Concern for people aged over 65 is growing as cases surge across Europe in that age group.
Five of the 22 European regions with the highest coronavirus infection rates are in the north of England, Sky News analysis has found.
Greater Manchester, Merseyside, Northumberland and Tyne and Wear, West Yorkshire and Lancashire were among the top 5% of areas in Europe with infection rates of more than 350 cases per 100,000 people between 21 September and 4 October.
The Spanish capital of Madrid remains the region with the highest COVID-19 infection rate among the European countries analysed by the European Centre for Disease Prevention and Control (ECDC).
Over the past two weeks, the city has had a rate of 754 cases per 100,000 people.
The Estonian region of Ida-Viru is close behind, with 741 cases per 100,000.
Merseyside comes in third, with 685 cases per 100,000.
Spain has more regions – one-third (seven) – among the top 22 highest infection rates than any other European country.
The UK is second, with five regions, and the Czech Republic comes in third with four regions.
Analysis of the recent infection rates found Europe is still dealing with high infection rates, with the ECDC defining rates of more than 60 cases per 100,000 as high.
Two-thirds of the 420 regions analysed are over that threshold.
Surge of cases in over-65s
Numbers of COVID-19 cases started to increase in late summer in most European countries.
The rise was driven mainly by young people, but cases among the over-65 population are now rising.
According to the ECDC, 18 countries are seeing high levels or sustained increases in that older age group over the past two weeks.
Countries badly affected in April and May, like Spain, Belgium, France and the UK, are recording higher infection rates than before.
However, Germany and Italy – among the worst-hit countries in spring – are dealing with the situation better as although cases are increasing, they are still well below the rates in spring.
Virologist Dr Stephen Griffin, associate professor at the school of medicine, University of Leeds, said Germany’s healthcare system is in a “far fitter state” than the UK’s so has been able to deal with the pandemic better.
He added: “Germany had a better set of messaging than the UK and Merkel brought people with her, they listened.
“They implemented test and trace early on, and it worked. Cases will continue to increase as they have land borders, but there is better compliance with measures.
“Italy is very well prepared now and because they have mitigations such as social distancing, they will have fewer people in hospital at a time so will be better able to cope.”
The number of cases is heavily dependent on how many tests each country is carrying out, which is why the positivity rate – the number of cases found in 100 tests – is important.
The risk of burdening hospitals
An increase in older people getting COVID-19 will likely lead to a rise in hospital admissions and then deaths.
Dr Griffin said: “Already, we are seeing hospital admissions going up.
“In the UK last week, we already had several thousand people on ventilators and some hospitals are seeing wards filling up.
“That is only going to increase as more older people get it – there’s always a lag in hospital admissions after a spike in cases, and that’s what we’re starting to see across Europe.”
Weekly admissions in most European countries are still relatively low, compared to previous levels. But data shows a slight increase, although not at the same rate as in March and April.
In spring, a surge in the number of admissions was followed by an increase in the number of deaths.
Although the number of people with COVID-19 who need hospital treatment is increasing again during the autumn, deaths are still relatively low. But this does not mean people are not dying and the number of deaths could increase again in the coming months.
As winter arrives, the issue of flu is also a big concern for hospitals, but Dr Griffin believes a lot of European countries are prepared to handle both.
However, he added: “I think this winter is going to be terrible for the UK, and we’re going to be looking at Europe in envy.”
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Countries included in the regional analysis for infection rates are: Spain, Portugal, Ireland, the UK, France, Belgium, the Netherlands, Italy, Germany, Denmark, Poland, Czech Republic, Greece, Estonia, Austria, Bulgaria, Croatia, Cyprus, Finland, Lithuania, Latvia, Hungary, Iceland, Luxembourg, Malta, Norway, Sweden, Slovenia, Slovakia and Romania.
Data comes from the ECDC, except for the UK and France, for which COVID-19 cases data comes from their national governments and population figures from the NUTS division of Eurostat.
The regional division used is the standardised Nomenclature of Territorial Units (NUTS), except for Estonia which uses its national administrative division.
High values are defined as at least: 60 per 100 000 for 14-day case notification rates (total and age-specific); 10 per one million for death rates; 3% for test positivity; 25% of the maximum rate to date during the pandemic for hospital or ICU admissions and occupancy rates.