Europe’s failure to cooperate on Covid-19 is a universal problem

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

Who’s tested?

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.

Tansy E. Hoskins
London’s financial district on 22 March 2020

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.

Equipment shortages

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.

Europe’s backwardness

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. 

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