Europe is preparing for a surge in coronavirus cases to hit hospitals, and authorities are acutely worried about a key resource: trained medical staff.
During the initial wave of the pandemic, clinics scoured basements for spare beds and governments pushed manufacturers to churn out ventilators and face masks. Equipment is now at hand, but a shortage of doctors, nurses and medical technicians is putting health care services to the test, as record infections hit across the region simultaneously.
Europe has re-emerged as a global hot spot for the virus, which has infected more than 5 million people and caused over 200,000 fatalities on the continent. Germany and the Czech Republic recorded record numbers of new cases Thursday, a day after Italy also had the most in a single day since the start of the pandemic and Spain became the first Western European nation to top 1 million infections.
With fewer severe cases currently, hospitals are coping, but signs of strain are multiplying.
In the Czech Republic — the hardest-hit European country — Prime Minister Andrej Babis on Wednesday imposed a partial shutdown, and warned that the hospital system may collapse by early next month.
The government has already enlisted medical students and asked doctors working abroad to come home, and hospitals are calling for volunteers and offering part-time jobs for medical, cleaning and maintenance staff.
The armed forces are setting up a field hospital in Prague, while the U.S. ambassador announced Wednesday military medical personnel would be sent over to help.
"I cannot even imagine what will happen if the number of patients that need intensive care continues to rise," Petr Sladek, head of the hospital in the hard-hit Moravian town of Uherske Hradiste, told the website Seznam Zpravy. "It will be like doing battlefield medicine."
While Eastern Europe is particularly exposed because of chronic underfunding of health care — Poland is establishing temporary hospitals at stadiums and conference centers — it's a similar situation in Belgium.
In Europe's second-worst outbreak, authorities are looking at recruiting out-of-work restaurant staff, pensioners and refugees to fill in. With so many Belgians now in quarantine, there are fewer people available to treat the sick than during the initial wave in the spring.
"We have less workers now in the field, and that's a real problem," said Jan-Piet Bauwens, vice president at the Setca trade union.
Belgian medical facilities are now reserving 50% of their available ICU beds for COVID-19 patients. Some clinics in Brussels and the province of Liege have transferred patients to other hospitals as they reach limits.
To be sure, the situation isn't as severe everywhere. The U.K. has so-called Nightingale hospitals designed to cope with a sudden spike in virus patients. Named after Florence Nightingale, some of them weren't used during the first wave of infections, and the ones that were in operation only treated a handful of people.
The Nightingale hospitals in Manchester, Sunderland and Harrogate are preparing to accept patients in coming weeks, according to an NHS spokesperson. Those in London, Birmingham, Exeter and Bristol remain on standby.
The chances of a critically ill patient hospitalized with COVID-19 surviving at least 28 days has risen to 72% for those admitted since September, compared with 61% previously, according to a report by the Intensive Care National Audit & Research Centre.
But even in Germany, which has experienced lower infection rates than most of its neighbors, concern is growing. With more than 70% of intensive-care beds filled, a spike in severe COVID-19 cases could quickly force other patients aside.
"We're looking ahead to the coming weeks with concern if we can't slow the exponential growth in infections," Susanne Herold, a professor of pulmonary infections at the University of Giessen near Frankfurt, said on broadcaster ZDF.
In France, the jump in virus cases is putting pressure on ICUs and already exhausted staff.
Health Minister Olivier Veran said Tuesday that an additional 2.5 billion euros ($3 billion) would be spent on the country's hospitals, adding to the extra 10 billion euros earmarked for health care in the 2020 budget.
"Public authorities haven't learned the lessons from the first wave," said Benoit Labenne, a general practitioner in Le Raincy in the Paris suburbs, who helps local emergency services a few times a week.
Italian authorities are preparing to expand coronavirus wards. New facilities built this year at exhibition centers in Milan and Bergamo will open in the coming days, with an initial capacity of 200 beds.
The situation is worse in Campania. The region around Naples, which largely escaped the first wave, has more than 1,000 hospitalized COVID patients, above the April peak of around 700.
Even as hospitals convert wings for intensive care and equipment stands ready, staffing is in issue.
"It's like having a Ferrari Testarossa in the garage and no driver," Bruno Zuccarelli, vice president of Naples' doctors' association, said. "There are not enough specialists."