PARIS – In the early days of the pandemic, President Emmanuel Macron admonished the French to wage a "war" on the coronavirus. Today his message is: "Learn how to live with the virus."
France and much of the rest of Europe have chosen to coexist as infections continue to rise, summer regresses into a risky autumn, and the possibility of a second wave has hit the continent.
After giving up hope of eradicating the virus or developing a vaccine within a few weeks, Europeans largely returned to work and school, leading the most normal lives possible amid an ongoing pandemic that has killed nearly 215,000 people in Europe came.
The approach is in sharp contrast to the United States, where restrictions to protect against the virus have been politically controversial and where many regions have pushed schools, shops, and restaurants to reopen without basic protocols in place. The result was almost as many deaths as in Europe, albeit in a much smaller population.
For the most part, Europeans are capitalizing on the hard-won lessons from the early stages of the pandemic: the need to wear masks and practice social distancing, the importance of testing and follow-up, the key benefits of a quick and local response. All of these measures, tightened or relaxed as needed, are designed to prevent the kind of national lockdowns that paralyzed the continent and paralyzed economies earlier this year.
"It is not possible to stop the virus," said Emmanuel André, a leading virologist in Belgium and former spokesman for the government's Covid-19 task force. "It's about maintaining balance. We have few tools to do that."
He added, “People are tired. You don't want to go to war anymore. "
The fighting language has given way to more measured assurances.
"We are at a stage where we are living with the virus," said Roberto Speranza, the Italian health minister, the first country in Europe to impose a national lockdown. In an interview with La Stampa newspaper, Speranza said that while Italy does not have a “zero infection rate”, it is now far better equipped to deal with a surge in infections.
"There won't be another lockdown," said Speranza.
Nevertheless, risks remain.
New infections have risen sharply in recent weeks, especially in France and Spain. France recorded more than 10,000 cases in a single day last week. The jump is unsurprising as the total number of tests being run – now roughly a million a week – has grown steadily and is now more than ten times what it was in the spring.
The death rate of around 30 people a day is a small fraction of what peaked when hundreds and sometimes more than 1,000 people died daily in France. That's because those infected now tend to be younger and health officials have learned to better treat Covid-19, said William Dab, epidemiologist and former French health director.
"The virus is still freely circulating, we have poor control of the chain of infection, and people at high risk – the elderly, overweight, diabetics – will end up being affected," said Dab.
In Germany, too, young people are overrepresented among the increasing number of infections.
While the German health authorities test over a million people a week, a debate has begun about the relevance of infection rates for taking a snapshot of the pandemic.
According to the country's health authority, only 5 percent of confirmed cases had to be hospitalized in early September. During the peak of the pandemic in April, 22 percent of those infected ended up in hospital care.
Hendrik Streeck, head of virology in a research hospital in Bonn, warned that the pandemic should not only be assessed on the basis of the number of infections, but on the basis of deaths and hospital stays.
"We have reached a phase in which the number of infections alone is no longer so important," said Streeck.
Much of Europe was not prepared for the arrival of the coronavirus because masks, test kits and other basic equipment were missing. Even nations like Germany, which fared better than others, recorded far higher death tolls than Asian countries, which were much closer to the source of the outbreak in Wuhan, China, but responded more quickly.
National bans have helped bring the pandemic under control across Europe. But infection rates spiked again in the summer after countries opened up and people, especially the young, reunited, often without following social distancing guidelines.
Although infections have increased, Europeans returned to work and school this month, giving more opportunity for the virus to spread.
"We control chains of infection better than in March or April when we were completely powerless," said Dab, the former French health director. "Now the challenge for the government is to strike a balance between reviving the economy and protecting people's health."
"And it's not an easy balance," added Dab. "They want to reassure people so they can go back to work, but at the same time we have to worry them so that they can continue to take preventive measures."
Under these measures, masks are now widespread across Europe and governments largely agree that they must be worn. Earlier this year, the French government stopped people from wearing masks in the face of shortages, saying they failed to protect wearers and could even be harmful.
Wearing face-covering has become part of the life of Europeans, most of whom in March of last year still viewed tourists masked with suspicion and incomprehension from Asia, where the practice has been widespread for two decades.
Instead of applying national bans without taking regional differences into account, the authorities – even in a highly centralized nation like France – have begun to react more quickly to local trouble spots with specific measures.
On Monday, for example, Bordeaux officials announced that they would limit private gatherings to 10 people, limit visits to retirement homes and ban standing at bars amid an increase in infections.
While Germany has started the new school year with compulsory physical classes across the country, authorities have warned that traditional events like carnivals or Christmas markets may have to be restricted or even canceled. Football games in the Bundesliga are played without fans at least until the end of October.
In the UK, where the wearing of masks is not particularly common or strictly enforced, authorities have tightened rules for family gatherings in Birmingham, where infections have increased. In Belgium, people limit themselves to limiting their social activity to a bubble of six.
In Italy, the government has cordoned off villages, hospitals or even migrant shelters to contain emerging clusters. Antonio Miglietta, an epidemiologist who carried out contact tracing in a quarantined building in Rome in June, said months of fighting the virus helped officials clear outbreaks before they got out of hand, as did this year in northern Italy was the case.
"We did better," he said.
Governments need to get better at other things.
At the height of the epidemic, in France, as in many other European countries, test kits were so urgently lacking that many sick people could never be tested.
Although France is now running a million tests a week, the widespread use of tests has caused delays in getting appointments and results – up to a week in Paris. People can now be tested regardless of their symptoms or the history of their contacts, and officials have not established priority tests that would speed up outcomes for the people who are most at risk for themselves and others.
"We could have a more targeted testing guideline that would probably be more useful in fighting the virus than what we are doing now," said Lionel Barrand, president of the Union of Young Medical Biologists, adding that the French government should restrict testing for prescription-only individuals and running targeted screening campaigns to combat the formation of clusters.
Experts said French health officials also need to significantly improve contact tracing efforts, which have been shown to be crucial in containing the spread of the virus in Asian countries.
After its two-month lockdown ended in May, the French social security system put in place a manual contact tracing system to keep track of infected people and their contacts. However, the system, which relies heavily on the skills and experience of human contact tracers, has produced mixed results.
At the start of the campaign, each infected person gave the contact tracer an average of 2.4 other names, most likely family members. The campaign steadily improved as the number of names rose to more than five in July. This emerges from a recently published report by the French health authorities.
Since then, however, the average number has gradually fallen to fewer than three contacts per person, while the number of Covid-19 confirmed cases has now increased tenfold after having an average of 800 new cases per day in the middle of seven days – according to the The New York Times currently averages 8,000 a day.
At the height of the epidemic, most people in France were extremely critical of the government's handling of the epidemic. However, polls show that a majority now believe the government will handle a potential second wave better than the first.
Jérôme Carrière, a police officer who visited Paris from his home in Metz, northern France, said it was a good sign that most people were now wearing masks.
"At first, like all French people, we were shocked and concerned," said Carrière, 55, adding that two older family friends had died of Covid-19. "And then we adjusted and went back to our normal life."
The reporting was written by Constant Méheut and Antonella Francini from Paris, Matt Apuzzo from Brussels, Gaia Pianigiani and Emma Bubola from Rome and Christopher F. Schuetze from Berlin.