Thread by @dgurdasani1

A quick look at what's happening in at least some parts of Western Europe where cases are surging.
Seems to be a combination of:
-school related surges due to lack of mitigations
-premature easing of restrictions
-over-reliance on vaccines, lack of multi-layered strategies
🧵

1) Austria: There's no doubt that children and young people are driving the pandemic. Austria removed masks from within classrooms when schools re-opened in Sept replacing this with a 3x wkly testing.

They also relaxed rules on quarantine, exempting vaccinated contacts & shortening quarantine with test and release on the 5th day for quarantine of contacts. There was supposed to be focus on better ventilation and air-purification but this doesn't seem to have materialised.

Unfortunately overall vaccination rates in Austria are still quite low, with a similar rate of vaccination to the UK. (67%). While mask requirements are in place on public transport, retail, cultural places (museums, theatres), they do not need to be used in other settings.

2) Netherlands:
Highest cases again in school age children. The Netherlands has some of the poorest mitigations in schools (possibly even comparable to the UK) and aerosol transmission doesn't seem to figure in the guidelines.

As in the UK, all contacts in schools are not required to quarantine unless there is a large outbreak. Exceptions also for vaccinated children. No masks, no social distancing in classrooms. And inadequate attention to ventilation.

73% of the whole pop, and 60% of 12-17 yr olds have got 2 doses. The higher coverage in secondary school children may explain why rates aren't higher.
Other measures: Until recently masks were only required on transport and in shops - now extended to other indoor places.

The Netherlands has had a coronapass (vaccine passport) which is meant to used for concerts, large gatherings and indoor dining, but it's not used extensively like in other countries (e.g. Italy, France), where use is very strict in many settings.

Denmark: Infection rates highest in 20-29 yr olds and 10-19 yr olds. On 10th Sept, Denmark removed all domestic coronavirus restrictions (including vaccine passports for large gatherings) because it had vaccinated 70% of it's population. The rest is (entirely predictable) history

Germany:
Vaccination in Germany has been slow, and is now similar to the UK (67%). Children were also offered the vaccination quite late. Germany has relied heavily on vaccine passports (2G or 3G restrictions). Mask requirements in some schools have been recently relaxed in Oct.

Cases seem high across the younger age groups, but generally high across all groups.

It's worth noting that unfortunately these rises in cases are translating to an increase in deaths. e.g. Germany is now seeing ~200 deaths/day, potentially also because their vaccination uptake in vulnerable age groups while high, is still lower than other countries like the UK.

Meanwhile cases are still low in Italy, France and Portugal, which have very strict measures in schools, higher vaccination rates (Portugal 88%, Spain 80%). All these countries have strict mask mandates, including in schools. Vaccination in children is reasonably high.

Vaccine passports are quite strict in Italy and France. e.g. Italy requires a green pass for workers even in workplaces. In France it's required in almost all spaces, including long-range transport. For 65+ soon booster doses will also be needed for the pass.

Mask wearing indoors has remained mandatory in these countries. France relaxed mask wearing on Oct. 4 no longer in French primary schools in areas with a low COVID-19 infection rate, but mask wearing remains in all other contexts in schools.

Unfortunately early rises are apparent in France, Italy and Portugal even though the case rates are still low. It's likely we will see rises over winter, unless stricter measures are taken to contain this, alongside the roll-out of the booster programme.

It's worth noting though that many countries are taking action at rates either below the UKs, or at rates that have just gone above the UKs, while we've been persisting with extremely high case rates for weeks if not months, while taking no action.

If you look at cumulative cases over time, the UK will be well ahead of many countries, because our daily cases have been around 500/million for months, while in other countries cases have been less than half ours for a long time, and action is being taken now as cases rise.

What can we learn from this?
-we cannot rely on a vaccine only strategy
-strict multilayered protections are needed with delta
-mitigations in schools are a vital part of this- and multilayered mitigations- masks, ventilation, quarantine, testing all important

-vaccine passports may have some value as long as they are used *along with* not *instead of* mitigations. These do not replace mitigations (masks, quarantine, ventilation)
Recent work shows secondary attack rates in household even among the vaccinated were 25% (38% in unvax)!

-high grade masks, and indoor mask wearing still vitally important
-vaccination of children important to contain spread
-high rates of vaccination important to protect the vulnerable (e.g. in Germany where vaccination lower than in UK in older people, deaths are rising high)

-booster roll-out will be an important measure to reduce severe disease, and transmission over winter.
I don't think there is any current 2 dose vaccination threshold that will allow a full easing of restriction of measures with delta.

Things may change with boosters, and broader vaccination for 5-11 year olds but that remains to be seen. But for now, it's important to keep strict multilayered measures in place alongside vaccine/booster roll-out to prevent deaths, protect health services & prevent lockdowns.

What stands out starkly when I read about Europe is the contrast with the UK where the govt seems to have given up on containing the pandemic, and is apathetic to what happens while HCWs sound the alarm. Other countries are responding to threat. While we do absolutely nothing.

Just want to add that I'm not an expert on what measures are in place in different countries- a lot of this is just research from govt websites & dashboards, so do correct me if I've got something wrong, or if things aren't the way I've understood.

Adding a bit more after replies on the thread.
Switzerland: Rapid exponential rises in infection - appear to be driven largely through school outbreaks but spreading to other age groups.
Only 65% of the population is fully vaccinated, with inequality across different regions.

Courtesy @Andreas49900169

Cases appear highest in 10-19 yr olds across all regions. Mask wearing in secondaries is patchy as it's the responsibility of the canton (regional authority).
kinder-schuetzen-jetzt.ch/corona-drehsch…

Masks are required on transport but don't seem to be mandated widely. Vaccine certificates are used for hospitality, leisure settings, and for large indoor gatherings. Asymptomatic rapid testing has been made paid for adults since Oct 11th.

Predictably the increase in cases is translating to an increase in hospitalisations and deaths, as cases predictably spread from children to older age groups. Unfortunately, there seems to be little appetite in govt to take early action, which could avert a crisis before winter.

There also seems to be significant vaccine hesitancy in Germany and Switzerland, which might also explain the lower vaccine uptake. I'm not sure why, but would be good to understand this better.

Ireland:
Ireland has very high infection rates, and is showing very rapid exponential rises. Restrictions have been eased in recent months, including allowing large gatherings, and return to work from late Sept.

Rates are very high in young people, followed lower down by school age children. Vaccine/recovery passports are used in some contexts- in pubs, nightclubs, cinemas - but there is no limit on size of gathering when these are used.

Masks are mandated on transport and in shops. 75% of the population are fully vaccinated.
Mask wearing in secondary but not primary schools. Overall, the largest number of outbreaks appear to have been recorded in workplaces and schools:
hpsc.ie/a-z/respirator…

There is no contract tracing for under 12s in school- which means contacts of cases no longer need to isolate (much like the UK). Vaccine rates are reasonably high in 10-19 yr olds (60% fully vaccinated), which may have helped limit transmission in schools to some extent.

Return to workplaces do appear to be contributing to spread. The govt appears to have postponed the final step of full opening on 22nd Oct (when nightclubs were planned to open and vaccine passports would no longer be needed for hospitality). Cases are rising rapidly.

It's unlikely that things will change unless stronger restrictions are put in place while vaccine/booster roll-out continues. Predictably, the number of deaths is increasing in line with cases, but of course to a much lower extent than before due to high levels of vaccination.

But exponential rises are unforgiving, and cases are rising very rapidly. Early action is needed to prevent further increases in cases, hospitalisations and deaths.