Central Europe bends under strain of coronavirus – POLITICO

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WARSAW – Central Europe was barely affected in the first wave of the coronavirus pandemic, but it is much worse now – something that threatens to overwhelm the medical systems of many of the EU’s poorest member countries.

In the spring, countries like Slovakia, the Czech Republic, Hungary, Poland and others in the region severely clamped down on borders – closing borders, locking up their populations, closing schools, restaurants, bars and the most stores. As a result, infections were significantly lower than in Western Europe. Slovakia has even been compared to New Zealand as an example for the rest of the world to follow.

But a smoother summer combined with a reopening of schools, along with mixed messages from politicians, helped spark a huge rise in infections.

“I think we are paying for our behavior in August: parties, trips to Croatia and Balaton, preschool camps, etc.” said a Hungarian doctor, who spoke on condition of anonymity.

The leader is the Czech Republic, which has the highest infection rate in the EU, according to the European Center for Disease Prevention and Control. Throughout the summer, it has hovered around 200 cases per day, which started to increase in September and soared in October, reaching a daily high of 8,618 on Friday.

The virus is putting pressure on health systems that have long struggled with under-resourcing and high levels of nosocomial infections.

The rest of Central Europe follows a parallel trajectory. Slovakia has 10 times more daily cases than at the end of the summer, and Poland is increasing at a similar rate, reaching a record 5,300 new cases on Saturday. Hungary fell from just nine new cases on August 2 to 1,374 on Saturday, while Romania’s cases tripled from the summer to 3,517 on Friday.

Death rates, as well as hospitalizations and the number of patients on ventilators, are also increasing sharply. This is a problem for a region – with the exception of the Czech Republic – where health expenditure and the number of doctors and nurses are much lower than Western European levels.

“It doesn’t look good,” said Konstanty Szułdrzyński, senior doctor at the University Hospital in Krakow. “We still have relatively low death rates, but we have a problem. If it starts to increase, we have no tools to deal with it. ”

He predicted that Poland would be able to handle the pandemic if new infections persisted around 2,000 per day – less than half the rate recorded in recent days.

The virus is putting pressure on health systems that have long struggled with under-resourcing and high levels of nosocomial infections.

Hungary enjoys high-quality medical education – with foreign students flocking to its medical universities – but many Hungarian doctors are leaving for better-paying jobs in Western Europe. Doctors and patients often complain about poor conditions in Hungarian hospitals – the pandemic exacerbating concerns.

It’s similar in other countries. Although higher salaries now keep Polish doctors at home, in previous years many had left to work for better pay, and these gaps were never filled. It’s even worse for nurses.

Poland has only 237 doctors per 100,000 inhabitants, the lowest level in the EU, according to Eurostat. Hungary has 338 and Slovakia 352, while Germany has 431.

As for nurses, Romania has only 73.9 per 100,000 inhabitants, Poland 510 and Germany 1,106.

Health spending is also much lower as a percentage of GDP. In 2017, Romania spent just 5.2% of its GDP on health, the lowest in the EU, while Poland spent 6.5% and Hungary 6.9%, according to data of the EU. The Czech Republic spent 7.2%, which is closer to the EU average of 9.9% of GDP.

This means that central European medical systems lack the capacity to cope with a long-lasting emergency like COVID-19.

Health spending is also much lower as a percentage of GDP. In 2017, Romania spent only 5.2% of its GDP on health | Vincenzo Pinto / AFP via Getty Images

“Our system was on the verge of effectiveness even before the pandemic,” Szułdrzyński said, pointing to long wait times and worse outcomes for diseases like cancer. “If we devote all of our resources and time to the coronavirus, an even bigger problem is that the system will stop healing all other people. ”

The trend here also looks bleak. This weekend, Poland Noted 4,924 hospital beds occupied by patients with COVID-19 – out of 11,000 available – and 383 ventilators used, nearly double a week earlier.

Test time

Across the region, there are complaints that authorities are not performing enough tests.

Many doctors and ordinary Hungarians say the actual numbers are likely to be much higher, as authorities maintain narrow definitions of who is eligible for testing through the national health system.

“A lot of other tests should be done,” said Ferenc Falus, who served as Hungary’s chief medical officer between 2007 and 2010.

Experts say that while there are many facilities in Hungary where testing could be processed, relatively few labs have been licensed to handle coronavirus testing. And while Hungarian authorities have indicated in recent days that they are working to build testing capacity, it is still unclear how many more tests will be available.

Politicians are partly responsible for the explosion of new cases, as just a few weeks ago they wanted to reduce coronavirus fears.

The very high level of positive results indicates that too few tests are being performed. In Poland on Saturday, 18% of tests were positive. In contrast, the World Health Organization has advised governments that the percentage of positive test results should be less than 5%.

János Mucsi, a Hungarian pulmonologist who has treated patients with coronavirus, said the lack of sufficient testing threatened the stability of the healthcare system.

“We are doing enough tests when 95% of the tests done are negative, this is not the case now, that means we are not doing enough tests,” Mucsi said. “We cannot trace those who infect – the super-spreaders – and that way many will be infected, others will end up in hospital, more and more will die, the health care system will be exhausted.

Policy responses

Governments are starting to react.

Poland on Saturday declared the entire country a “yellow zone”, with some areas “red” for a very high risk. Everyone must now wear masks when going out and the opening hours of bars and restaurants have been limited.

The Czech Republic declared a 30-day state of emergency on October 1; As of Monday, a series of new restrictions come into effect, including the end of live teaching at universities and limits on fitness centers, restaurants, bars and cultural events. Slovakia is deploying its army to help in hospitals and plans to quarantine areas with high infection rates.

The Hungarian government this month announced salary increases for doctors, while the country’s borders – with some exemptions – remain closed to foreigners.

Orbán (and some opposition politicians) often did not wear masks in public, but that has changed in recent weeks | Jacek Szydlowski / Epa

“If we unite, we will succeed again without having to shut down the country,” Hungarian Prime Minister Viktor Orbán said in a television interview on Wednesday evening.

“Our strategic objective is first of all to reduce the number of deaths and to take care of the elderly,” Polish Prime Minister Mateusz Morawiecki said on Saturday.

Politicians are partly responsible for the explosion of new cases, as just a few weeks ago they wanted to reduce fears of the coronavirus.

In July, Morawiecki said the pandemic was “on the decline”. Jarosław Kaczyński, leader of the ruling Law and Justice Party, did not wear a mask during much of last week’s ceremony to swear in a new government. The new Minister of Education, Przemysław Czarnek, visited his grandmother in hospital last week. He has since been diagnosed with COVID-19 and the hospital is suffering from a major outbreak of the virus.

Orbán (and some opposition politicians) often did not wear masks in public, but that has changed in recent weeks. There was also controversy when Foreign Minister Péter Szijjártó was photographed on a yacht in Croatia after Orbán asked people to stay in Hungary for the summer.

“The signal from the summit is not good,” Szułdrzynski said.

This article is part of POLITICOPremium Police Service: Pro Health Care. Whether it’s drug prices, EMAs, vaccines, pharmaceuticals and more, our specialist journalists keep you up to date on the topics driving the health policy agenda. E-mail [email protected] for a free trial.



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