Hospitals are struggling to cope as Covid-19 sweeps through large unvaccinated populations in central and eastern Europe, where low levels of trust impeded acceptance of inoculation programmes.
Austria, Denmark, France, Italy, the Netherlands and others have teamed up to send oxygen supplies, medicines and ventilators to Romania after it appealed for help from the European Union to cope with a crushing fourth wave of the pandemic.
Just 36 per cent of adults are fully vaccinated in the country, according to EU figures, the second-lowest level in the union after Bulgaria, where the rate is just one in four adults, far below the pan-EU rate of 75 per cent.
Both countries are suffering a brutal surge of infections, hospitalisations and deaths. Romania has seen an average of more than 400 deaths a day for the past week, in a population of 19 million, the highest rate in the EU according to the European Centre for Disease Prevention and Control. In Bulgaria, in a population of seven million, more than 100 people have died on average each day for the past week.
Romania on Monday imposed a night-time curfew, shut schools and introduced mandatory Covid-19 passes for most public venues in a bid to curb the soaring infections as its intensive-care wards ran out of beds.
Infections are also soaring in the Baltic states of Lithuania and Latvia, which became the first European country to reimpose sweeping restrictions last week by shutting schools and all non-essential shops, and imposing a curfew from 8pm to 5am for a month. Restrictions were also tightened in the Czech Republic and in Slovakia.
In neighbouring Russia, daily Covid-19 infections reached a record high of 37,930 in 24 hours on Monday, and some regions shut workplaces in response.
World Health Organisation director general Tedros Adhanom Ghebreyesus warned that with 50,000 Covid-19 deaths a week the pandemic was "far from over", but he said it would end "when the world chooses to end it".
“It is in our hands. We have all the tools we need,” he said. “Unlike so many other health challenges, we can prevent this. Complacency is now as dangerous as the virus.”
In Austria, where 73 per cent of adults are fully vaccinated, chancellor Alexander Schallenberg warned that restrictions could be placed on the unvaccinated if Covid-19 patients began to take up the country's ICU capacity.
“The pandemic is not yet in the rear view mirror,” Mr Schallenberg said. “We are about to stumble into a pandemic of the unvaccinated.”
He warned that if Covid-19 patients took up a quarter of national ICU beds, then only the vaccinated or people who had recovered from the virus would be allowed entry into restaurants and hotels. If the percentage reached a third, the unvaccinated would be allowed to leave home only for specific reasons.
Vaccination rates have reached above 90 per cent for those eligible in several countries in western Europe including Ireland, though coverage is lower in some cities and particular populations.
This is helping to keep hospitalisations under control, but infections are still rising and many countries have opted to continue with some precautions including mask-wearing, working from home recommendations, and mandatory Covid-19 passes in public settings. Last week, Italy made the passes mandatory for workplaces.
The WHO warned last week that Europe region was the only region in which Covid-19 cases were rising, led by surges in the Czech Republic, Hungary and Poland.
Emergencies chief Dr Mike Ryan appealed for the unvaccinated to come forward for jabs, and said the rise in infections came as restrictions were dropped in many countries, coinciding with "the winter period, in which people are moving inside as the cold snaps appear".