COVID-19: How is the 'Vaccines Rule' policy working in Hungary?

There are ample of reasons for which one may bash Prime Minister Viktor Orbán’s government, including the country’s rule of law backslide, rampant corruption, anti-LGBTQ+ legislation, the systematic dismantling of independent media etc. However, when it comes to its maverick approach in the procurement of Eastern vaccines (Russia’s Sputnik V, China’s Sinopharm) without European regulatory approval, all it deserves is praise.

If the severity of a country’s COVID-19 situation depended solely on the availability and variety of vaccines, Hungary would be the beacon of hope. Sadly, there are other factors, as well. One of these is the willingness of the population to get vaccinated and tolerate lockdown measures even if they are as ridiculously simple and effective as wearing a face mask.

A glimpse at the vaccination situation

• Hungary has contracted for over 30.4 million COVID-19 vaccines (23.42 million from EU procurement, 5.2 million from Russia and over 2 million from China).
• Of these, nearly 20.5 million doses have been delivered.
• Of these, 11.2 million doses have been administered.
• About 40% of the total population (9.73 million) or more than 4 million people are not vaccinated.
• About 33%, or about 2.7 million people of the adult population (8.024 million) are not vaccinated.
• About 35%, or about 3 million people of the 12-17 plus adult population are not vaccinated.
• More than 40%, or about 2.5 million people of those under 60 (12-59) are not vaccinated.
• With more people getting their third doses since 2 August than 1st and 2nd doses combined, and rising hospitalisation and ventilation figures, you may wonder if relying solely on vaccination is the right way to go.

We will not answer this question, but the charts below might just do that for you.

Here are a few charts depicting how enthusiastically Hungarians have been getting themselves vaccinated against coronavirus.

Number of patients in hospital, days spent in hospital

The left-hand chart depicts the accumulated number of confirmed daily COVID-19 cases and days spent in hospital by coronavirus patients. The accumulated number of new cases in the period under review is about half what we had a year ago. Up until 22 September, those admitted in hospital stayed there longer than in the base period, but then the trend changed.

It is as if only those people were tested that end up in hospital. The orange curve runs more ore less parallel with the orange columns. The same time last year the green curve took off and gained quite a distance from the light green columns, i.e. the number of cases rose sharply, but the days spent in hospital did not follow suit, at least not at that rate.

The conclusion is that only those infected people are found and included in the statistics that seek help due to their severe symptoms.

On the right-hand chart you find that the both curves (accumulated number of new cases) keep more or less parallel with the columns, but the accumulated number of COVID-19 patients on ventilator is much higher in 2021.

Ratio of COVID-19 patients on ventilator to those in hospital

There are currently 627 COVID-19 patients in hospital, with 92 of them on ventilator, versus 656 and 41 a year ago, respectively. Whereas the former figure is largely the same (-4.4% yr/yr), the latter is way higher (+125%).

As regards the two charts below, the percentage of ventilated COVID-19 patients relative to the number of patients hospitalised has been rising in the period under review in 2021, it was dropping in the base period. The gap can only be described as dramatic.

The conclusion is that even those with mild coronavirus symptoms were admitted to hospital a year ago, while these days only those are hospitalised that are in severe/critical condition, hence the higher number (and ratio) of them ending up on ventilator.

Patients in hospital, on ventilator, days spent in hospital and on ventilator

The left-hand chart depicts the number of coronavirus patients in hospital and on ventilator (3-day averages) between 18 July and 5 October, both in 2020 and 2021. The right-hand chart shows the accumulated number of days spent in hospital and on ventilator by COVID-19 patients, also between 18 July and 5 October in 2020 and 2021.

On the left-hand chart we can see that the number of COVID-19 patients in hospital was largely the same in 2020 and this year up until mid-September. Thanks to vaccination coverage the number this year should not have been even half of what we had last year, especially if cross-immunity gained earlier (in the previous waves or epidemics) work. Yet, the numbers (green columns and green area with yellow curve) basically overlapped until mid-September, and they are getting closer again (644 vs. 595).

If you look at the curves showing the number of needing artificial ventilation, though… it is obvious what is happening here.

On the right-hand chart, the ratio of days spent in hospital to the accumulated number of COVID-19 cases is close to 95% this year (pinkish columns), while it was less than 58% last year (green area). The conclusion is the same. At least 60% more coronavirus patients should be in hospital to match this ratio, and there are still a lot more than what the number of cases would warrant. If the detection rate of coronavirus infections was low in 2020, it’s cannot even be registered this year.

The number of days spent on ventilator relative to the accumulated number of new cases was around 3.7% last year (green curve), while it is 12.6% this year (red curve). What’s the deal here?

What we see is the piling up of various factors: (i) underdetection, (ii) fewer people in hospital than there should be, (iii) patients hospitalised in more serious condition. There’s an over fourfold difference between 2020 and 2021 in terms of the ratio of COVID-19 patients in ICUs and the number of confirmed cases.

Accumulated number of COVID-19 cases and fatalities, days spent in hospital and on ventilator

On the left-hand chart, the green curve shows the accumulation of new cases in 2020 (in the period under review) which correlates more with the black columns, i.e. the accumulated number of COVID-19 deaths in 2021. Why is that? The number of detected cases is half this year than in the base period; see the green and the yellow curves. (Additionally, the test positivity rate is also half, but that’s another story). Meanwhile, a lot more people die of coronavirus-related diseases this year than in 2020 in the period under review (black vs. grey columns).

This wave / eidemic is deadlier than it was in the same period a year ago. If we divide the cumulated number of COVID-19 deaths in the 28 Aug – 6 October period with the number of confirmed cases, we get 1.37% versus 0.95% in 2020.

On the right-hand chart you see that the accumulated number of days coronavirus patients spent in hospital this year was higher than in 2020 in the period under review up until 22 September (red columns are higher than the light blue columns), while the number of days spent in ICUs is about 80% higher than the 2020 data.

Possible scenarios

1. We are way ahead in relative time, and this is actually a ‘wave’ of unvaccinated people, in which case the numbers will skyrocket shortly. This is the official narrative. Well, not in Hungary, but globally. The Hungarian government believes in Scenario 3. Controversially, this is actually the best-case scenario. If the situation worsens substantially and suddenly, the Delta variant will not last so long. On the other hand, if we are in Scenario 2 (see next) and the situation keeps worsening gradually and for an extended period, then there will be a lot of casualties.
2. This ‘wave’ is affecting everyone, only those that had their shots stand a better chance of avoiding severe symptoms and have a higher chance of surviving an infection. This is practically a new epidemic that we can label as another wave in the pandemic. In that case there will be no sharp rise in the numbers, and the ‘wave’ will have a similar shape as last year only it will go higher. This is the worst-case scenario.
3. Everything will be just fine, because a) we are ahead in relative time, and b) vaccines (all of them, for each age group) and cross-immunity also need to be factored in and matter a lot. In this case, the numbers should start to ebb soon.

Based on data available in mid-September the conclusion was that we are likely in some kind of a combination of scenarios 1 and 2. Date since then confirmed this assumption. If it was the third scenario then we should have already seen a significant drop in the number of COVID-19 patients in hospital, in ICUs (on ventilator) and in the number of fatalities. It did not happen.

Béla Merkely, rector of Semmelweis University, believes the epidemic curve of the fourth wave of the coronavirus pandemic will look entirely differently in Hungary than the previous ones. He has also warned that practically everyone that is not inoculated against SARS-CoV-2 will contract the virus.

We know we cannot fully compare the current situation to the one we were in a year ago for a number of reasons. Yet, based on the current trends, looking back might just give us an idea of a possible future. And that does not look good. The charts on the right go up to 31 October 2020, and considering that the number of coronavirus patients in hospital is almost as high, and more of them are on ventilator, well... you draw the conclusion. It's fairly safe to say that things will get worse before they would start to improve.

Cover photo: MTI /Sándor Branstetter