spokesman for the European Commission in Milan. “On this specific problem of the Coronavirus, it was activated immediately.”
On 22 January, “the members of the ECDC worked closely in Rome with the task force of the Italian Ministry of Health to give their level opinion to our authorities.”
But the contradictions continued: On 16 March, European Commission spokesman Eric Mamer said in an empty press room: “We recommend not to close Schengen (for the free movement of people within the EU), because the contagion is now in all countries, so closing borders is useless”.
But his words were not heard, and by late afternoon 12 countries (Germany, France, Spain, Austria, Hungary, among others) had already closed their borders to citizens’ movements.
European Commission spokesman Eric Mamer said in an empty press room: “We recommend not to close Schengen (for the free movement of people within the EU), because the contagion is now in all countries, so closing borders is useless”
“No export ban”
A few days earlier, French Commissioner Therry Breton had publicly reprimanded France and Germany for declaring an embargo on the export of masks and medical equipment. He was given assurances by Germany that the embargo, in place since March 4, would be lifted.
We decided to see for ourselves if this was the case. One of the members of Investigate Europe in Berlin tried to send masks to the Bergamo Hospital (near Milan) which is in the tragic situation of having no more intensive care beds or medical equipment (gloves, shoes, masks) to protect doctors. On trying to print an online stamp through the private company DHL, he received a warning: “ban on exporting medical devices abroad.”
The ban was finally lifted on Thursday, 19 March. For 15 days Germans (with some exceptions such as NGOs) have been blocked from sending basic equipment to Italy, a crucial time frame in such a fast developing crisis.
For 15 days Germans (with some exceptions such as NGOs) have been blocked from sending basic equipment to Italy, a crucial time frame in such a fast developing crisis
Last Thursday, the European Commission launched three urgent joint purchases of medical equipment and a RescEU operation (to store medical equipment in one EU country and then distribute it according to urgent need).
This is an urgent mechanism, without a call for tenders, without a contract, without a budget, in which the Commission calls companies directly and proposes an agreement. In order not to influence this very sensitive market, the Commission does not reveal the names of the companies that are negotiating with Brussels.
The first contract will be signed at the end of March for masks, medical equipment and ventilators.
By the time the EU has completed just this first step to combat Covid-19, some European countries will have already spent weeks in isolation and a “state of emergency.” While in Italy, each day brings more tragic news that hundreds more people have died from the virus.
Click here for Investigate Europe’s graph based on hourly updated data from Johns Hopkins University. This unique graph has been developed by Investigate Europe in order to aid research and a greater understanding of the situation we face in Europe.