4 SEPTEMBER 2020 • VOL 369 ISSUE 6508 1151SCIENCE sciencemag.org

CR

ED

ITS

: (P

HO

TO

) J

OA

N V

AL

LS

/U

RB

AN

AN

DS

PO

RT

/N

UR

PH

OT

O/A

P I

MA

GE

S;

(GR

AP

HIC

S)

X.

LIU

/SCIENCE

;

(DA

TA

) W

OR

LD

HE

AL

TH

OR

GA

NIZ

AT

ION

CO

RO

NA

VIR

US

DIS

EA

SE

DA

SH

BO

AR

D

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.

0

2000

4000

6000

8000

0

2000

4000

6000

8000

10,000

Ne

w c

ase

s p

er

da

y

Germany

Ne

w c

ase

s p

er

da

y

Spain

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

http://science.sciencemag.org/

Dow

nloaded from

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

http://science.sciencemag.org/

Dow

nloaded from

Can Europe tame the pandemic's next wave?Kai Kupferschmidt

DOI: 10.1126/science.369.6508.1151 (6508), 1151-1152.369Science 

ARTICLE TOOLS http://science.sciencemag.org/content/369/6508/1151

CONTENTRELATED

http://stm.sciencemag.org/content/scitransmed/12/555/eabc9396.fullhttp://stm.sciencemag.org/content/scitransmed/12/556/eabc7075.fullhttp://stm.sciencemag.org/content/scitransmed/12/557/eabc5332.fullhttp://stm.sciencemag.org/content/scitransmed/12/559/eabc3103.full

PERMISSIONS http://www.sciencemag.org/help/reprints-and-permissions

Terms of ServiceUse of this article is subject to the

is a registered trademark of AAAS.ScienceScience, 1200 New York Avenue NW, Washington, DC 20005. The title (print ISSN 0036-8075; online ISSN 1095-9203) is published by the American Association for the Advancement ofScience

Science. No claim to original U.S. Government WorksCopyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of

on January 6, 2021

http://science.sciencemag.org/

Dow

nloaded from