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What's causing the COVID-19 surges in Europe and Asia


COVID cases are once again surging in parts of Asia and Europe. Countries which acted swiftly to curb infections early on in the pandemic are now facing lockdowns and mandatory vaccinations. Here in the U.S., cases are also rising, driven by the highly contagious delta variant and also by the large numbers of people who are not vaccinated. And now there's word from South Africa about a troubling new variant that's spreading quickly, one that's led some countries to start banning flights from South Africa and nearby countries. Joining us now to talk more about what's causing these surges are NPR global health correspondent Michaeleen Doucleff and NPR correspondent Anthony Kuhn in Seoul and Rob Schmitz in Berlin.

Michaeleen, you're up first here. So it's early. What can you tell us about this new variant in South Africa?

MICHAELEEN DOUCLEFF, BYLINE: Yeah, so there isn't a lot known. The World Health Organization is going to talk about it today. But what is known is concerning. The last few days, this variant has caused a very fast increase in cases in one urban area of South Africa and has been found all the way to Hong Kong. The variant has many more mutations than other variants, including more than 30 in the spike protein. That's the important region of the virus that binds to human cells. And some of those mutations are known to help the virus evade the immune system by avoiding antibodies. Some are known to increase transmissibility. But what all these mutations do together is not known, and the big concern is that these mutations could make the vaccines even less effective than delta did. But it's really not known yet at all.

MARTÍNEZ: Rob, Germany is hitting record figures for infections every day. Many of its neighboring countries are also in the same spot. What's the reason for this? And what are governments doing?

ROB SCHMITZ, BYLINE: Yeah, this part of Europe is seeing the highest number of infections on a daily basis since the pandemic started. At least four countries in Central Europe have seven-day incidence rates of more than a thousand per 100,000 residents. One of them is Austria, which is now in the midst of a nationwide lockdown and has declared mandatory vaccinations beginning in February. Slovakia, the worst-hit country in Europe at the moment, is also under a lockdown order. It's no coincidence that the hardest-hit countries have tens of millions of unvaccinated people, large portions of their populations. While here in Germany, nearly every day this week, the country has set a new record for its number of infections. And today, it was more than 76,000. The worst-hit parts of Germany are in the southeast, where there are also the lowest rates of vaccinated people.

Earlier this week, Germany's Health Minister Jens Spahn had a pretty blunt message for unvaccinated Germans. Here's what he said.


JENS SPAHN: (Speaking German).

SCHMITZ: And he's saying here that by the end of this winter, Germans are likely to be vaccinated, recovered or dead. He acknowledged that it might sound pretty cynical, but he said that's the reality.

MARTÍNEZ: Wow. Anthony, at the beginning of the pandemic, South Korea was held up as an example of a government doing all the right things. What went wrong there?

ANTHONY KUHN, BYLINE: Well, the early successes stood them in good shape for later. It contributed to lower total case numbers and deaths. The fatality rate in South Korea is half what it is in the U.S. And their record-high daily case numbers of more than 4,000 this week are unprecedented here but not exactly eye-popping by international standards. What's happened this fall, though, is that they have recently hit 80% full vaccination rates in South Korea; at the same time, social distancing has sort of stopped working. People have given up on it. And so the government decided it's time to start lifting restrictions in stages, which is happening in other countries around Asia.

And in South Korea, they're calling it a return to normal life. And what they're saying is, we're not going to focus so much on keeping the case numbers down as much as keeping fatalities down and severe cases down and keeping hospitals from being overwhelmed. But as people start to move around, cases are surging, and ICU beds in the capital region are now 84% full. And the government is questioning whether it may have to suspend this loosening of restrictions.

MARTÍNEZ: Michaeleen, all of this is frustrating and disheartening all at the same time. And you've been talking to a lot of scientists. I mean, why are the numbers rising, even in countries with high vaccination rates? I mean, is it the type of vaccine, the delta variant? I mean, what's going on?

DOUCLEFF: Yeah, it's definitely not which vaccines countries are using. You know, in Germany, the most common vaccine is Pfizer, you know, what we have here. What's really driving these surges is unvaccinated people. Even if you have a large percentage of your population vaccinated, you still have a huge number of people who are vulnerable to this virus. So take Germany. About 70% of its population is vaccinated. Maybe another 7% have some natural immunity, which sounds like a lot of people that are protected. But if you do some quick math, that leaves, like, very roughly 18 million people unprotected. I talked to Michael Osterholm about this. He's an epidemiologist at the University of Minnesota. He says these unvaccinated people are kind of like dry, unburnt kindling in a forest fire.

MICHAEL OSTERHOLM: Exactly, exactly. And so I keep saying that's more than enough human wood for this coronavirus forest fire to keep burning.

DOUCLEFF: And this is even a bigger problem with the delta variant. It is so contagious that a 70% vaccination rate is just not enough to stop a surge. You really need 100%.

MARTÍNEZ: Let's go back to Rob Schmitz in Germany for a second because the government has been urging people to get vaccinated, and it's beginning to restrict freedoms for the unvaccinated. Rob, is that leading to more people getting vaccinated?

SCHMITZ: Yeah, it is. It's almost working too well. Starting this week, all Germans need to be vaccinated, recovered or tested to ride public transportation and to go to their workplace. Here in Berlin, the rules are even stricter. Starting tomorrow, the unvaccinated are only allowed into essential stores like supermarkets and gas stations. And that's led to a big spike in vaccinations across Germany. I've been monitoring the registration page for Berlin's vaccination centers. And a week ago, you could easily find appointments the next day, but when these new rules were announced, suddenly there were no time slots left, and the next appointments were suddenly sometime in January. People are waiting now for six to seven hours in line just to get a shot.

And it's clear that Germany now has another problem - it doesn't appear to have enough staff to administer vaccines to keep up with this sudden demand. We've seen similar spikes in vaccination demand in Austria, as people there realize they're not going to be allowed into restaurants and most other places unless they are vaccinated.

MARTÍNEZ: Now back to Anthony Kuhn in South Korea. Anthony, many people there were vaccinated very early in the pandemic. Do experts worry that maybe people's immunity there is declining?

KUHN: Actually, A, South Korea got off to a kind of slow start with vaccinating in part because they did well last year relying mostly on contact tracing and testing. But now they're ahead of the U.S. and other developed economies at 80% percent, but it's not clear how far beyond that they can go. The problem now is that they've been slow to administer third or booster shots to the elderly and vaccinate kids. Over the past week or so, more than a third of the new cases were over age 60, and they were the first to be vaccinated. Less than 10% of them have received their third shots. Then we have another 17% who are below age 18, and less than a fifth of Koreans aged 12 to 17 have been vaccinated. They haven't even started on kids younger than 12. And so that's half of the new cases right there and plenty of room for the virus to spread.

MARTÍNEZ: Michaeleen, some British experts claim that because they allowed the delta variant to flourish over the summer that they had their surge when people were outside and hospitals were not so busy. Any truth to that?

DOUCLEFF: Yeah. No, actually, the U.K. surge came in the summer, like you said, but it really hasn't stopped. They still have 44,000 cases a day right now. That's similar to Germany. One thing that has been really interesting in the U.K., though, is even though they've had this massive number of cases for a long time now, they haven't had the massive number of deaths in this latest surge. And so the U.K. has been much more successful than the U.S. in preventing deaths as cases rise. And really, this is the key to the future of COVID, right? When surges of infections don't result in surges in hospitalizations and deaths.

MARTÍNEZ: Anthony and Rob, let me ask you both how public opinion is being affected by this surge. Anthony, by international standards, South Korea's situation doesn't look so bad, so are people there worried?

KUHN: Well, they definitely feel things are getting worse. The thing is that before, they were really unhappy about the restrictions, and the government, I think, realized that these restrictions were unsustainable in the long term, so they started lifting them. So now we're at, you know, highs of around 4,000 new cases a day, but experts fear that if they continue lifting restrictions that they could go to 10,000, 20,000 a day. And then the question becomes how many cases - how far can cases go before the public feels that the government is not protecting them, that they're dissatisfied, and they call for restrictions to be reinstated?

MARTÍNEZ: Rob, what about Germany? What are the effects of the COVID upsurge there?

SCHMITZ: Yeah, the restrictions here have sort of - I mean, there's a vocal minority of people that are opposed to them and the vaccinations themselves. And - you know, in Austria, Belgium, Netherlands, Germany. It's important to point out, though, that this is a - it's a minority. The policy of increasing restrictions for the unvaccinated is having an effect, and it seems that most people just want the new government here in Germany to get their act together, take a lead, distribute the vaccines and booster shots effectively and try to get things back to as close as normal as possible. You know, the Christmas season is an important economic time for this part of Europe. You know, consumer activity spikes. People start traveling. They go skiing. And all of these restrictions will mean another tough season for a region that could definitely use an economic rebound.

MARTÍNEZ: Michaeleen, you get the last word. What are the chances we could see surges like the ones we've been talking about in the U.S.?

DOUCLEFF: Very good. You know, in some parts of the country, it's kind of already happening. There are some sharp increases in cases in the upper Midwest, also in the northeast. You know, one scientist I talked to predicted that New York is about to, quote, "take off." You know, our vaccination rates are lower than countries like Germany, and we have a lot of people for this virus to easily infect, you know, all that stacks of unburnt kindling. Our total population is only about 60% vaccinated. So again, if you do some math - you know, and this is really, really rough - but there could be tens of millions, even close to a hundred million people who still have little or no protection. So that's a lot of fuel for a surge right now.

MARTÍNEZ: That's NPR's Michaeleen Doucleff, also NPR's Anthony Kuhn in Seoul, Rob Schmitz in Berlin. My thanks to all three of you.

SCHMITZ: Thank you, A.

DOUCLEFF: Thank you.

KUHN: Thank you.