In early August, seven groups of young people returned home from Croatia, Greece and Malta to the Italian province of Padua, one of Europe’s early battlegrounds against Covid-19, and tested positive for the virus.
The new clusters, involving at least 25 positive cases, led to 159 other people also being placed in isolation for having had potential contact with the virus, according to public health documents reviewed by the Financial Times.
But the positive cases were only detected by track-and-trace protocols after they had developed symptoms — a lag of weeks in many cases. Faster tracing across borders or testing before travel would have limited the spread, experts say.
More than five months after the World Health Organization declared the coronavirus outbreak a pandemic, the state of cross-border contact tracing across Europe remains deeply fragmented as travel has resumed.
With holidaymakers moving across the continent, experts are forecasting another coronavirus peak. Several countries have already seen an uptick in new cases, with many linked to travellers, both domestic and international.
“The problem of return contagion is very serious and one to be dealt with common directives,” said Andrea Crisanti, a leading Italian microbiologist. “Europe’s decision mechanisms aren’t up to the task.”
While the threat of coronavirus is relatively new, Europe’s challenge is not: public health policies are a national matter, as are the ways countries respond to new clusters, making co-ordination difficult across the bloc.
Belgium and the Netherlands, for example, radically differ in how they are tracking the virus, despite being neighbours and sharing a long, open border. That lack of alignment could be disastrous as free movement increases. And tracing cases after people have travelled is a worse option than testing them before they change locations.
“At this, point, tracing will not suffice in preventing community transmission. We have to test all contacts, family members and co-workers,” Prof Crisanti said, adding that health systems were likely to buckle again “unless a lab network that can test individuals before they travel comes to exist”.
EU member states are working on a mechanism that will allow them to trace positive cases and their contacts across borders through smartphone apps that use a standard developed by Apple and Google, with the support of SAP and Deutsche Telekom.
But that solution is expected to materialise in October, after the tourist season. It will also exclude countries such as France — one of the most visited in the world — after it opted out of the common tech standard.
Pan-European approaches are emerging. Italy, for example, is weighing the reciprocity of testing with Spain and France, a health official told Rai News 24 over the weekend, in order to test passengers arriving and departing at airports and to make contagion easier to trace.
One pan-European tracing mechanism, the Early Warning and Response System, already exists, but the low number of cases it has flagged since the start of the pandemic indicates it is not keeping pace with infection numbers.
Created in 1999 to track tuberculosis, the European Commission said 408 notifications had been logged through the system since 2017, including for Covid-19, with member states exchanging information through the system.
Some countries, such as Italy, Germany and the UK, are introducing ad hoc quarantine measures and requiring testing for travellers from certain countries, including Greece, Croatia, Malta and Spain, at their borders. Local lockdowns have been introduced in France and the UK, among others. But these policies are far from universal, underscoring a lack of preparedness in cross-border Covid-19 control.
“The fact that countries react by saying you can’t travel from Spain or other countries, or if you do, get ready to be confined for 14 days, implies that many think the processes that are set up inside each country in Europe are insufficient,” said Rafael Bengoa, a former official at the WHO and a former health minister for Spain’s Basque region.
With a pan-European tracing mechanism not ready, much of the legwork to contain new clusters relies on armies of contact tracers on the ground.
Manual contact tracing is resource-intensive. The European Centre for Disease Prevention and Control estimates that for an average 1,000 reported cases a day, as many as 359 staffers are needed to track and trace contagion — and that estimate is based on about half of potential contacts using web-based applications to aid tracing.
In Spain, Catalan authorities, to whom healthcare is devolved, anticipated in May that case rates would remain flat at 300 per day until infections increased in mid-October, according to an internal document seen by the Financial Times. On this basis, they planned to hire 182 tracers.
Then infections spiralled out of control in July as bars and restaurants reopened and tourists returned, crippling the system’s ability to trace clusters and allowing transmission to take root in the community.
The Catalan government hired 500 more tracers, but by then, new cases in Barcelona, the region’s capital and a tourism hotspot, were surging. Quarantine measures for travellers from Spain to the UK and other European countries were imposed and some Spanish regions have asked the army for help with tracing.
The French ministry of health said it had handled “more than a dozen” cross-border cases per day since July in co-ordination with foreign countries. Italy has until now been able to keep its daily new count below 1,500, while testing widely.
Belgium meanwhile appears to have curbed exponential growth in cases. But the country’s many local and regional governments have raised concerns about tracing between the country’s francophone and Flemish regions.
Hans Bonte, mayor of Vilvoorde, a Flemish town outside Brussels, has described the system as “Kafkaesque”. “If you do not clarify how the following up should be done, there will never be a decent contact tracing of infected persons across the regional borders,” Mr Bonte told local media.
Additional reporting by Mehreen Khan in Brussels and Davide Ghiglione in Rome