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Europe and the world battle the surging SARS-CoV-2 pandemic

Europe and the world battle the surging SARS-CoV-2 pandemic

It is difficult to remember any disease or situation that has transformed the world as rapidly as the SARS-CoV-2 coronavirus, which is causing COVID-19 disease across all European countries and wreaking havoc across daily life. Across all of ESA’s member states, cases are increasing, in some cases rapidly. WHO has said that Europe is now the centre of the global pandemic.

It most cases, it is anaesthesiologists that are on the front line caring for patients. Anaesthesiologists are the prime specialists in treating severely ill patients needing haemodynamic and ventilator support. All over Europe, anaesthesiologists are involved in the care of the critically ill COVID-19 patients and are working day and night to combat the severe consequences of the disease and improve the status of the critically ill patients.

ESA’s President Professor Kai Zacharowski is Director of the Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Germany, and has himself treated a number of patients with COVID-19. “On a European level more than 70% of intensive care patients are treated by anaesthesiologists. This reflects our responsibility being equipped with the best possible training and competencies to treat and, whenever possible, to heal and improve the outcome of our patients 24 hours a day.”

He adds: “Our members are to face a very intense working period over the months to come. We at ESA will aim to keep all our members as up to date as possible with key developments as the pandemic develops.”

Despite suffering over 80,000 cases, China has used all of its state powers to gradually take control of the pandemic within its borders, reducing the number of new daily infections and deaths to relatively low levels after the explosion of new infections in Hubei province which began with a trickle of cases in December 2019.

However, now ESA member states — including some of Europe’s largest countries — are suffering one of the most serious public health crises of modern times. Since Monday 9 March, Italy has been in a nationwide lockdown, with all 60 million of its citizens asked to stay home for all but essential journeys for food, drug supplies and to care for relatives. As of Friday, March 13, there have been 15,113 confirmed cases of COVID-19, causing 1,016 deaths. The Italian Prime Minister, Giuseppe Conte, has asked all Italians to stay home for all but exceptional circumstances, and all public gatherings are banned.

One of the most acute problems experienced by Italy is one that is now being faced by France and Spain and will likely soon be faced by other ESA member states and countries worldwide — a shortage of intensive care beds. Even in Lombardy, in Italy’s wealthier northern region, hospitals and especially their intensive care departments are being overwhelmed by a huge increase in cases, many requiring life-saving respiratory interventions. Intensivists, critical care specialists and anaesthetists are among the teams battling to save these patients. Very difficult choices are being made regarding which patients will receive treatment and those who will not. These new COVID-19 cases, of course, come on top of the usual requirements for critical care from other sources such as road accidents and emergency surgery.

“According to the data provided by our Italian colleagues the mean age of all COVID-19 patients is 70 years, and one of the major risk factors for ICU admission is obesity,” explains ESA Immediate Past President Stefan De Hert, based at Ghent University Hospital in Belgium. “Interestingly, patients less than 50 years old without major comorbidities seem to constitute 20% of the COVID-19 ICU patients. Finally, infected women seem to develop less symptoms than men, and also children seem to experience the infection without important clinical problems. These data are quite similar to what we have learned from the experiences of our Chinese colleagues.”

The situation in Spain is also rapidly worsening, with reports that Madrid’s public health system is creaking under the strain and several well-known politicians have been diagnosed with COVID-19. On Friday, March 13, Prime Minister Pedro Sanchez declared a state of alert, giving the government emergency powers to take control of factories and restrict people’s movements. The entire Spanish parliament is going through testing as a result of these alerts, and there are concerns that the entire region of Madrid may need to go into quarantine. As of this date, Spain has 4,200 confirmed cases of COVID-19, and 120 recorded deaths, around half in the Madrid region. The country has banned medical conferences, asking all doctors to remain available for work, and the country’s La Liga football league has been suspended after the entire Real Madrid Team was potentially exposed.

In Germany,  Europe’s most populous country, many regions have closed schools and universities, and a raft of measures have been proposed, including bus passengers in Berlin being asked to enter through the back door, to protect the health of the drivers who must continue working. By Friday March 13, the country had recorded 3,059 cases and 6 deaths.

The German Chancellor, Angela Merkel, said in a press conference on March 11 that up to two-thirds of the country could eventually be infected. On Thursday, March 12 it was announced, also in Berlin, that “With the aim that the hospitals in Germany concentrate on the expected increasing need for intensive care and ventilation capacity for the treatment of patients with severe respiratory diseases by COVID-19, as far as medically justifiable, basically all planned admissions, surgeries and interventions in all hospitals be postponed and suspended indefinitely from Monday, March 15.”

The French President, Emmanuel Macron, was one of the first Western leaders to publicly accept the inevitability of the COVID-19 pandemic. And France has experienced one of the highest number of cases: 2876 cases and 61 deaths as of Thursday, March 12. Doctors in Paris have reported intensive care units filling up rapidly, with a risk that the country will follow the same trajectory as Italy but with an 8-day delay, having to choose who among coronavirus patients and others requiring critical care can receive treatment. It has already banned any public meetings of 1,000 people or more, reducing this from the previously announced number of 5,000.

Countries in Europe are not all adopting the same measures to fight the pandemic. Despite having one of the smallest number of cases, Ireland decided that from Friday 13 March, all schools and universities would be closed. Irish Prime Minister Leo Varadkar all banned all indoor gatherings of more than 100 people, and all outdoor gatherings of more than 500 people.

Within the UK, which has 798 cases and 11 deaths so far, Prime Minister Boris Johnson has not yet adopted some of the more severe tactics to confront the epidemic. On Thursday, March 12, he asked all people with the symptoms of a high temperature or continuous cough to self-isolate for seven days, but has so far ruled out closing schools and cancelling major events, although the English and Scottish football leagues decided on Friday, March 13, to postpone all fixtures for at least two weeks. The advice from medical experts in the UK is attempting to push the peak of the pandemic into the summer months and also flatten its intensity, to ensure as many people who need critical care in the coming months are able to receive it, and thus reduce the mortality rate.

Both Slovenia and Austria have closed their borders with Italy in order to stop the flow of cases, and Czechia has banned all non-citizens and non-permanent residents to manage its own increase in cases, as has Slovakia. Israel has effectively suspended its tourism economy by asking all incoming nationals of other countries to self-isolate for 14 days.

And late on March 11, US President Donald Trump announced a ban on travel to the USA from residents of 26 European countries, a move that was rapidly condemned as without evidence by the European Union. The announcement came as cases in the USA passed 1,000, with the actual toll thought to be far higher due to problems accessing testing kits nationwide and a fear that community transmission had been occurring long before the USA reacted properly to the pandemic. At the time of writing of this article, President Trump was expected to declare a state of emergency to tackle COVID-19.

At a personal level, people are being asked to wash their hands, for 20 seconds at a time with soap and water, as often as they can, or use a hand sanitiser. Avoiding touching your face with your hands at any time has also been proposed by public health experts, as has maintaining a minimum distance of 2 metres from any other person to reduce transmission.

“The European Society of Anaesthesiology, like all medical societies, has reviewed its own activities as this pandemic has developed,” explains Prof Zacharowski. “We have postponed all of our courses and the European Diploma in Anaesthesiology and Intensive Care (EDAIC) exams. We have also changed the meetings of our board of directors from face-to-face to teleconferences. Most importantly, we have decided to postpone our annual Euroanaesthesia congress to a later date. We realise how vital anaesthetists and intensivists are during this time, and that being present in their hospitals far outweigh any other normal activities.  Our members and community are crucial in containing this epidemic and saving countless lives.”

Two dates are currently under consideration for the new date for Euroanaesthesia: either 21-24 August or 28-31 August. The ESA team will inform all members as soon as a decision has been taken.

Tony Kirby