Resilience of Health Systems to the COVID-19 Pandemic in Europe: Learning from the first wave

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This article is part of a series in which OECD experts and thought leaders  from around the world and all parts of society  address the COVID-19 crisis, discussing and developing solutions now and for the future.

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Co-authored by Guillaume Dedet, Health Economist/Policy Analyst; Chris James, Senior Health Economist; and Gaetan Lafortune, Principal Administrator, Department for Employment, Labour and Social Affairs, OECD

COVID-19 is testing the resilience of health systems and placing immense pressure on health workers. As of mid-November 2020, over 10 million people in Europe had been infected and more than 265 000 died from COVID-19, with the numbers continuing to rise rapidly. Excess mortality data — reflecting deaths above the norm, including those indirectly linked to the virus — highlight the severity of the pandemic (Figure 1). The health crisis has led to a major economic crisis, with countries hardest hit by COVID-19 experiencing the largest economic contractions.

Sources: ECDC (for COVID-19 deaths) and Eurostat (for calculation of excess deaths). Note: Data on excess deaths are only available until end of August at time of writing.

Factors beyond immediate policymakers’ responses, such as demographics and population density, explain why some countries have been hardest hit. But the crisis also highlights differences in the resilience of health systems. The new edition of Health at a Glance: Europe 2020 offers emerging insights that can help health systems emerge better prepared in the future.

Quicker policy implementation and better use of data  

The first wave of the pandemic showed how European countries need to prepare better and emerge better prepared from current restrictions to avoid future costly containment and mitigation measures. Effective testing, tracking, tracing and isolation are essential to contain the spread of the virus. Yet many European countries struggled to scale up their response, leaving them with fewer measures at their disposal. The number of daily tests performed 30 days after each country reached a mortality rate of ten deaths per million population varied substantially across countries, with Denmark, the country with the highest number, delivering roughly five times more daily tests than countries at the lower end.

Most European countries implemented similar containment and mitigation measures during the first wave of the pandemic, but some acted more quickly than others. For instance, public spaces were closed less than ten days before the country reached the threshold of ten deaths per million population in Italy, Spain, France, Belgium, but more than one month before in Hungary, Lithuania, Poland, Latvia and the Slovak Republic.

Over 50 million Europeans downloaded digital contact tracing apps in the first nine months of 2020, but despite their potential, these apps still present challenges with implementation. Furthermore, many countries lag behind in using routine health data to obtain real-time surveillance. Only ten European countries are able to undertake national dataset linkages in support of COVID-19 research and very few had data timely enough to be useful for decision-making.

Read the report: Health at a Glance: Europe 2020

Investing in health workforce and in adaptive surge capacity  

The success of many European countries in rapidly creating surge capacity — by converting regular hospital beds into intensive care beds, creating temporary field hospitals, or transferring patients to hospitals with spare capacity — shows that flexible solutions can work. Yet countries had to operate from very different starting levels of capacity — e.g. the number of ICU beds per 100 000 population varied from 34 in Germany to around 6 or less  in Ireland, Greece and Finland.

The lack of health personnel has been more of a binding constraint than hospital beds, reflecting the fact that training skilled health workers is more time-consuming than creating temporary facilities. Beyond creating and mobilising reserve capacity to respond to surges in demand as in France, Belgium, Iceland and Ireland, the need to invest more in health workforces to address structural shortages has never been more apparent. 

Strengthening primary health care and prevention

Primary health care and mental health services are critical to foster longer-term resilience. In France, Germany, Iceland, Slovenia and the United Kingdom, community care facilities or home-based programmes have been expanded. Enhanced roles for pharmacists and community health workers, as in Austria, France, Ireland, Portugal and Spain, have offered practical ways to maintain continuity of care when people are less able to access doctors. In addition, much wider adoption of telehealth has helped preserve continuity of care for non-COVID-19 patients. Similarly, online advice and phone support lines for people experiencing mental distress have been scaled up in at least 23 countries, including Belgium, Denmark and Sweden.

There is hope as such innovations are set to remain beyond the pandemic. But the crisis has exposed the limit of health systems that invest only 3% of total health spending on health promotion and disease prevention, and still struggle to address underlying health inequalities. The social gradient of deaths from COVID-19 shows that the social determinants of health — lifestyle, poverty, unemployment, stress — need greater attention. Beyond renewing efforts towards effective Universal Health Coverage, countries should focus on policies that make populations healthier by addressing more directly the reasons why disadvantaged groups are at higher risk.

The crisis has also highlighted the need to address underlying structural weaknesses in the long-term care (LTC) sector, such as in nursing homes. In nearly all European countries, 90% or more of reported COVID‑19 deaths were amongst people aged 60 years and over. Yet countries focussed first on hospitals, with slow policy responses in LTC. In some of the hardest hit European countries, the time between the first reported COVID-19 cases and the issuance of guidelines on preventing infection in LTC institutions was at least two months, and the availability of personal protective equipment also lagged behind hospitals.

Health resilience is a multi-system challenge that requires close international cooperation

The COVID-19 crisis has highlighted that stronger and more resilient health systems are not a cost to our economies, but an investment in future preparedness. It has also shown that broader health resilience is a multi-system challenge that relies on interactions across health, social and economic systems of interconnected economies. Whether to address weaknesses in global supply chains for medical goods, manage cross-broader movement of patients and health professionals, or create lasting solutions for R&D related to vaccines, more, not less, international collaboration will be needed.

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Tackling COVID-19 Health International Co-operation

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Francesca Colombo

Head, Health Division, Directorate for Employment, Labour and Social Affairs, OECD

Francesca Colombo oversees work on health, which aims at providing internationally comparable data on health systems and applying economic analysis to health policies, advising policy makers, stakeholders and citizens on how to respond to demands for more and better health care and make health systems more people centred. Major activities of the OECD Health Division cover trends in health spending; measuring of health care outcomes, activities and inputs; health care quality policies; assessing health system efficiency and value for money; long-term care systems and ageing; the economics of public health; pharmaceutical policies, new technologies and big data in health; and health workforce. Mrs Colombo has over 20 years of experience leading international activities on health and health systems. Over her career, she travelled extensively in Europe, South America and Asia, advising governments on health system policies and reforms. Follow me on Twitter @OECD_Social http://twitter.com/OECD_Social

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