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https://www.washingtonpost.com/coronavirus/

Coronavirus pandemic

Georg Hochmuth/Pool

A team of firefighters and volunteers turned a 15,000-square-foot hall in a convention center in Vienna into an 880-bed <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> hospital over the course of a weekend.

Soldiers in Germany, France and Spain have been deployed to help build similar temporary facilities for thousands of patients. Across Europe, tens of thousands of nurses and doctors are being graduated early or called back from retirement.

As coronavirus cases surge in the biggest infectious disease crisis to hit European hospitals in a century, officials and health-care workers are scrambling to keep national health systems above water.

The grim harbinger of how bad things could get lies right in Europe’s midst, as <a href="https://www.washingtonpost.com/world/europe/italy-coronavirus-deaths/2020/03/20/4a385552-6a20-11ea-b199-3a9799c54512_story.html" title="www.washingtonpost.com">Italy’s death toll leaps</a> by hundreds each day. Doctors there are struggling to keep more than 2,800 people in intensive care alive, an effort that requires staff, beds and a constant supply of protective equipment.

[Much of Europe is now on lockdown. But can authorities actually enforce the rules?]

But countries are competing against one another for medical supplies on an international market that has been sucked dry. To address shortages, Spanish clothes manufacturers are turning their lines to making medical masks, and Parisian perfumers are producing hand sanitizer in an effort that <a href="https://www.washingtonpost.com/world/europe/germany-coronavirus-merkel/2020/03/18/9f34f2aa-6880-11ea-b199-3a9799c54512_story.html" title="www.washingtonpost.com">harks back to wartime</a>.

As the number of critically ill rises, analysts expect even the continent’s best prepared health systems to be stretched to their limits.

“There’s been nothing on this scale in the postwar period,” said Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine. “The problem is that health systems, we talk about them as adaptive, but they have the capacity to fall over. They can expand so much, but at some point, the whole thing collapses.”

Miguel Riopa

Some countries began preparations earlier than others, but by now, the scale of the crisis has set in across the continent. In Britain, which was particularly slow to act, government pronouncements are now accompanied by a palpable sense of panic and ever more desperate appeals. The mood in France has shifted from an initial nonchalance to heightened anxiety, as President Emmanuel Macron has imposed an increasingly strict lockdown period of 15 days, which officials have suggested may be extended.

[How coronavirus overwhelmed Italy, with more than 4,000 deaths in one month]

Spain, which has suffered Europe’s second-worst outbreak  after Italy, opened a coronavirus hospital in a 359-room hotel last week. Authorities say they expect to convert as many as 4,000 hotel beds to hospital beds and add 5,500 more in a convention center.

In the race to respond to the virus, countries in Europe do not begin on an even footing. Germany has 6 acute care beds per 1,000 people, according to Organization for Economic Cooperation and Development data, nearly three times as many as in Britain, with about 2.1. France has 3.1, according to the OECD; Spain has 2.4.

The number of acute care beds includes all those for curative purposes. The organization does not give data for the number of intensive care beds, but Germany has 28,000, around 25,000 of which are equipped with ventilators. Berlin has ordered 10,000 more from a German medical manufacturer. Britain’s National Health Service has only 8,000. The government last week asked <a href="https://www.washingtonpost.com/world/europe/car-manufacturers-ventilators/2020/03/19/2d1c9c22-6920-11ea-b199-3a9799c54512_story.html" title="www.washingtonpost.com">automakers such as Jaguar to try to quickly manufacturer them</a>. The NHS wants 20,000 to 30,000 more.

But the exponential growth in cases in many countries is concerning to even the best prepared. German Health Minister Jens Spahn is offering financial bonuses for hospitals to add intensive care beds. In a letter to hospitals this month, he asked managers to free up beds by postponing nonessential surgery “now” — using boldface type.

Reinhard Busse, head of the department of health-care management at the Berlin University of Technology, predicted pressure on the German health system would grow.

“Clearly when the number of ICU patients also goes up exponentially, even though we have more beds than anywhere else, obviously there will be a shortage,” he said.

[U.K. asks Rolls-Royce and Jaguar to make ventilators in wartime-like effort]

Some analysts say one advantage Europe has is centralized, socialized systems that may be easier to reorganize and adapt to changing needs. By comparison, some U.S. hospitals have said they <a href="https://www.washingtonpost.com/national/health-science/hospitals-warn-of-shortages-closures-without-emergency-aid/2020/03/21/6ba3e9d8-6b90-11ea-9923-57073adce27c_story.html" target="_self" type="[object Object]">might have to close</a> if they do not receive financial relief.

Spain and Britain have announced they will take over private hospitals. Britain’s deal to take over private health care adds 8,000 hospital beds, 1,200 ventilators and more than 250 operating-theater and ICU beds. It also adds almost 20,000 health-care professionals, including 10,000 nurses and 700 doctors, who will pivot to providing care for coronavirus patients.

In Spain, the deal adds 1,172 intensive care beds, according to the Ministry of Health. Public hospitals have 4,627.

France, which has about 5,000 intensive care beds with ventilators for its 66 million people, is trying to secure more through a jointly negotiated European Union initiative.

LVMH/AFP/Getty Images

Just getting basic medical supplies such as masks and gloves remains a challenge. Some 4,000 health-care workers in Britain sent an open letter to Prime Minister Boris Johnson decrying an “unacceptable shortage” of medical equipment. An Italian doctor who died after developing covid-19, the disease the virus causes, said <a href="https://www.washingtonpost.com/nation/2020/03/20/coronavirus-italy-doctor-dies/" target="_self" type="[object Object]">in a television interview</a> that doctors in his hospital had to work without gloves.

A glance at public tenders is a window into the desperation. The French Interior Ministry is offering 15 million euros for 1.5 million liters of hand-sanitizing gel, one tender shows. Italy’s region of Veneto, one of the first struck by the coronavirus, wants 250,000 liters of the coveted liquid, 50,000 testing swabs and a half-million face masks. Luxembourg is looking for 61,000 respiratory masks with “extreme urgency.”

Wartime-like efforts to make up shortages have brought surges in national solidarity. But the panic over the coronavirus also, initially at least, brought an air of everyone for themselves to the continent.

Italy has complained that its European brethren have been slow to step in to assist, forcing it to turn to China instead.

“Italy needs tens of millions of face masks,” Italian Foreign Minister Luigi Di Maio said.

“One-hundred-million face masks will be arriving from China,” he said. “Should other countries want to help us out in this war, they’re welcome to. Our country is on the front lines.”

[As the world retreats due to coronavirus, NATO is still holding meetings]

Central European and Balkan states have also turned to Beijing for help, and on Saturday, Serbian President Aleksandar Vucic tweeted his appreciation.

“Thank you very much to my brother, President Xi Jinping, the Communist Party of China and the Chinese people. Long live our steel friendship!” he wrote.

Elias Mossialos, head of the Department of Health Policy at the London School of Economics, predicted the number of countries “knocking on China’s door” will give Beijing’s soft power a boost.

“There is no European solidarity,” he said.

In an effort to build some, European Commission President Ursula von der Leyen last week announced a common European medical reserve that will include a stockpile of ventilators, protective equipment and other items. She had criticized earlier bans on medical exports from France and Germany.

In a glimmer of European collaboration, hospitals in France’s Alsace region have begun transferring some critically ill patients across the border to Germany, where the state of Baden-Württemberg offered assistance.

Ina Fassbender

Whatever the preparations in hospitals, analysts say, a key in how well health services cope will be how effectively earlier measures on distancing and containment have been in “flattening the curve,” or slowing the spread of infection to avoid overwhelming the systems. There are early indications that levels of intensive care admissions in Germany will be lower than in Italy, Busse of the Berlin University of Technology said, but data is incomplete and affected by varying levels of testing.

Germany, where the death rate is notably lower than elsewhere, could be seeing the benefit of tracking and containing its early clusters, epidemiologists say. But it was slower than some countries to ban mass events and has refrained from a total lockdown. On Sunday, it limited nonfamily social gatherings to two people.

[Locked down like the rest of Italy, a poet draws his country close — by phone]

Health authorities in Austria, which enacted tighter restrictions earlier, said they were beginning to see the impact as the growth rate of new infections in the country slows. Britain, meanwhile, has held back from implementing the stricter measures seen elsewhere.

“The question is now, is it too late for the U.K.?” Mossialos said. “Now they are panicking, big time.”

A group of British scientists reported that it would take just 2.5 percent of the British population to be infected to cause a bed shortage in most counties. If infections reach 10 percent, the group said, the country would see “<a href="https://osf.io/g8s96/" target="_self" type="[object Object]">hospital deserts</a>.”

One Spanish doctor, who spoke on the condition of anonymity because he did not have permission to talk to the media, lamented that his country had wasted valuable time. He said his hospital now looked like a “wartime clinic.”

“It seems we didn’t learn very much from what happened in China or Italy,” he said.

<email>loveday.morris@washpost.com</email>

<email>william.booth@washpost.com</email>

Morris and Beck reported from Berlin. Booth reported from London. Pamela Rolfe in Madrid, James McCauley in Paris, Stefano Pitrelli in Rome, Karla Adam in London and Quentin Aries in Brussels contributed to this report.


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Exeter University, BA in Middle Eastern studies with Arabic

Loveday Morris is The Washington Post's Berlin bureau chief. She was previously based in Jerusalem, Baghdad and Beirut for The Post.

Loveday Morris

Overseas Press Club, Kim Wall Award, "Occupied," 2018

 Overseas Press Club, Robert Spiers Benjamn Award Citation, "Mexico's Middle Class," 2012  

Overseas Press Club, Robert Spiers Benjamin Award Citation, "Mexico at War," 2010

Finalist, Pulitzer Prize, Breaking News, "Fort Hood Shooting," 2010

University of Texas at Austin, literature 

Massachusetts Institute of Technology, Vannevar Bush Fellow

William Booth is The Washington Post’s London bureau chief. He was previously bureau chief in Jerusalem, Mexico City, Los Angeles and Miami.

William Booth

Fulbright Berlin Capital Program, 2016

DAAD (German Academic Exchange Services) Scholarship, 2009

University of California at Berkeley, BA in philosophy

Luisa Beck is a reporter in The Washington Post’s Berlin bureau. Before joining The Post, she made radio stories, audio walks and podcasts for NPR, the Center for Investigative Reporting and museums in the San Francisco Bay area.

Luisa Beck

The Washington Post

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