Shared crises, unequal paths: European Covid-19 trajectories

Background

Covid-19 evolved unevenly in Europe, with countries showing diverse infection and mortality patterns. Understanding these patterns is essential for strengthening preparedness through resilient health and social systems and tailored public interventions. Yet comparative evidence on combined infection and mortality trajectories is limited.

Methods

We applied group-based trajectory modelling to weekly reported Covid-19 infections and deaths for European countries over two major pandemic periods (1-75 and 75-150 weeks) to identify country clusters. Then we assessed how these clusters were shaped by population structure, health system capacity, and government response.

Results

In both periods, five clusters emerged but with distinct composition and temporal patterns. During the first 75 weeks, infection and mortality generally increased across all clusters, but peaks occurred at different times: some countries experienced early, high infection rates but relatively low or earlier mortality, while others showed later and sharper mortality. During the second period, the ordering and timing of peaks shifted: clusters with the highest infection rates did not always have the highest mortality. Across both periods, younger, more urban, densely populated countries more often decoupled high infection from high mortality, whereas clusters with larger and older populations had higher mortality burdens despite comparable or lower infection rates. Government response indicators increased with infection and mortality levels over time, but policy intensity converged across structurally different high-burden clusters.

Conclusions

European countries exhibited evolving and partially hidden differences in joint infection–mortality trajectories. These findings underscore the need for integrated surveillance that routinely considers both cases and deaths, and for cross-country learning on urban health, health equity, and crisis preparedness.

Key messages

• European countries exhibited distinct and changing Covid-19 infection–mortality patterns.

• Mortality was more influenced by population structure than by infections, highlighting the need for tailored and integrated preparedness.