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Europe prepares for a 'tridemic' of respiratory diseases

January 11, 2024

Influenza, COVID and RSV are on the rise in Europe. Italy and Spain are on high alert, and face masks are back.

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An older couple walk on the street in Spain as they wear their masks
Spain has introduced face mask rules as cases of COVID, flu and RSV rise across EuropeImage: Luis Soto/ZUMA/dpa/picture alliance

European countries — especially Spain and Italy — are witnessing a surge in the number of people infected with respiratory illnesses.

Many local news agencies have reported shortages of hospital beds and overflowing health care facilities.

Flu infections across the continent are the biggest concern at the moment. The disease's impact on the health care system is compounded by an increasing number of cases of  coronavirus and respiratory syncytial virus, or RSV. 

A potential 'tridemic' in Europe — plus swine flu 

Other parts of the continent, including Germany and the United Kingdom, have observed a spike in cases of the three diseases — COVID, RSV and flu — in recent weeks.

Many countries in Central and Eastern Europe also reported an increase in respiratory illnesses over the final weeks of 2023.

"Almost 10,000 deaths from COVID-19 were reported to WHO in December, mostly in Europe and US, and there was a 42% increase in hospitalizations and a 62% increase in [intensive care unit] admissions, compared with November," said Tedros Adhanom Ghebreyesus, director-general at the World Health Organization. 

The European Center for Disease Prevention and Control, the ECDC, said rates of influenza-like respiratory illness in the community was still increasing in most European countries. "Following relatively low respiratory illness activity over the summer period, consultation rates increased in primary care settings from September," it said in a press release in December.

The rates of severe acute respiratory infection (SARI) cases presenting to secondary care were at a level comparable to the same time last year and are now notably increasing in some countries.

Flu spike in late December

Among those tested, the percentage of people with influenza had increased from 19% in mid-December to almost 25% at the end of the year.

Ten countries in Europe, including Italy and Spain, reported seasonal influenza activity above the 10% positivity testing rates in sentinel primary care.

But the ECDC said the figures could be affected by the end-of-year holiday season and fail to reveal the real picture — it noted that fewer people got tested during the holiday season.

The sharp increase in spread could also be attributed to massive gatherings during Christmas and other festive events, common in Spain. The ECDC said both influenza types A and B had been detected.

Swine flu alert in Italy

Italy recorded two flu-related deaths in early January in the northeastern city of Vicenza. Doctors suspect the deaths were caused by an outbreak of swine flu, otherwise known as H1N1 influenza.

Three other patients are hospitalized in intensive care due to complications, such as interstitial pneumonia, arising from the disease. Local health authorities in Vicenza have appealed to the public to get vaccinated against swine flu.

Swine flu is only the most recent addition to existing stresses on Italy's public health system. The Italian National Institute of Health has estimated that around 2 million people were infected with COVID, RSV or influenza in the last two weeks of 2023.

Into January, ambulances were seen lining up outside hospitals in Rome. Health care centers in cities like Milan and Turin were overcrowded, with patients waiting for beds.

Spain brings back face masks in health care centers

Spanish Health Minister Monica Garcia has made it mandatory for all people to wear face masks in health care centers around the country.

"[We have to] protect the most vulnerable people," Garcia told reporters. "It's just common sense."

Some hospitals in Spain are also struggling to cope with the influx of new patients.

The government has said restrictions may be removed if infection rates fall consistently for two weeks. But it's worth noting that Spain was among the last countries to drop face mask regulations during the COVID pandemic.

The data for this article were gathered and visualized by Eva Höppner and Hermann Wirt of DW Data.

Edited by: Zulfikar Abbany

DW Sushmitha Ramakrishnan
Sushmitha Ramakrishnan Journalist exploring the interplay of science, politics and society.