ANALYSIS: Why are Covid cases in Austria rising and how worried should we be?

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ANALYSIS: Why are Covid cases in Austria rising and how worried should we be?
People hold up placards during a protest, organized by the Evidence-Based Corona Information Initiative (ICI), against the safety measures during the new coronavirus COVID-19 pandemic ordered by the Austrian government in Vienna, Austria on May 14, 2020. (Photo by JOE KLAMAR / AFP)

In the 24 hours leading to Friday, Austria reported 9,388 new Covid cases, not far off an all-time high, while the high level of Covid patients in ICUs has prompted stricter national measures. So what are the factors behind the fourth wave and how bad could it get?


The number of Covid-19 infections in Austria is rising quickly again - especially when compared to neighbouring European countries.

Cases in Austria are now twice as many (per capita) as in neighbouring Germany and three times as many as in Switzerland, while the number of Covid patients in ICUs has reached a high enough level to trigger the next step of Covid restrictions. 


Testing rates

First, it's useful to make sure we're comparing like with like. 

As the chart below from Our World in Data shows, Austria is carrying out significantly more tests relative to its population than many European countries (we have chosen to compare Austria with its neighbours and the eight other countries covered by The Local; to add other countries to the comparison, you can click the 'Add country' button).

This is likely due to the widespread use of 3G or 2.5G rules which mean that either proof of a negative test, vaccination or recovery is required to enter many locations ranging from restaurants to workplaces.

Some people are asymptomatic despite having Covid-19, so a higher rate of testing increases the likelihood of picking up on asymptomatic cases.

In fact, Our World in Data shows us that of these 12 countries, despite having the highest rate of positive test results, Austria has the lowest rate of test positivity except for Italy. That suggests that the other countries have a higher number of cases that aren't reflected in the test numbers.

But that doesn't mean Austria's rapidly rising incidence rate is a red herring.

Because on the discrepancies in testing policy, one of the most reliable measures of how serious the pandemic situation is, is the number of patients in intensive care. This too has been rising in Austria in recent weeks and has now passed 300, which is 15 percent of total capacity and is the milestone to trigger the next stage of restrictions in Austria's five-step plan.


Again, if we compare Austria with its European neighbours, the number of Covid patients in intensive care is very high relative to the population. This means that more people are getting seriously ill due to Covid, more people are at risk of dying from the virus, and the healthcare sector is coming under increasing strain.

The next question is what's caused the upward trend.

Low vaccination rate and falling immunity

Vaccination rates across Austria have plateaued in recent months at just over 60 percent of the total population - far from the European Commission’s goal of 80 percent. A low rate of vaccination, combined with the fact that those vaccinated early on may now have reduced immunity (it is normal for the protective effect of vaccines to decline over time) means that the virus can spread more easily.

If we compare Austria to neighbouring Italy using the data shown above, it's clear that Italy is also carrying out lots of tests -- like Austria, it has a widespread requirement for vaccine passes or negative tests -- but has a low test positivity rate, and a much lower rate of intensive care admissions.

A clear difference between the neighbours is that Italy's vaccination rate is much higher, meaning more of the population is protected from serious illness. In Austria, around one in four of the population eligible for vaccination has chosen not to get the jab.

Currently, around 90 percent of symptomatic cases in Austria are in unvaccinated people.

The number of vaccination breakthroughs - when a fully vaccinated person becomes infected with Covid-19 - is also rising, especially in the 18 to 59 age group, but it's still less than in unvaccinated people. The latest figures from AGES show the current seven-day incidence rate for vaccination breakthroughs in Austria is around 220.


Austria has tried several initiatives to encourage vaccination, from the government updating its own Covid dashboard to make it clear how vaccinations protect individuals, to organising drop-in vaccination centres with no need for an appointment, to more innovative ideas like a vaccination lottery in Burgenland where vaccinated residents can enter to win prizes. 

Even still, the vaccine rate lags behind its neighbours. There are several possible explanations for the apparent vaccine scepticism in Austria.

One important factor is that Austria's far-right Freedom Party (FPÖ) has openly opposed Covid vaccination, with leader Herbert Kickl speaking at anti-vaccination rallies. Austria's Medical Association has criticised Kickl for spreading misinformation, with its president calling the politician's words a "slap in the face" to Austrian medical workers.

This contrasts to countries such as Denmark where governments have worked with the opposition to create and communicate Covid policy, but it is difficult to define the precise cause and effect. In a September election, anti-vaccination party MFG achieved a shock result by passing the 4 percent threshold needed to enter the local parliament. Only founded in February this year, the party's success suggests that populist parties may be reflecting scepticism that already existed as well as fuelling it.

Austria has now approved Covid booster doses for all residents, and these are possible from six months after the second dose. In Vienna, the mayor has even announced plans to open up "off-label" vaccination for under-12s to boost the vaccination rate. This has not yet been approved by the European Medicines Agency, though the vaccine has been rolled out to under-12s in the USA.


Seasonal factors

We've been here before, so we know that part of the reason for the rise in cases is seasonal. Cold weather favours the spread of viruses, and people are more likely to socialise indoors than during the summer months, again creating better conditions for Covid-19 to spread.

This time last year, Austria was also recording high levels of Covid-19 cases with a seven-day incidence rate of 433 - not much more than the current rate of 430. 

However, in early November 2020, national restrictions were already in place, including a night time curfew and partial shutdown of non-essential services. Then, in mid-November, the country moved into its second national lockdown with all non-essential shops and services (including bars, cafes and hairdressers) closed. 


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