4 SEPTEMBER 2020 • VOL 369 ISSUE 6508 1151SCIENCE sciencemag.org
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We’re at risk of gambling away
our success,” virologist Christian
Drosten warned in the German
newspaper Die Zeit earlier this
month. His message referred to
Germany, but it could have been
addressed to all of Europe. After beating back
COVID-19 in the spring, most of Europe is
seeing a resurgence. Spain is reporting close
to 10,000 cases a day, more than it had at the
height of the outbreak in the spring. France
is back to reporting thousands of cases a day.
In Germany, numbers are still low, but ris-
ing steadily. The pandemic is affecting coun-
tries that saw few cases in the spring, such
as Greece and Malta, but is also rebounding
in places that suffered terribly, including the
cities of Madrid and Barcelona.
Drosten, of the Charité University Hos-
pital in Berlin, is one of many calling for
renewed vigilance, and he and others are
urging a new control strategy that trades
blanket lockdowns for measures specifi-
cally targeting clusters of cases, which play
a key role in spreading the coronavirus.
“We successfully aborted the [first] wave
and now we should make sure that no
new wave builds,” epidemiologist Christian
Althaus of the University of Bern says.
Few dispute that Europe rose to the initial
challenge. In Bergamo, a hotspot in Italy’s
Lombardy region, crematoria were so over-
burdened in March that army trucks had to
transport the dead to other cities—but on
24 May, Lombardy registered zero COVID-19
deaths for the first time. By early July, the
European Union and the United Kingdom
together averaged fewer than 5000 new
cases per day, whereas the United States
and Brazil (which together have roughly the
same population) had 50,000 and 40,000, re-
spectively. Europeans enjoyed a surprisingly
normal summer, with northern Europeans
flocking to Mediterranean beaches.
The rising case numbers today aren’t
quite comparable to the peak in April be-
cause countries are now testing far more
people on a daily basis. But the increase
shows that Europe relaxed measures too
early and too much, says virologist Ab
Osterhaus of the University of Veterinary
Medicine in Hanover, Germany. “The wrong
message was given, basically: We have done
a great job and now we can relax again.” In-
stead, Europe could have tried to emulate
New Zealand by stopping community trans-
mission completely and zealously guarding
against reintroductions, says Devi Sridhar,
a global health expert at the University of
Edinburgh who has been advising the Scot-
tish government. Scotland committed early
on to pushing case numbers down to zero,
but other countries did not, and now almost
all are seeing a resurgence.
People’s willingness to stay alert and
remember new rules wanes quickly, says
Cornelia Betsch, a psychologist at the Uni-
versity of Erfurt who has been monitoring
attitudes toward the pandemic in Germany.
“And we have been going for a while now,
and the end is not even clear.” Some coun-
tries saw workplace infections rise as people
returned to their offices, says Gianfranco
I N D E P T H
By Kai Kupferschmidt
COVID-19
Can Europe tame the pandemic’s next wave?Countries seek new strategies as coronavirus cases are rising again across the continent
Vacationers on the beach
in Tamariu, on Spain’s
Costa Brava, on 17 August.
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Mar. Apr. May Jun. Jul. Aug.
Mar. Apr. May Jun. Jul. Aug.
The coronavirus comebackThe number of new COVID-19 cases soared this past
month in France (not shown) and Spain. Germany
and other European countries saw a slower increase.
“
Published by AAAS
Corrected 9 September 2020. See full text.
on January 6, 2021
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1152 4 SEPTEMBER 2020 • VOL 369 ISSUE 6508 sciencemag.org SCIENCE
Spiteri, a public health expert at the Euro-
pean Centre for Disease Prevention and Con-
trol. But in many countries the resurgence is
driven by “young people partying and basi-
cally people living their life back in a kind of
normal way,” he says. Because new cases are
younger, fewer of them die, but “it’s a mat-
ter of time before the elderly are affected,”
Spiteri says. The reopening of schools across
the continent may make matters worse.
As in the spring, every country has its own
strategies for controlling the pandemic, lead-
ing to a sometimes confusing patchwork.
Belgium has one of the strictest face mask
policies, for instance, but Belgians crossing
the Dutch border to shop in Maastricht can
take off their masks. Even within countries,
the rules can change at dizzying speed. Ger-
many went from a mandatory 14-day quar-
antine for people arriving from countries
considered risky to voluntary tests at the
airport and other entry points, with no quar-
antine for those who tested negative. Next, it
made the tests mandatory, then returned
to mandatory quarantine with testing after
5 days. “What would be necessary is that
we define one central policy in Europe,”
Osterhaus says. “The problem is,
who is going to do that?” The Eu-
ropean Union has little power to
coordinate health measures.
Yet countries are better prepared
this time. Whereas the virus spread
largely under the radar in Febru-
ary, widespread testing now reveals
its movements. (Fewer than 3% of
tests are positive in most European
countries, a sign of a healthy testing capac-
ity.) Face masks, not available or even rec-
ommended in the beginning, have become
ubiquitous in most countries. More than a
dozen EU countries have developed apps
to help contact tracing efforts. Better treat-
ments are saving lives.
Meanwhile, new insights into viral spread
are leading to better targeted control mea-
sures. The emphasis on hand hygiene is
gone because it has become clear that con-
taminated surfaces don’t play a large role.
In the spring, some countries banned al-
most any outdoor activity, including jog-
ging; now, the focus is on indoor activities.
“We’ve learned outdoor hospitality is gener-
ally fine, nonessential shops are fine as long
as people wear face coverings, public trans-
port doesn’t seem that risky,” Sridhar says.
Instead, public health experts increasingly
argue for targeting clusters of cases and
superspreading events. Some studies esti-
mate that 10% of patients cause 80% of all in-
fections, whereas most don’t infect anybody
at all (Science, 22 May, p. 808). Drosten has
urged that contact tracers spend more time
finding the source of a new case—along with
that person’s contacts—than the new case’s
contacts; after all, the patient may not infect
anybody else, but is likely to have caught the
virus as part of a cluster, Drosten says.
Adam Kucharski, a disease modeler at the
London School of Hygiene & Tropical Medi-
cine, agrees. “Looking backwards can actu-
ally give you a disproportionate benefit in
terms of identifying infections,” he says. In a
recent preprint, Kucharski and his colleagues
estimated that “backward contact tracing”
could prevent twice as many infections as
tracing contacts forward alone. Experience
in South Korea, where clusters at churches
drove the epidemic early on, confirmed the
value of this approach, says University of
Florida biostatistician Natalie Dean.
Putting more effort into finding clusters
should also help epidemiologists under-
stand where and how they emerge, says
Hitoshi Oshitani of Tohoku University in
Japan—which may have changed since
the spring. “We’ve seen a massive change
in the social structure and interactions of
populations … from the start of the pan-
demic,” Kucharski says. The conditions
that spread the virus then “won’t necessar-
ily be the same ones that are creat-
ing the risk now.” In Germany, for
instance, many large outbreaks
early in the pandemic occurred
in long-term care facilities. Now,
clusters are increasingly reported
from workplaces.
More-targeted measures prob-
ably won’t be enough to keep the
virus from resurging, Althaus
says. “A point will be reached again where
stricter measures have to be taken,” he says.
But rather than complete lockdowns, he as-
sumes they will be more like the lighter ver-
sion applied in Sweden, which encouraged
people to work from home and banned large
gatherings while keeping shops and restau-
rants open. Scotland recently closed pubs
and restaurants in Aberdeen for more than
2 weeks after a cluster of cases emerged; it
asked inhabitants not to travel more than
8 kilometers outside the city and visitors to
stay away. But schools remained open.
Compared with the United States, Eu-
rope has one advantage as it faces its first
pandemic winter: Control measures aren’t
nearly as controversial. Protests against
masks and social distancing broke out in
many European cities in August, but they
represented a small minority of the popula-
tion, Betsch says. In Germany, support for
control measures declined somewhat after
infections peaked in spring, but a large
majority still backs them, Betsch says. And
with case numbers back on the rise, she
says, “We can already see acceptance num-
bers go up again.” j
Academic researchers in São Paulo,
Brazil’s wealthiest and most popu-
lous state, are warning that a pro-
posed budget bill could cripple
major universities and long-term re-
search projects. The state is home to
three of Latin America’s most prestigious
universities and produces 40% of Brazil’s
scientific publications.
The proposal, now before the state’s
legislature, aims to avoid a 10.4 billion
reais ($1.9 billion) shortfall in São Paulo’s
2021 budget, caused in large part by the
COVID-19 pandemic. One provision calls
for the three major academic institutions—
the University of São Paulo (USP), the Uni-
versity of Campinas (Unicamp), and São
Paulo State University—to transfer money
in their long-term reserve accounts to the
state government. The São Paulo Research
Foundation (FAPESP), a state agency that
funds research and fellowships, would also
have to hand over its reserve funds. To-
gether, researchers estimate, the accounts
hold more than 1 billion reais, money the
institutions rely on to weather economic
challenges and pay for long-term projects.
The prospect, coming on top of a
yearslong decline in science funding from
the federal government, has sparked an
outcry among researchers. If enacted in
its current form, the bill “will paralyze
all scientific activities in the state of São
Paulo,” the Brazilian Academy of Sciences
predicted in a 17 August letter. The Brazil-
ian Society for the Advancement of Science
warned the same day of “irreversible dam-
age.” As Science went to press, more than
110,000 people had signed an online peti-
tion opposing the bill, issued by the São
Paulo Science Academy.
“We would have to close some [research]
areas, we would struggle to pay salaries”
if the proposal becomes law, says Marcelo
Knobel, Unicamp’s chancellor. “It would be
an unprecedented situation.”
Bill threatens key Brazilian universitiesProposal to strip São Paulo institutions of reserve funds draws fierce opposition
RESEARCH FUNDING
By Ignacio Amigo
NE WS | IN DEPTH
Science’s
COVID-19
reporting is
supported by the
Pulitzer Center
and the
Heising-Simons
Foundation.
Published by AAAS
Corrected 9 September 2020. See full text.
on January 6, 2021
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Can Europe tame the pandemic's next wave?Kai Kupferschmidt
DOI: 10.1126/science.369.6508.1151 (6508), 1151-1152.369Science
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