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Covid-19 hospitalisations in Europe still only a fraction of what they were at the pandemic’s peak

Coronavirus hospital admissions in Europe are still at only a fraction of the level they were in March and April, despite warnings from officials that a second wave is rolling across the continent.

Countries such as France, Spain and Belgium, which are now seeing hospital patient numbers rise again, are recording far fewer admissions than at the peak of the pandemic.

UK health officials including Health Secretary Matt Hancock have warned of a ‘second wave rolling across Europe’ and told Brits to act now to stop a resurgence here.

Data shows, however, that although hospital admissions are rising around Europe they are still low, despite thousands of cases being declared each day.

In France, for example, the weekly rate of admission to hospital is now two per 100,000, down from more than 35 at the peak of the outbreak in March. This is despite the country counting record numbers of infections in recent weeks.

And in Spain, where the admission rate was one per 100,000 in June, hospitalisations hit four per 100,000 at the end of August – still a far cry from the 50 per 100,000 being admitted in early April. 

Mr Hancock claimed today that Spain’s hospitalisations had ‘risen 15 times since mid-July’. But data from the European Centre for Disease Prevention and Control shows admissions rose by four times in that period.

Professor Paul Hunter, an epidemiologist from the University of East Anglia, told MailOnline that in the science community ‘nobody expects hospital admissions and death rates to stay flat for more than two weeks’.

But the kinds of people ending up in hospital is crucial for judging the severity of the outbreak — younger people are significantly less likely to die than the elderly.

Professor Hunter said: ‘Most people would expect that in two, three, four, weeks we’ll see an obvious increase in both in hospitalisations and deaths.’

Professor Keith Neal, an infectious diseases expert at the University of Nottingham, added that rising cases in Spain ‘hasn’t really been reflected in the hospitalisations’, so outbreaks may not follow the same trajectory that they did the first time round. 

Scientists agreed that cases and, as a result, hospitalisations and deaths, would rise when lockdown was lifted. The Government’s task now is to keep them under control.

Although poor testing during the worst of the outbreak meant not all cases were picked up, whereas most of them likely are now, experts have also said many infections now are among younger people who are less likely to get seriously ill. 

Coronavirus hospital admissions could start to rise in the UK in three weeks, data from other European countries suggests. When Spain, France and Belgium hit 18 cases per 100,000 (which the UK did on Sunday) they then saw admissions increase by up to four-fold

But European nations are only seeing a fraction of the weekly admissions they had during the peak of the pandemic, raising questions about whether it can really constitute a 'second wave'

 But European nations are only seeing a fraction of the weekly admissions they had during the peak of the pandemic, raising questions about whether it can really constitute a ‘second wave’

In late March, thousands of people were being admitted to French hospitals per day, and the weekly hospitalisation rate was 35 per 100,000. Now, about 800 people are being taken to hospitals across the Channel every week, giving it a rate of about two per 100,000

In late March, thousands of people were being admitted to French hospitals per day, and the weekly hospitalisation rate was 35 per 100,000. Now, about 800 people are being taken to hospitals across the Channel every week, giving it a rate of about two per 100,000

Spain had a Covid hospitalisation rate of four per 100,000 in late August, up from one per 100,000 a month prior. While admissions technically quadrupled, they were still miles away from the level seen in late March, when 50 per 100,000 people were being hospitalised a week

Spain had a Covid hospitalisation rate of four per 100,000 in late August, up from one per 100,000 a month prior. While admissions technically quadrupled, they were still miles away from the level seen in late March, when 50 per 100,000 people were being hospitalised a week

In August the hospitalisation rate in Belgium doubled from one two, which is not even a tenth of the worst levels seen in April (30 per 100,000)

In August the hospitalisation rate in Belgium doubled from one two, which is not even a tenth of the worst levels seen in April (30 per 100,000)

Cases per capita in Britain are now higher than 20 per 100,000 people, a level at which UK officials consider putting foreign countries on a quarantine list because they are deemed to have lost control of the virus. 

It comes after nearly 3,000 people tested positive for two days in a row on Sunday and Monday and marks a near threefold rise from last week’s rate of 12.8 per 100,000. 

British hospital admissions have remained stable, however, with just one in 100,000 people currently needing medical care for Covid-19 infection.

It represents a fraction of the approximately 32 people per 100,000 who were taken to hospital with the virus at the peak of the UK’s crisis in mid-April.

There are currently about 800 patients in British hospitals fighting Covid-19, compared to 20,000 six months ago.

Data from Spain, Belgium and France shows when case rates were at a similar level to the UK’s, admissions then spiked over the following three weeks.

HOW COVID-19 HOSPITAL ADMISSION RATES HAVE CHANGED 

UK

APRIL: 32 PER 100,000 

JUNE: 1 PER 100,000

SEPTEMBER: <1 PER 100,000

 

FRANCE

APRIL: 35 PER 100,000 

JUNE: 1 PER 100,000

SEPTEMBER: 2 PER 100,000

 

SPAIN

APRIL: 50 PER 100,000

JUNE: 1 PER 100,000

SEPTEMBER: 4 PER 100,000

  

BELGIUM 

APRIL: 30 PER 100,000

JUNE: 1 PER 100,000

SEPTEMBER: 2 PER 100,000

When the case rate goes above 20 per 100,000, it indicates that the reproduction ‘R’ rate has likely risen above one and the virus could grow exponentially.

The case rate rose above 18 per 100,000 in France three weeks ago in mid-August and, at the time, hospital rates were about one per 100,000 people, on par with the UK’s.

In the three weeks that have followed, admissions have doubled to two per 100,000, but they still remain just a fraction of the level seen at the peak, 

In late March, thousands of people were being admitted to French hospitals per day, and the weekly hospitalisation rate was 35 per 100,000.

Now, about 800 people are being taken to hospitals across the Channel every week and about 5,000 people in total are currently being treated.

Spain has seen the most dramatic rise in hospitalisations of any European country, data shows.

After successfully squashing the epidemic with one of the strictest lockdowns on the continent, Spain then saw hospitalisations creep up in mid July.

The country had a Covid hospitalisation rate of four per 100,000 in late August, up from one per 100,000 a month prior.

While admissions technically quadrupled, they were still miles below the level seen in late March, when 50 per 100,000 people were being hospitalised a week.

And crucially, the weekly rate of ICU admissions in Spain is now well below one per 100,000, whereas it peaked at five per 100,000 in April.

Most recent figures show that about 1,800 people are being taken to hospital with Covid every week, and 140 into ICU. 

This compares to the more-than-8,000 being admitted to general wards per week in late March and hundreds being rushed into intensive care daily.

Meanwhile in Belgium, hospital admissions followed a similar trajectory to those in Spain and France.

After coming right down to around one per 100,000 in June, they then started creeping up slightly in the weeks that followed.

By late August the rate had doubled to two, which is not even a tenth of the worst levels seen in April (30 per 100,000).

In total, 235 patients are currently in hospital, of which 52 are in the intensive care unit – but Belgium’s smaller population means its admission rate is still higher than the UK’s. 

Data from Public Health England shows that more than 40 per cent of coronavirus tests done in hospitals were positive in March and April but this has now plummeted and remains below 2.5 per cent in both hospitals and the community. This shows that there remains only a small proportion of people with the symptoms of coronavirus who actually have it

Data from Public Health England shows that more than 40 per cent of coronavirus tests done in hospitals were positive in March and April but this has now plummeted and remains below 2.5 per cent in both hospitals and the community. This shows that there remains only a small proportion of people with the symptoms of coronavirus who actually have it

But the number of people who receive a 'positive' result after getting tested under Pillar 2 has increased in recent weeks (blue line) to 2.3 per cent. It's also increased under Pillar 2 (red line), but is nowhere near the levels seen at the height of the pandemic

But the number of people who receive a ‘positive’ result after getting tested under Pillar 2 has increased in recent weeks (blue line) to 2.3 per cent. It’s also increased under Pillar 2 (red line), but is nowhere near the levels seen at the height of the pandemic

At the peak of Belgium’s crisis, in early April, hospitals were filled with 6,000 coronavirus patients every day. 

Keith Neal, emeritus professor in the epidemiology of infectious diseases at the University of Nottingham, told MailOnline: ‘I think the likelihood is that hospital rates go up in the coming weeks because even some young people will end up in hospital – because infections are quite high.

‘A small percentage of young people will be badly affected and need hospitalisations, and the threshold for admissions has probably been lowered compared to in April when only the sickest people were admitted.

HOW DOES TESTING AFFECT CASE NUMBERS?

If more people are being tested for Covid-19, this will show up in cases data, experts say. On the surface, it may look like a spike in infections, but broadly is not something to worry about because it just means more people are being diagnosed than before, when testing was limited to those in hospital.

Professor Kevin McConway, an emeritus professor of applied statistics, The Open University, said: ‘In the early stages of the pandemic, there was far less availability of testing in most countries than there now is. So one reason there are more cases is just that people have got better at looking for and finding them.’

And Dr Andrew Preston, a reader in microbial pathogenesis at University of Bath, said: Test more people, you will find more positives.

‘Initially, testing was restricted to those reporting symptoms, but this has eased and it’s now possible for a wider range of people to request tests.’ 

Testing capacity has rapidly increased over the course of the pandemic in order to reach more people. And this has caused a slight increase in the number of people getting a positive result – but not to levels that suggest prevalence of the virus is soaring. 

A significantly higher number of people are being tested since July – when diagnosed cases were at their lowest, NHS Test and Trace data shows.

Some 442,392 people were tested between 13 August and 19 August – an almost 20 per cent increase on the 355,597 tested between July 9 and 15.

However, the positive result rate only slightly went up, from 1.12 per cent to 1.4 per cent in the same period. This shows there no that many more people testing positive compared to negative in August than in July.

Other data from Public Health England reveals a similar trend over the course of the pandemic. 

Testing has increased vastly from no more than 13,000 tests per day at the start of April to around 150,000 in July. 

During the same period, positive test results in Pillar 2 – which are those outside of hospitals and care homes –  went drastically down from a peak of 5.2 per cent in May to 1.4 per cent in mid-July, showing that less people were testing positive for the coronavirus despite testing reaching thousands more people.

This figure has risen slightly over this month from 1.6 per cent to 2.1 per cent in the week ending August 23. But it’s a small increase when comparing with the 5 per cent seen in May. Testing has shot up to almost 200,000 per day this month.

Commenting on these figures, Dr Duncan Young, a professor of intensive care medicine at University of Oxford, told MailOnline: ‘It is therefore very possible that the increase in cases is mostly related to increased testing, but will a small additional effect from the increased prevalence.’

Despite this, it doesn’t necessarily rule out that transmission of the disease is, indeed, climbing. 

Scientists admit that the evident rise in cases will be driven by more transmission in the community as a result of easing lockdown restrictions. 

‘But the position isn’t like it was back in March and April,’ Professor McConway said. 

‘The level of cases [in the UK] remains a very long way below what it was at the peak of the pandemic here in March and April.

‘If we look to Spain, it has had very high rates in the north east and lower in rest of country – but it hasn’t really been reflected in the hospitalisations, when you compare them to April – which is a bit of a mystery.’ 

Professor Neal warned, though, that as more and more young people continue to test positive it is ‘only a matter of time’ before infections spill over into the older age groups, who are most likely to fall criticially unwell and die. 

Lawrence Young, a virologist and oncologist at the University of Warwick, said that although cases are on an upward trajectory, ‘it is becoming increasingly clear that people are less likely to die if they get Covid-19 now compared with earlier in the pandemic, at least in Europe’.

He told MailOnline: ‘Possible explanations include that a larger number of younger people (15-44 year olds) are now being infected compared to the first peak in cases in April and this group are less likely to get severe disease.

‘Two; there is now more effective treatment for patients with Covid-19 with far fewer needing mechanical ventilation; and three; less aggressive variants of SARS-CoV-2, particularly the D614G variant, are more prevalent – these remain very infectious but are less likely to cause severe disease.’

Professor Young added: ‘It was not unexpected that easing of lockdown and a return to more regular activities would result in more infections.

‘I guess the question is ‘when do local spikes in coronavirus infections become a second wave?’ 

There has been much confusion about whether the UK or any European country is actually experiencing a second wave. 

Scientists accused the UK Government of losing its grip on the disease as the highest number of cases since May were reported on Sunday – 2,988 – and a further 2,948 were added to the toll yesterday.

But even though case numbers are high, the percentage of people testing positive for the disease is still dramatically lower than it was at the peak of the crisis.

When the disease was out of control in March and April, rationed testing meant that at times more than 40 per cent of test results were positive, but this has since plummeted to just 2.3 per cent in the community and 0.5 per cent in hospitals.

That means around one in 50 people test positive in testing centres, while just one in 200 hospital patients who get swabbed actually have the disease. 

As more and more people get tested, the proportion of the tests that come back positive has stayed level, showing the current strategy is successfully finding more and more people who actually have the disease but that still only a small proportion of those suspected of having Covid-19 actually do. 

And numbers cannot be directly compared, either. Although there were days in April and March with similar numbers of cases to what the country is seeing now, only a fraction of people who were sick were getting tested. The true number of cases is now thought to have been in the hundreds of thousands at any given time during the peak at the end of March, while no more than 5,200 people were ever diagnosed in a day.

For this reason, 3,000 cases in a day now, when everyone who thinks they might be ill can get tested, cannot be compared like-for-like with 3,000 cases per day in April, when only severely ill people were tested and the real size of the epidemic was a mystery. 

Eminent statistician Sir David Spiegelhalter told MailOnline that infection rates could ‘no longer give a simple answer’ about the virus’s trajectory. He admitted that a huge increase in testing was skewing the figures upwards, but he noted that the proportion of people testing positive was also rising very slowly, suggesting a mixture of more swabs in high risk areas and ‘some increase in infection risk’ was driving the case rate up.

The current case rate – the number of people per 100,000 who test positive for Covid-19 – has risen since June and July as lockdown rules have loosened but is still only a fraction of what it was during the worst days of Britain’s crisis.

A surge in positive tests over the weekend pushed the rate to 21.3 per 100,000 for the past week, which is above Britain’s own holiday quarantine threshold. Once infections rise above 20 in 100,000 in other countries, the British Government begins seriously considering enforcing a quarantine period for holidaymakers returning from abroad. 

Scientists say it was always inevitable that more tests would yield more cases, and that there would be a rise in infections when rules were lifted.

Professor Kevin McConway, a statistician at The Open University, said: ‘In the early stages of the pandemic, there was far less availability of testing in most countries than there now is. So one reason there are more cases is just that people have got better at looking for and finding them.’ 

Read more at DailyMail.co.uk


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