HEPL blog series: Country Responses to the Covid19 Pandemic

Austria’s Response to the Coronavirus Pandemic – a second perspective (read the alternative report here)

Thomas Czypionka, Institute for Advanced Studies Vienna (IHS), Austria and London School of Economics, UK
Miriam Reiss, Institute for Advanced Studies Vienna
Isabel Pham, Institute for Advanced Studies Vienna

Despite its fragmented healthcare system, strong federalism and relatively poor public health capacity, Austria has so far fared surprisingly well in the current crisis. After the swift and decisive introduction of rather drastic measures, infections have shown considerable decline. As one of the first European countries to impose them, restrictions will be gradually lifted in the coming weeks. In the following, we will discuss some of the factors that have contributed to this development.

How it all began

On February 25, a young woman working in a hotel in Innsbruck and her partner – both Italian nationals who had recently visited their home in Lombardy – were the first persons in Austria to test positive for SARS-CoV-2. Geographical vicinity and close ties to Northern Italy alongside disturbing footage of the country’s overextended ICUs gave rise to concerns among the population as well as the government. In press conferences that began airing almost daily, more and more substantial restrictions to social and economic activity were announced in quick succession. On March 15, the parliament enacted the first COVID-19 law mainly covering general movement restrictions and economic support measures that since have been followed by several amendments.

Key public health measures

The first measures put into place regarded travel and education. In early March, travel warnings were issued for China, Iran, Israel and South Korea and expatriates were asked to return. In the light of the increasing spread of the virus in Europe, travel restrictions were significantly tightened in the following weeks, starting with refusal of entry from Italy. It might, however, be argued that such restrictions – in particular, entry bans from Italy and China – should have been introduced earlier.

On March 10, the government announced that all Austrian universities and upper secondary schools needed to switch to distance learning. Suspension of classroom teaching was subsequently extended to all types of schools, and childcare restricted to parents working in critical infrastructure. While the role of children in transmission of SARS-CoV-2 is not yet clear – they tend to show only mild or no symptoms, but may still be able to transmit the virus – this measure was based on the assumption that children could act as facilitators of transmission within families.

With regard to daily life, the government had initially urged the population to voluntarily practice social distancing and stay at home in case of symptoms. However, Austria soon faced daily infection growth rates of more than 40%, and consequently, the first movement restrictions were announced on March 12. Initially these only applied to large gatherings and events, but substantially broadened just a few days later, requiring people to shelter in place except for covering basic needs, assisting others in need, performing essential work and taking walks with persons from the same household. The hospitality industry and all non-essential shops were closed on March 17. Considering the relatively low number of total cases at the time (around 360 on March 12) and the lack of comparable measures in most other European countries, these actions initially appeared rather drastic. Guidance on the implementation of measures came from the “coronavirus taskforce”, a group of medical professionals and civil servants from the Ministry of Health, and the “COVID forecast consortium”, a team of researchers simulating the spread and providing a forecast of hospital and ICU use. It is probably owed to both institutions that Austria’s ample bed and ICU capacity never came under pressure.

Following the example of its eastern neighbours, Austria also introduced mandatory use of face masks in supermarkets and public transport, despite inconclusive evidence regarding their effectiveness.

Growing tensions

Surprisingly, for several weeks there had been virtually no protest from opposition parties or other political institutions, enhancing the impression of a shoulder-to-shoulder stance in the face of crisis. Consequently, support of and compliance with the measures have been consistently high among the Austrian public.

As the crisis evolved, however, at least some political controversy was bound to arise. The Green Party found itself under growing tension as it ironically had to play a prime role in restricting personal freedom. Unsurprisingly, first dissent among the conservative-green coalition broke out when the (conservative) president of the parliament mused about making a contact tracing app mandatory. Furthermore, the suggestion to identify persons at risk via medication data in electronic health records has been publicly opposed. Another point of contention was the number of tests performed. Opposition parties began to criticise the government for the allegedly low number of tests. This put the Green-led Ministry of Health with its more focused testing policy at odds with the Chancellery, with the latter having the final word in promising to increase tests to 15,000 a day.

Relaxation of measures

The goals of the implemented measures were to slow the spread of the virus – the famous “flattening the curve” was repeatedly mentioned in press conferences – and to protect risk groups, thus avoiding a collapse of the healthcare system and unnecessary deaths. By early April, the daily number of confirmed cases had begun to stabilise with the growth rate decreasing from 40% to now 2%. This development has led the government to announce a cautious relaxation of measures within the coming weeks. Small shops will be allowed to reopen on April 14, and all other stores, shopping centres and the service industry will follow on May 1. The hospitality industry will possibly reopen from mid-May. It was, however, stressed that the relaxation of measures was conditional on the public remaining compliant with current restrictions as well as on infection rates continuing to stabilise. Moreover, re-openings will be accompanied by strict distancing and sanitary regulations.

Reflection

The Austrian government’s swift and decisive response can be explained by several factors:

• Vicinity and close ties to Northern Italy, which made a spread to Austria very likely.
• The pre-existence of an agent-based simulation model of epidemic spread that informed decision makers about scenarios and consequences for the population and the health system.
• A newly formed and novel (conservative-green) coalition that wanted to show resolve, unity and prove a capacity to act.

The measures were introduced using a piecemeal tactic, which seemingly led to wide acceptance as shown in polls and in turn to a decreasing growth rate of positive tests in recent days. A likely contributing factor to the comparably low number of deaths is that the infection was majorly introduced by business travellers and younger people doing winter sports. Additionally, fewer people live in intergenerational households in contrast to Italy. However, some aspects have not been managed well. It is now widely accepted that officials should have reacted sooner regarding community spread in the ski resort Ischgl, a European hotspot from which many tourists took the contagion home. The state attorney’s office has even started an investigation for fraudulent concealment. Nursing homes are a growing concern, as they seem to have been ill-prepared for an epidemic. Even though measures are to be lifted after Easter, there does not appear to be an evidence-based exit strategy. In this context, it seems like a fluke that in Austria’s rather barren landscape in terms of public health and epidemiological research, one of the most advanced simulation models had been developed at the Technical University Vienna that visualised the consequences of inaction.

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