Every evening this spring, when the clocks struck eight, thousands of people across Europe came out to applaud from their balconies. They did this to recognise the immense effort of healthcare workers who are still fighting to save the lives of thousands of patients. Since the crisis began, Europe has recorded over 1.5 million cases. COVID-19 has killed at least 174,000 Europeans. “These have been very hard months. What health centres have experienced is appalling,” says María José García, spokesperson for SATSE, the main Spanish nursing union. García, who works in Madrid, has been one of thousands of healthcare workers who have been on the front line against the virus. As in other European countries, they have made a titanic effort despite the lack of resources.

However, there is an invisible line across Europe. Before COVID-19 hit, the Nordic and Central European countries had the best prepared health staff. Although the number of doctors per capita was similar to southern Europe, another important link in the chain differed: nursing. The northern and central European countries had many more nurses than did southern European countries. According to Eurostat data, Germany had almost 13 nurses per thousand inhabitants, similar to Luxembourg (11.72), Belgium (10.96), Sweden (10.90), the Netherlands (10.88) or Denmark (9.95).

At the other extreme, Greece had 3.31 nurses per thousand inhabitants in 2017, the lowest number. According to Eurostat data, other southern countries also had large staffing shortages. Spain, with 5.74 nursing specialists per thousand inhabitants, and Italy, with 5.80, were far more short-handed than their northern neighbours. During the height of the pandemic, both Spain and Italy became epicentres of the health crisis. The COVID-19 emergency has revealed, more clearly than ever, one of the historical weaknesses of those countries’ health systems: the nursing shortage. The fewer the nurses per patient the worse the health outcomes, according to a study of 300 hospitals in nine European countries.

The following questions and answers explore everyday practicalities and doubts about the COVID-19 pandemic, using the latest available scientific research. The Spanish newsroom Civio wrote them for readers in Spain and have translated and adapted them for a wider audience.