Will the Delta coronavirus variant cancel Europes summer vacation?
Press play to listen to this article Voiced by Amazon Polly  Holidaymakers worried about the Delta coronavirus variant destroying their vacation plans can cautiously relax  so long as Europe keeps pushing ahead on vaccinations and jumps on any outbreaks. That's what most experts are saying about the Delta variant, first identified in India, as it sweeps across the U.K., pushing up rates of infection since mid-May to a high of 11,007 cases on Thursday. In a country where 60 percent of adults have had two vaccine doses and 80 percent at least one dose, Delta now accounts for 99 percent of infections and has prompted the government to delay a full reopening in England until mid-July. Wales followed suit on Thursday, delaying a final easing of restrictions as First Minister Mark Drakeford warned a third wave was "certainly underway." And now, Europe is closely watching whether these cases translate into severe illness and deaths. So far, deaths in the U.K. have remained stable and low, mostly in daily single figures. But hospitalizations have been creeping up this month  in line with analysis from Scotland that found the variant doubles the risk of hospitalization. This all began in April, when the U.K. received flak for delaying a travel ban from India until April 23, well into that country's devastating crisis. In the four weeks before that decision, 425 travelers arriving from India tested positive, or 6 percent of arrivals. At that point, 63 percent of Britons had had their first vaccine dose, but only 23 percent their second dose. That gap may have had major consequences for the variant's subsequent spread. The dose count is crucial in assessing the risk of the Delta variant, as two shots provide significantly better protection than one, according to U.K. data this week. And now, concern is growing that the Delta variant is surfacing in Europe, accounting for around a single-figure percentages of cases. So all eyes are on the U.K. to see if enough has been done to prevent another wave of deaths  and importantly, to allow pandemic-weary Europeans a much-needed break. Countries such as Germany, Belgium and Ireland are staying vigilant, and have introduced stricter entry requirements for travelers from the U.K., requiring quarantine and testing. The Delta variant in Germany now accounts for 6 percent of all cases, "but the share is increasing," warned Lothar Wieler, president of Germany's Robert Koch Institute, on Friday. "Were very focused on the U.K., said Steven Van Gucht, a Belgian virologist serving as the federal governments COVID-19 spokesperson and head of viral diseases at the national public health institute Sciensano. Were waiting to see if the U.K. will be able to control this outbreak, what kind of measures they use. But were also monitoring the situation in Belgium." Cautious optimism  In the past few weeks, Belgium, like elsewhere in Europe, has opened up society to near-normal again. Bars and restaurants are buzzing, terraces are teaming and gyms are pumping. And yet, the country hasnt seen an anticipated rise in cases, Van Gucht noted. Infection rates are plummeting while hospital intensive care units are emptying out and COVID-19 deaths are falling. But there's a flip side to the good news, in his view: "It makes it really difficult to talk about any kind of pause in relaxations or postponing future relaxations or tightening measures" due to the Delta variant. Van Gucht and other scientists made that point when they warned the government against opening up too quickly, ahead of its last coronavirus meeting on June 4. "But the message was more or less ignored," he said. He also said that while infection rates are falling, the proportion accounting for Delta is increasing, while the share of the Alpha variant, first identified in the U.K., is falling. "Alpha used to be 90 percent, now its 80 percent, he said. Last week, Delta accounted for around 4 percent of cases. With no political will to consider further restrictions, he said, the next best solution is to keep up the pace on vaccinations. "We don't have this pressure on the absolute numbers from the Delta variant, and we're hoping we might be able to avoid it if we vaccinate fast enough," he said. "We still have a few weeks before the Delta variant becomes dominant," he said, based on rough estimates drawn from its rate of growth elsewhere. Currently, around 29 percent have been fully vaccinated in Belgium and around 51 percent have had at least one dose. More broadly, the good news is that vaccines still work against the variant, albeit with slightly lower protection than against the Alpha variant. Data from a Scottish study calculated 70 percent protection from hospitalization with two doses of any vaccine, while data from England put rates at 96 percent protection from hospitalization with two doses of the BioNTech/Pfizer vaccine and 92 percent with two doses of the Oxford/AstraZeneca jab. A matter of trade-offs  Spain is doing almost as well in its vaccination rates as Belgium and, coupled with a very high rate of natural immunity  believed to be far higher than reported  the country is holding the tide against the Delta variant, said Vicente Soriano, director of infectious diseases at Madrids Universidad Internacional de la Rioja. Citing data from the Coordination Centre for Health Alerts and Emergencies, he said between 5 and 7 percent of Spains cases are tied to the variant. Although the rate of Delta infections is increasing exponentially, those reasons may help explain why Spain didnt experience another wave after Easter celebrations, along with vaccinations having been mostly rolled out to vulnerable groups and care workers, he argued. There are also ongoing measures such as masks and social distancing, while the warmer weather is allowing more outdoor activities, he said. While nightclubs remain closed, some are experimenting with outside venues with public health measures such as testing before entry. However, to the relief of locals and holidaymakers, masks will no longer be mandatory outside in Spain from June 26. These days, the number of people Soriano sees in his clinic with COVID-19 has fallen drastically compared to three or four months ago.  Spain is among the easiest countries for Britons to enter, with no requirements for quarantine or COVID-19 testing. Only those traveling directly from India have to quarantine for 10 days, which can be shortened to seven with a negative test on that day. People arriving from other at-risk countries, meanwhile, can enter by presenting proof of full vaccination, negative test result or natural immunity. But the Delta variant looms large. And it's already a concern in neighboring Portugal, which just ringed off Lisbon for weekend travel following a local surge of Delta-driven cases. "Our biggest concern now" is community transmission of the Delta variant, said Javier Segura del Pozo, an epidemiologist and deputy president of the public health association of Madrid. At the same time, the country is under pressure to open up to tourists, especially from the U.K., who significantly prop up the national income each year. "In one sense, I'd prefer bigger controls or barriers to control the relationship between the U.K. and Spain," he said. "But there's an economic pressure to facilitate British tourists arriving here." While del Pozo declined to say whether another wave is coming, saying there's not enough clear data, Soriano is more optimistic. What we have seen since February is something incredible, he said, calling protection from vaccines better than we expected.  This protection will be sufficient this summer to protect against variants, including Delta, so long as vaccinations continue at pace and, crucially, people get their second dose, he said. Outbreak whack-a-mole  While most of Europe is seeing falling infection rates, there are some pockets where cases are once again climbing, including Malta and Iceland  but that's coming off of very low rates to start with. Andrea Ammon, director of the European Centre for Disease Prevention and Control, said it's hard to say how much this rise comes from variants, in part because sequencing samples is limited. She also pointed out that "non-pharmaceutical interventions are currently being reduced," which might also be affecting case counts. This relaxation of mask requirements and social distancing rules shouldn't happen too quickly, she said, or it could produce another rapid rise of cases among the non-vaccinated. Allyson Pollock, clinical professor of public health at the University of Newcastle, is less concerned. "The public should not have to worry about variants," she said, calling them "a normal evolution of viruses." Instead, governments should be beefing up their public health control systems to locally pounce on any outbreaks as soon as they are detected, argued Pollack, who has criticized the U.K. government's approach as excessively centralized. This effort should order local outbreak teams to work on the ground to help identify symptomatic cases through testing and tracing their contacts; following them up and supporting them as they isolate; and putting case detection back into the health system to monitor them. If countries fail to grasp this, she warned, we will be in the same mess when we do get another funny variant because we havent built up local public health outbreak control.  Then there is the issue of low uptake of vaccines among certain regions and communities  one of the biggest hurdles in Belgium and elsewhere, warned Van Gucht. Belgium is doing well overall, he said, but vaccine uptake is higher in the north than in the south and in some cities. In Brussels, for example, roughly a quarter of over 65s are still not vaccinated, many of whom live in communities where French or Dutch isn't the first language. Health care workers are trying hard to reach these people to avoid preventable deaths in the autumn, he adds. "Thats our main strategy," he said. "Vaccinate our way out of it and hope that immunity will be big enough to stop the spread" of the Delta and any other variants. "This can be a summer  we have reason to be confident," agreed German Health Minister Jens Spahn, speaking on Friday. "But only if we remain cautious." Shawn Pogatchnik and Laurenz Gehrke contributed reporting. This article is part of POLITICOs premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.