Londoners wear masks on the Tube.

Scientists warned the world this spring: Nations could see a second, larger wave of coronavirus cases in the fall as they relaxed lockdown restrictions. That worst-case scenario has now come to fruition in a number of European countries.

Daily cases in the UK have risen steadily since August, reaching an all-time peak of more than 17,000 daily cases on Thursday (aside from a technical glitch that led to 23,000 cases being reported on October 4). France has seen a similar pattern: On Wednesday, the nation reported 19,000 new cases in just 24 hours — its highest daily count so far.

In Belgium and Poland, new daily cases have surpassed peak levels recorded during the first wave of infections. Cases are also surging in Germany, Ireland, Italy, and Sweden. 

Public-health experts have a few ideas as to why.

There is more testing, but there is also more socializing

To start, European countries are getting better at testing and surveillance. By early September, the UK was conducting nearly 45 times more tests compared to early April and France was conducting nearly eight times as many tests, according to data from the European Centre for Disease Prevention and Control. Testing capacity was also nearly three times higher in Germany and Italy by early September.

Another reason that infections have risen is that European countries are lifting lockdown restrictions, thereby increasing social interactions — particularly among younger groups. At a press briefing on Monday, Dr. Maria Van Kerkhove, the World Health Organization's COVID-19 technical lead, said "quite a few" recent outbreaks have been linked to entertainment venues, religious settings, and sporting events.

This desire to socialize coincides with a rise in "pandemic fatigue" across Europe.

A recent WHO report found that a growing share of European residents aren't sufficiently following lockdown restrictions or are decreasing their efforts to keep informed about the pandemic. People may also perceive activities as lower risk compared to the start of the pandemic, even though transmission is higher.

As countries relax lockdown restrictions, residents may get the false impression that certain activities are now safe as opposed to economically necessary. The UK's Eat Out to Help Out scheme, for instance, encouraged residents to visit restaurants, cafés, and pubs in August by offering 50% discounts. But it may have undermined the message that eating indoors is relatively risky, given the opportunity for airborne transmission.

Over time, residents may become desensitized to health warnings altogether.

"Even the most outrageous circumstances become normal when experienced over longer periods of time," according to the WHO report. "People may become used to the pandemic and the threat it poses, and complacency may result."

Cases were climbing before schools reopened

Many European countries began to significantly relax lockdown restrictions as early as the spring. Italy and Germany reopened bars and restaurants in May. France implemented the same measure in June and the UK followed suit in July.

An analysis from Morgan Stanley's research unit, AlphaWise, found that half of UK workers surveyed had returned to their normal workplace in August. That figure was even higher in Spain, Italy, and Germany, where three-quarters of surveyed employees had returned to work. In France, more than 80% of surveyed workers had gone back in August.

By the time European countries reopened schools in the fall, cases were already beginning to climb.

Germany reopened schools on August 7 — a trade-off for maintaining its bans on large public gatherings such as concerts and sporting events. Within a week, the country had identified around 150 coronavirus cases in schools, but most of those were single infections traced to outside the classroom. 

French and UK classrooms also welcomed students back in September.

Within four days of reopening schools, France saw 22 schools close temporarily due to coronavirus cases. UK schools also began to implement temporary closures around the same time. The number of UK schools that weren't fully open due to coronavirus cases rose from 1% on September 10 to 4% on September 17. 

That same month, the UK's Scientific Advisory Group for Emergencies proposed a two-week lockdown to help lower transmission. Other scientists have suggested closing bars and restaurants again to allow UK schools to remain open.

'Pandemic fatigue' is setting in as risk perception declines

At the same time that European residents have more opportunities to interact, they've also found it increasingly difficult to abide by lockdown restrictions.

Just 11% of UK residents who were exposed to a confirmed COVID-19 case said they had isolated at home for two weeks, according to a King's College London survey conducted from March to August that's still awaiting peer review. Only 18% of those surveyed said they hadn't left home after developing COVID-19 symptoms in the last seven days.

Many respondents said they couldn't quarantine because they had a dependent child at home — but other Europeans may simply be tired of restricting their movement. Surveys show that, as the pandemic wages on, people have become more stressed about their jobs or incomes, while their perception of risk has declined.

Over time, people may start to prioritize personal freedom over their own health.

People crowd the streets in London's Soho area on July 4, as lockdown restrictions are eased.

Others may have trouble determining which activities are low-risk due to conflicting messages from public-health officials. At the start of the pandemic, for instance, UK health officials said there was "mixed" evidence about whether masks prevented transmission. Studies now overwhelmingly suggest that they do.

"Since the virus arrived in the European region eight months ago, citizens have made huge sacrifices to contain COVID-19," Dr. Hans Henri Kluge, WHO's regional director for Europe, said on October 6. "It has come at an extraordinary cost, which has exhausted all of us, regardless of where we live, or what we do. In such circumstances it is easy and natural to feel apathetic and demotivated, to experience fatigue."

One group that may be particularly afflicted with "pandemic fatigue" — teenagers and young adults — is also a key driver of coronavirus transmission.

While young people are less vulnerable to severe outcomes, rising cases among younger groups already seems to be driving up hospitalizations in Europe. UK hospitals now have more coronavirus patients than in March, when the nation's lockdown began, according to data from Pantheon Macroeconomics.

"What we are beginning to see, worryingly, in places like France, like the UK, Ireland, and other countries is hospitalization rates increasing, ICU occupancy rising," Dr. Mike Ryan, the executive director of the WHO Health Emergencies Programme, said. "It's really important that health systems are able to cope with what will be an increase in cases in hospitals and ICUs over the coming weeks."

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