If Belgium were to abandon all coronavirus restrictions and vaccinations, the virus "could cause another 4,500 deaths and 15,000 new hospital admissions," recent research shows.
In a study of what would be the worst-case scenario, the London School of Hygiene and Tropical Medicine found that despite the continent's high vaccination rate, the pandemic could cause 300,000 more deaths across Europe if all restrictions were lifted and people returned to life as normal.
The findings were published on the preprint website MedRxiv, which means that it has not yet been peer-reviewed. But infectious-diseases modeller at the University of Cambridge Megan O'Driscoll called it "an elegant analysis" on Nature.com.
So far, 26,669 people already died as a result of Covid-19 in Belgium, according to the latest figures by the Sciensano national health institute on Tuesday 23 November; another 4,500 could die if the authorities were to lift all measures and stop vaccinating.
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The analysis, led by epidemiologist Lloyd Chapman, is based on the age distribution in the population, the proportion of people who have built up immunity through infection, and the proportion who are protected through vaccination.
Researchers could then calculate what proportion of those still susceptible to Covid-19 would be likely to die or be hospitalised if the entire country were exposed to the virus again.
For Belgium, this would also mean some 15,000 hospitalisations, in addition to the 4,500 extra deaths, according to the analysis.
The full study covers 19 European countries: Austria, Belgium, the Czech Republic, Denmark, England, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Portugal, Norway, Romania, Slovakia, Slovenia, Spain and Sweden.
For the whole of Europe, the researchers estimate some 300,000 deaths and one million additional hospital admissions in this worst-case scenario.
The estimates for hospitalisations per 100,000 citizens vary widely and highlight the disparity in vaccine coverage and other measures to combat the pandemic: in England this would be just 62, compared to 840 in Romania.
'Far too imprecise'
In absolute numbers, the death toll ranges from 1,200 additional deaths in Slovenia to 115,000 in Germany, but these differences are "not so significant because of an instability in the calculation and because countries report mortality differently," according to biostatistician Geert Molenberghs (KU Leuven/UHasselt).
Importantly, the study does not account for other factors that could increase the risk such as new variants or waning immunity. It also does not factor in the rollout of booster doses.
According to the researchers, the overall results show that even with high vaccination levels, countries can still expect waves of hospitalisation and deaths. However, Chapman stressed that this prediction "is the maximum worst-case scenario."
"This is a useful study because it shows how bad things could get," biostatistician Tom Wenseleers (KU Leuven) said on social media. "And what is indeed included here is the effect of the decreasing protection against symptomatic infection. This shrinks by about 4% per month, so that too adds up in the long run."
"So how quickly and how massively boosters are used is an important factor," Wenseleers said. "What these colleagues are also not counting is the non-Covid-related mortality that such a worst-case scenario would cause."
The calculation of the number of already infected people is "far too imprecise," Molenberghs told De Morgen. "But I can agree with the general conclusion. In the absence of measures, we would see hospitalisations and deaths of these orders of magnitude."
In Nature, infectious-disease modeller at the University of Sydney in Australia Sheryl Chang stated that, while the figures should be read with caution, the study is a useful exercise in helping countries prepare for the challenges ahead.
"The numbers are shocking, and they may or may not happen, but people need to be aware that Covid-19 is not over," she added.
