A significant surge in COVID-19 cases is currently taking place across Europe, something that Hans Kluge, WHO Regional Director for Europe, described as the “fall/winter surge” in a press briefing Thursday. Europe has reported its highest weekly number of COVID-19 cases since the beginning of the pandemic, with nearly 700,000 cases. 

Even though mortality rates remain lower, in comparison to those seen in the first wave in April, the unprecedented number of new infections mean that the death toll is mounting daily as well. With 1,000 deaths per day, COVID-19 has now become the fifth leading cause of death in WHO’s European Region, which in fact cuts a broad swathe, including the former Soviet Union republics, Turkey and Israel. 

“Projections from reliable epidemiological models are not optimistic,” Kluge said. “These models indicate that prolonged relaxing policies [of restrictions] could propel – by January 2021 – daily mortality at levels 4 to 5 times higher than what we recorded in April.”

Stronger national and local restrictions on large gatherings and social distancing measures are needed to stave off the worst consequences, he said. Measures need to anticipate the worsening situation and flatten the course of the virus – although they don’t necessarily need to include lockdowns, he added.

“Today, lockdown means a very different thing. It means a stepwise escalation of proportionate, targeted and time-limited measures. Measures in which all of us are engaged both as individuals and as a society together in order to minimize collateral damage to our health, our economy and our society,” said Kluge. 

Indeed, most European countries have sought to take a more incremental approach. Spain,  Germany and the United Kingdom have drastically increased their restrictions on commercial and leisure activities, and public gatherings, as well as imposing curfews or partial closures on “red” cities or regions. Israel, however, imposed a total, nation-wide lockdown three weeks ago, after racking up some of the highest daily rates of new infections in the world; it is now exploring ways to relax restrictions gradually and selectively. 

Against the patchwork of policies being adopted, Ursula von der Leyen, president of the European Commission, said on Thursday that the European Union needs to establish common rules on quarantining and testing, for suspected cases as well as travel. 

Speaking at the start of a two-day meeting of EU leaders, “I think it is also necessary that there will be an agreement on the time of quarantine or the necessity of testing. Here I call on the stakeholders that we also find an agreement. This is important.” 

United States & India Both Facing COVID Surges In Rural Areas 

Meanwhile, in the United States, the country was seeing a ‘third wave’ in cases, with predominantly rural states now reporting some of the country’s highest daily number of new cases, per capita. The surges have been particularly striking in midwestern and western states such as North Dakota, Montana, Wyoming, Idaho, and Alaska. 

“We, as North Dakotans, find ourselves in the middle of a regional Covid storm,” said Governor Doug Burgum. 

“We are starting from a much higher plateau than we were before the summer wave,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University. “It concerns me that we might see even more cases during the next peak than we did during the summer.”

A similar trend of rising infection rates in less populous areas has also been reported in India. The proportion of cases occurring in India’s rural areas increased from 15 percent to 24 percent between July to August, Indian media reported.  In Mahara­shtra state, five districts recorded a rise of 400 percent in August, as compared to 28 percent in Mumbai, India’s largest city.

The common thread linking these trends on opposite sides of the earth may be that COVID-19 mask and social distancing rules are being ignored, experts said. That may be deliberate defiance, particularly in parts of the US where such measures have become highly politicized. Or it may simply be a result of the economic costs of quarantining and lack of awareness, particularly in the case of India. 

In India, most public awareness campaigns have taken place in urban areas, with few strategies targeting rural areas, as a result. Many people in rural Indian towns also may believe the government is exaggerating the severity of the pandemic. An additional issue is the limited capacity of health systems in rural areas, experts say.

“Covid is spreading to smaller towns and villages and this is truly worrying,” K. Srinath Reddy, president of the Public Health Foundation of India, was quoted as saying in India Today. “A rural pandemic will be very different and far more challenging than an urban one,” rural India has just 3.2 hospital beds per 10,000 people. Although it represents 65 percent of the nation’s population, only 37 percent of doctors work in rural areas.

India also is catching up with the US in terms of the total number of COVID-19 cases, with 7.3 million cases and 7.9 million cases respectively. The US, however, remains the worldwide leader in numbers of cases as well as in deaths from COVID-19.

Open Letter in The Lancet Warns of “Dangerous Fallacy” of Herd Immunity 

Countering the COVID-skeptics, an open letter published in The Lancet on Thursday, signed by over 80 experts and specialists, called out the herd immunity approach of allowing large, uncontrolled outbreaks in low-risk populations in an attempt to develop infection acquired population immunity as a “dangerous fallacy.” 

“Uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population,” say the authors, outlining measures to mitigate the transmission of SARS-CoV2 and the need for multi-pronged population-level strategies.

With increasing cases across many countries worldwide, effective measures to find, test, trace, and isolate COVID-19 cases are critical and have been successful in several countries, including New Zealand, Japan, and Vietnam. 

“Controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months,” said the authors. 

Image Credits: Flickr – Trinity Care Foundation, Flickr – Trinity Care Foundation, Johns Hopkins, Flickr – The National Guard, Flickr – Trinity Care Foundation.