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Central Europe Buckles Under Coronavirus Strain

The region has fewer doctors and spends less on health than Western Europe.

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

In the spring, countries like Slovakia, the Czech Republic, Hungary, Poland and others in the region clamped down hard and fast — slamming shut borders, locking up their populations, shutting down schools, restaurants, bars and most shops. As a result, infections were significantly lower than in Western Europe. Slovakia was even compared with New Zealand as an example for the rest of the world to follow.

But a looser summer combined with a reopening of schools, plus some mixed messaging from politicians, has helped spark a huge surge in infections.

“I think we pay for our behavior in August: Parties, traveling to Croatia and the Balaton, pre-school camps, etc.,” said one Hungarian doctor, who spoke on condition of anonymity.

The leader is the Czech Republic, which has the highest rate of infections in the EU, according to the European Centre for Disease Prevention and Control. Through the summer, it oscillated around 200 cases a day, which started to rise in September and rocketed higher in October, hitting a daily record of 8,618 on Friday.

The virus has put pressure on health systems that have long experienced problems with a lack of resources and high levels of hospital-acquired infections.

The rest of Central Europe is on a parallel trajectory. Slovakia has 10 times more daily cases than in the late summer, and Poland is rising at a similar rate, hitting a record of 5,300 new cases on Saturday. Hungary has gone from only nine new cases on August 2 to 1,374 on Saturday, while Romania’s cases have tripled from the summer to 3,517 on Friday.

Death rates, as well as hospitalizations and the number of patients on respirators, are rising sharply as well. That’s a problem for a region — with the exception of the Czech Republic — where health care spending, and the number of doctors and nurses, is well below levels in Western Europe.

“This isn’t looking good,” said Konstanty Szułdrzyński, a senior doctor at the University Hospital in Kraków. “We still have relatively low death rates, but we do have a problem. If this starts to grow, we have no tool to handle this.”

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

The virus has put pressure on health systems that have long experienced problems with a lack of resources and high levels of hospital-acquired infections.

Hungary boasts high-quality medical education — with foreign students flocking to its medical universities — but many Hungarian doctors leave for higher-paid jobs in Western Europe. Both doctors and patients often complain about poor conditions in Hungarian hospitals — with the pandemic exacerbating worries.

It’s similar in other countries. Although higher salaries now keep Polish doctors at home, in previous years vast numbers left to work for better pay, and those gaps have never been filled. It’s even worse for nurses.

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

When it comes to nurses, Romania has only 73.9 per 100,000 people, and Poland has 510 while Germany has 1,106.

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

That means medical systems in Central Europe don’t have the capacity to deal with a long-running emergency like COVID-19.

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

The trend here looks grim as well. This weekend, Poland noted 4,924 hospital beds occupied by COVID-19 patients — out of 11,000 available – and 383 respirators in use, almost double from a week earlier.

Testing times

Across the region, there are complaints that authorities aren’t conducting nearly enough tests.

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

“Many more 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 tests could be processed, relatively few laboratories have been given licenses to handle coronavirus tests. And while Hungarian authorities have indicated over the past days that they are working to boost testing capacity, it remains unclear how many extra tests will be made available.

Politicians are getting some of the blame for the explosion in new cases because just a few weeks ago they were keen to lower coronavirus fears.

An indication that too little testing is being done is the very high level of positive results. In Poland on Saturday, 18 percent of tests were positive. By contrast, the World Health Organization has advised governments that the percent of positive test results should be below 5 percent.

János Mucsi, a Hungarian pulmonologist who has been seeing coronavirus patients, said that the lack of sufficient testing is threatening the stability of the health system.

“We are doing enough testing when 95 percent of the tests conducted are negative, that’s not the case now, that means we are not doing enough tests,” Mucsi said. “We can’t trace those who are infecting — the superspreaders — and that way many will get infected, more will end up in hospital, more and more will die, the health care system will be exhausted.”

Political responses

Governments are starting to react.

Poland on Saturday declared the whole country a “yellow zone,” with some regions “red” for very high risk. Everyone now has to wear masks when going outside, and the hours of bars and restaurants have been restricted.

The Czech Republic declared a 30-day state of emergency on October 1; as of Monday, a raft of new restrictions go into effect including ending live teaching at universities, and limits on fitness centers, restaurants, bars and cultural events. Slovakia is deploying its army to help out at hospitals and is considering quarantining regions with high rates of infections.

The Hungarian government this month announced pay raises for doctors, while the country’s borders — with some exemptions — remain closed to foreigners.

“If we pull together, then together we will succeed again without having to shut down the country,” Hungarian Prime Minister Viktor Orbán said in a television interview late Wednesday.

“Our strategic goal is to first cut the number of deaths and care for seniors,” Polish Prime Minister Mateusz Morawiecki said on Saturday.

Politicians are getting some of the blame for the explosion in new cases because just a few weeks ago they were keen to lower coronavirus fears.

In July, Morawiecki said the pandemic was “in retreat.” Jarosław Kaczyński, leader of the ruling Law and Justice party, didn’t wear a mask during much of last week’s ceremony swearing in a new government. The new education minister, Przemysław Czarnek, visited his grandmother in hospital last week. He has since been diagnosed with COVID-19, and the hospital is suffering through a large outbreak of the virus.

Orbán (and some opposition politicians) often didn’t wear masks in public, but that has changed in recent weeks. There was also a 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 top is not good,” said Szułdrzynski.


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