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Medical staffers take swabs as they test for COVID-19 at a drive-through clinic in Rome, on Oct. 13, 2020.Cecilia Fabiano/The Associated Press

Cases of COVID-19 are climbing across Europe, but some scientists and doctors are hesitant to call it a full-blown second wave even though a few countries are seeing record or near-record daily infections.

The reason: The fatality rates – so far – are not nearly as high as they were during the peak of the pandemic in March and April, when most of the continent was in tight lockdown for fear that hundreds of thousands, even millions, of people would lose their lives to the deadly novel coronavirus.

“I’m hesitant to call it a second wave,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. “A better term might be resurgence.”

There is no doubt a resurgence is under way. In June and into July, new cases in the big European countries fell to several hundred a day or less. Since then, the caseloads have steadily increased, triggering a new round of restrictions ranging from mandatory mask use once you leave the house, as the Italian government has ordered, to the partial lockdowns of Madrid and other cities where the health authorities are trying to keep the hospitals from being overwhelmed with COVID-19 patients.

Italy on Friday topped 5,000 new cases for the first time since March. They rose to 5,901 on Tuesday. Italy has been praised by the World Health Organization for keeping its new caseload relatively low, though the rising numbers suggest the country still faces a formidable challenge to control the pandemic.

On Saturday, France reported almost 27,000 new cases, a record daily high. Britain has often recorded 15,000 or more new cases a day in recent weeks. Britain is at a “tipping point,” Jonathan Van-Tam, the country’s deputy chief medical officer, said on Sunday.

While the relentless rise in caseloads has made many fearful of new national lockdowns, which would plunge already reeling economies back into deep recession, the number of fatalities suggests that worst-case scenario – tens of thousands of new deaths a day or worse – might be avoided.

Italy, for instance, was recording between 500 and 900 new deaths a day from late March to late April. In recent weeks, the daily death count has been running in the low double digits, even as infections have climbed. On Tuesday, Italy saw 41 pandemic deaths, a recent high.

France has fared somewhat worse, with 50 to 150 new deaths a day in recent weeks, although they are well short of the record 1,437 deaths seen on April 15. The European worry spot is Spain, where the numbers are triggering anxiety among health authorities. There, new deaths have reached 250 or more on some days since early September. Still, they are a quarter or less of the levels seen in March and April.

Damiano Abeni, an epidemiologist at the Dermopathic Institute of the Immaculate Conception in Rome, and other Italian scientists and doctors, have said the relatively low death rate in Italy and elsewhere in Europe can be explained by several big factors, starting with age. “The case mix of infected individual has changed radically,” Dr. Abeni said.

In Italy, the typical age of infected individuals has dropped substantially – the younger the patient, the more likely she or he is to survive. At the start of the pandemic, the median age of those infected in Italy was about 60; today it’s about 42, with slightly less than 26 per cent of new cases in the 51-70 age group and only 11 per cent aged 71 or older.

Treatments and hospital care have improved a lot since the spring. One proven life-saving medication is dexamethasone, an anti-inflammatory steroid that is often used on critically ill patients. The WHO says the drug can reduce mortality for patients on ventilators by a third and for those requiring only oxygen by a fifth.

Hospitals generally have more ICU beds than they did in the spring. Most, though certainly not all, hospitals in Europe now have enough capacity to handle the rising caseloads, at least for a while. In Umbria, a region in central Italy, there were only 11 patients in intensive care on Tuesday out of the total known positives of 1,491, according to the Italian health ministry.

“Italian hospitals will be able to hold out for at least five months and, at the moment, the situation is manageable,” Carlo Palermo, secretary of one of Italy’s biggest unions of hospital doctors, told the Italian news agency Ansa on Tuesday. “But if we were to witness an exponential increase in cases as is happening in other countries, such as France, then the hospital system would hold out for no more than two months.”

Dr. Abeni says another factor may be saving lives – face masks. More evidence is emerging that masks can reduce the “inoculum,” or dose, making the infection less severe.

A recent paper written by doctors at University of California San Francisco and Johns Hopkins University, entitled Masks Do More Than Protect Others During COVID-19, supported the theory that mask use reduces “the viral inoculum to which the mask user is exposed, leading to higher rates of mild or asymptomatic infection with COVID-19.”

They recommended the universal use of masks to control the pandemic.

Johnson & Johnson said on Monday it had temporarily paused its COVID-19 vaccine candidate clinical trials due to an unexplained illness in a study participant, delaying one of the highest profile efforts to contain the global pandemic.


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