As Covid-19 Cases Rise Across Europe, Hospitals Are Rushing to Prepare for Winter

Medical staff on a COVID-19 ward at a hospital in Liege, Belgium.

Europe’s second wave of the coronavirus pandemic is reviving the pressure on hospitals in the worst-hit cities, and forcing health-care systems around the continent to devise contingency plans that draw on the lessons of this spring’s deadly first wave.

Hospitals in Paris are stockpiling drugs and protective equipment to avoid a repeat of shortfalls that plagued them earlier this year. Hospitals across Spain have drawn up “elasticity plans” to increase the number of beds for Covid-19 patients as cases multiply. In Lombardy, the northern Italian region where Europe’s outbreak began in early 2020, the health-care system is preparing to move patients to where there is space for them, to prevent intensive-care units from being overwhelmed as happened in coronavirus hot spots this spring.

Infections are rising rapidly in most of Europe, but the pandemic’s second wave isn’t so far inflicting a death toll that is comparable with the continent’s lethal outbreaks in March and April. The rising wave of infections in Europe since the summer has affected many younger people, who are less likely to fall severely ill. The numbers partly reflect countries’ improved ability to detect the virus, whereas much of this spring’s outbreak wasn’t captured in official data. And more Covid-19 patients are getting early treatment, so fewer are ending up in intensive-care units.

But those mitigating factors are fading as the number of infected people spirals out of control, the virus is once again infecting older age groups, and Europe’s new systems for testing, tracing and isolating virus-carriers are struggling to keep up.

France reported 163 deaths from Covid-19 in hospitals on Tuesday, the highest toll since the country ended its lockdown in May. Daily deaths averaged more than 100 over the past week, up around 50% from the week before. Deaths are still much less frequent than in early April, when French hospitals were reporting around 400 to 600 a day.

In Italy, some 70 people a day are now dying. The country had managed to reduce daily Covid-19 deaths to single figures in August, but efforts to contain the virus since have unraveled. Current fatalities are still far from the levels of April, when daily deaths peaked at over 900.

In both countries, doctors fear the worst has yet to come.

“The first wave exhausted us, we are still emotionally tired. Just the idea of having to go through all of it again—I cannot imagine it,” said Daniel da Silva, head of the intensive-care unit at the Delafontaine hospital in the Paris suburb of Saint-Denis.

In the U.S., where infections have risen by about a third in the past three weeks while deaths have held relatively constant, hospitals are taking many of the same steps as their counterparts in Europe, including stockpiling Covid-19 drugs and protective equipment such as masks. Doctors and administrators have said they will be better prepared this time should new infections remain high, because of knowledge gained about how the virus spreads and which drugs have shown the best results.

The French government pledged this summer to boost investment in the national health-care system, as well as raising staffing and salaries in hospitals. But hospital capacity hasn’t increased significantly in recent months. In Saint-Denis, half of the intensive-care beds are already occupied by Covid-19 patients, and the hospital recently canceled many nonurgent procedures.

Doctors at Saint-Denis say they understand the virus better now than in early 2020, but worry that they still lack the staff and resources to handle the expected upsurge of cases. “It’s frustrating, because we know how to treat patients better now, but we won’t be able to do it,” said Dr. François Lhote, who heads the hospital’s Covid-19 unit.

A hospital in Brescia, Italy, on March 13. Provincial cities bore the brunt of the first Covid-19 wave.PHOTO: FRANCESCA VOLPI/BLOOMBERG NEWS

In the Lombardy region around Milan, health experts this week predicted that the number of coronavirus patients in intensive-care units would rise to 600 by the end of October, from around 120 currently. That forecast prompted Lombardy’s authorities to impose an 11 p.m. curfew, as well as other restrictions that go beyond Italy’s national virus restriction measures.

Provincial cities such as Bergamo that bore the brunt of the first wave are seeing fewer infections so far this fall. “The situation… is under control at the moment, but we are on high alert because of the surge in Milan,” said Carlo Alberto Tersalvi, medical director of the public health system in Bergamo. “We are reorganizing our hospitals… so we can better help Milan.”

The city might be taking a lighter hit this time because so many people were infected during the first wave and now have some level of immunity, Dr. Tersalvi said. In Nembro, a small town just outside Bergamo where 1.3% of the population died in March, half of the residents who were tested in July had antibodies for the virus.

In Madrid, one of the hot spots of Europe’s second wave, pressures are already visible in the hospitals. Covid-19 patients occupy 20% of all hospital beds in the Madrid region, and 39% of intensive-care places.

The city’s Gregorio Marañón hospital, the biggest in Spain with 1,150 beds, had to send patients to a nearby hotel as well as an army-built field hospital to cope with this spring’s first wave. “What we lived in those moments is difficult to imagine,” said Javier Muñoz, the hospital’s medical director. But, he said, the health system demonstrated its flexibility and is now better prepared for the next onslaught.

The hospital has stockpiled protective equipment for up to four months at maximum capacity, Mr. Muñoz said. Health workers have received training in new procedures as well as support for their mental health.

England’s northwest is another of Europe’s pressure points. Intensive-care beds in Liverpool, the worst-affected city, have been up to 95% occupied in recent days.

Part of the problem is that many beds have been filled by patients who had postponed surgery earlier in the year during the pandemic’s first wave, said Tristan Cope, medical director at Liverpool University Hospitals. “This time, hospitals were at normal or high occupancy levels, so the Covid-19 admissions are on top of that,” he said. Nonurgent elective surgery has already been stopped in many locations as hospitals focus their resources on maintaining cancer treatments and other urgent surgery for as long as possible.

The Clinico San Carlos hospital on Oct. 19 in Madrid, one of the hot spots of Europe’s second wave.PHOTO: JUAN MEDINA/REUTERS

Hospital pressures could soon reach critical levels in Central European countries such as Poland, which avoided the worst of Europe’s first wave but are now struggling with exponentially rising contagion. Polish authorities have instructed some hospitals to remove non-coronavirus patients at short notice and install the necessary controls to safely treat highly infectious virus cases.

On Tuesday, a small hospital in the town of Czarnków was still constructing the walls for a new Covid-19 ward to house 15 beds, the third Covid-19 ward it had built in just over a week. Outside, ambulances holding 15 patients were waiting by the entrance, said Director Bożena Sadowska.

Some doctors in Poland have walked off the job, complaining of too little support. At the Czerniakowski Hospital in Warsaw, staff received a government order on Oct. 9: It asked them to be ready to receive dozens of Covid-19 patients starting Oct. 8. “Where should we evacuate the sick who are currently occupying these beds?” said Tomasz Siegel, who said he resigned as the hospital’s medical director after a week. “Who will take care of patients who don’t have Covid, but have just been stripped of the last available places in hospitals?”

James Hookway and Natalia Ojewska contributed to this article.