“We have runaway numbers in terms of contamination and a major issue is the risk of the collapse of the hospital system of our country,” the minister-president of Brussels, Rudi Vervoort, said Saturday as he announced a host of new restrictions.
Unlike in the spring, there are enough masks and gowns to go around. But months of preparation haven’t been able to avert a shortage of people. And a decision by the national government to remove a mask mandate and loosen restrictions on social contacts this month contributed to an acceleration of the virus before being largely reversed in hard-hit areas since Friday.
Belgium’s infection rate is second only to the Czech Republic in the European Union and five times higher than in the United States.
The country's testing infrastructure is overloaded. As of this past week, Belgium is no longer testing people without symptoms, even if they may have been exposed.
“The situation is more serious” than in April, Christie Morreale, health minister of the French-speaking region of Belgium, told the RTL broadcaster on Friday. “If you are a nurse and you have a few hours to dedicate in a nursing home or a hospital, if you’re a nursing student, a medical student, an educator, they have need of support.”
This is what it means to be close to a coronavirus “tsunami” — a word used in northern Italy in the spring and deployed this past week by Belgian Health Minister Frank Vandenbroucke, who said that the virus could soon escape authorities’ control.
Vandenbroucke’s statement came before Foreign Minister Sophie Wilmès — who stepped down as prime minister earlier this month — was admitted into an intensive care unit with covid-19 on Wednesday. Wilmès is 45 and otherwise healthy.
“The situation is catastrophic,” said Philippe Devos, an intensive care doctor at the CHC Montlégia Hospital in Liège, the worst-hit Belgian city. “Liège is now is probably the most affected region in the world. We have a lot of doctors and nurses affected. But, starting this week, positive cases were asked to go back to work if they are asymptomatic.”
He said at some hospitals in the city, between one-fifth and one-quarter of the medical staff is sick or quarantining.
“We are in deep,” said Devos, who is also president of the Belgian Association of Medical Unions.
Daily caseloads, already posting records, are expected to double in the coming week, according to Yves Van Laethem, an infectious-disease specialist and spokesman for the country’s official covid-19 response. That means 1 percent of Belgium’s 11 million residents could soon be contagious with an active infection.
For a time, hospital admission rates remained relatively low in Europe’s second wave, providing a measure of comfort. But admissions have shot up rapidly, as infections have passed from younger, healthier people to older people predisposed to severe cases and complications of covid-19.
In Belgium, hospital occupancy is up 87 percent in the past week. If it keeps increasing at that rate, within days it will surpass April peaks, when the country led the world in deaths in proportion to its population. Some Belgian hospitals warn they are already as saturated as during the first wave.
The situation may be especially problematic in intensive care units. Belgium has comfortable ICU capacity for its population, and only a quarter of the country’s intensive care beds are currently occupied by covid-19 patients. But a full team of skilled personnel is needed to keep patients monitored in ICUs. Some hospitals are already warning they may not be able to keep all their ICU beds in operation if their personnel are too sick.
Staff shortages could reduce ICU capacity by more than a quarter, according to projections from Belgian public health researchers, meaning hospitals could reach maximum capacity within weeks.
“March 2020 revisited,” tweeted Marc Noppen, chief executive of the University Hospital of Brussels, one of the biggest hospitals in the Belgian capital, which announced this week that it was expanding its ICU capacity. “ANGRY that we were unable to avoid this predicted scenario.”
Even doctors who are healthy — for now — say they are close to burnout.
“Everyone is just tired. And not only physically exhausted. We are sick and tired of the situation,” said Nicolas Frusch, a pulmonologist at the Libramont Hospital in eastern Belgium.
Belgian nursing homes are also under stress. Seared by the experience of the spring peak, when nursing home residents accounted for two out of every three coronavirus deaths, policymakers pledged to do everything they could to protect nursing homes this time around.
But infections are shooting upward, and deaths are likely to follow. In Belgium’s French-speaking south, the epicenter of the current wave, cases in nursing homes nearly tripled in the last week, to 22 infections per 1,000 residents.
Belgian Defense Minister Ludivine Dedonder said Thursday the country’s military was prepared to deploy 1,500 troops to hospitals and nursing homes to help out, a measure of the strain.
The second wave is testing Belgian schools, as well.
Schools here have continued mostly in-person, the result of a nationwide push to prioritize education over other sectors of society. But the resolve is starting to fray: High schools were given more flexibility this past week to shift partly to virtual instruction, and a fall school holiday was extended by two days to try to nudge infections lower.
“As the pandemic grows, it becomes more and more challenging for us,” said Etienne Michel, the director of the federation of Belgium’s French-speaking Catholic schools, which educate about half of the children in the French-speaking part of the country. The federation recently surveyed its primary schools and found 23 percent of teachers are sick or quarantining, Michel said. Even that could be an undercount, since overstretched schools may not have had the resources to answer the questionnaire.
“It is a mess,” said Isabelle Allelyn, principal of the Communal School of Grand-Rechain, a small village in Belgium’s worst-hit eastern region.
Half her teachers are sick or quarantining, she said. Of her 225 students, 37 are quarantining and 45 can’t come in because there’s no teacher for them. In one classroom, first the teacher got sick — and then her substitute did, too.
“We are doing our best to cope with the pandemic,” Allelyn said, speaking from home, because she, too, has tested positive for the virus. “But now the situation is pretty unstable and is almost getting out of control.”
In Belgium’s full French-speaking school system, cases among students and staff more than doubled between the second and third weeks of October, according to figures released Thursday by the Office of Birth and Childhood, French-speaking Belgium’s official child welfare agency. (The separate school system in Belgium’s Dutch-speaking north does not maintain similar numbers.)
“Today it is daily fix-it work for the schools and administrations, which need to redo schedules and find replacements,” said Caroline Désir, education minister for the French-speaking region of Belgium, in an interview with the RTBF broadcaster on Thursday.
For now, Belgian leaders have avoided imposing a full lockdown, although increasingly frustrated public health experts say a new one is inevitable. But even more limited measures, such as a month-long closure of restaurants and bars and a regional curfew announced Friday depend in part on police being able to enforce the rules.
In at least parts of Belgium, that power is increasingly in question — because the police themselves are getting sick.
This month alone, 2,368 police officers across Belgium have tested positive or had to quarantine, according to an internal police document dated Tuesday.
In the province surrounding the city of Liège, “around 50 percent of police officers are not at work,” said Vincent Gilles, the head of the SLFP police union.
For now, many departments are filling the gaps by assigning double shifts.
A handful of police stations are closed entirely, including one in the southern town of Libramont, where at least 10 officers tested positive this month and the other 25 needed to quarantine because they had been in contact with the sick ones.
At a station in northern Belgium, three officers recently tested positive at one time, according to a police official who spoke on the condition of anonymity to discuss sensitive internal affairs. They had no symptoms, so their superiors simply put them together on a single patrol unit — they could keep working without fear of infecting each other.
“People do not realize the situation we are in,” said Thierry Belin, national secretary of the SNPS police union.
Birnbaum reported from Riga, Latvia.