This chapter provides an initial assessment of the impact of COVID‑19 and the resilience of European health systems to the pandemic, bearing in mind that the pandemic is ongoing and so any definitive assessment would be premature. As of 31 October, over 7 million people were infected and 220 000 died from the virus across EU countries, Iceland, Norway, Switzerland and the United Kingdom. During the first wave, the virus had a much more adverse impact on a number of Western European countries, notably Belgium, France, Italy, Netherlands, Spain and the United Kingdom, as well as Sweden. Since August, COVID‑19 also started to spread more widely across Europe. The virus has disproportionately hit older people, and there has been a clear social gradient in COVID‑19 deaths.Countries that were better prepared and acted quickly to reduce the spread of the virus through rapid scaling-up of testing, tracking and tracing strategies, were more able to avoid the most stringent and costly containment and mitigation measures. In terms of treating COVID‑19 patients, policies to temporarily boost hospital beds and equipment have helped deal with surges in demand. However, a lack of health personnel has been more of a binding constraint, putting health workers under intense pressure. Further, many non-COVID‑19 patients were unable to access needed care during the peak of the pandemic in Spring 2020. Health system resilience therefore also requires strengthening primary health care and mental health services to minimise delays and forgone care for all health care needs. Note that figure 1.8 was revised on 26 November 2020 to correct a miscalculation.

This chapter reviews the health and welfare impacts of air pollution in Europe. Although air pollution has decreased in most European countries over the past two decades, it remains above WHO guidelines in most countries, particularly in some large Central and Eastern European cities. This has serious consequences on people’s health and mortality: in the EU, estimates attribute between 168 000 and 346 000 deaths to air pollution from fine particles (PM2.5) alone in 2018. The welfare losses from air pollution are substantial. A conservative estimate of the welfare impact of PM2.5 and ozone shows that this amounts to an annual loss of 4.9% of GDP in the EU. This welfare loss is mainly attributable to the impact of these pollutants on mortality, along with lower quality of life, lower labour productivity and higher spending on health.Efforts to reduce air pollution need to focus on the main sources of emissions. These include the use of fossil fuels in energy production, transportation and the residential sector, as well as industrial and agricultural activities. The EU recovery plan from the COVID‑19 crisis provides a unique opportunity to promote a green economic recovery by integrating environmental considerations in decision-making processes, thereby supporting the achievement of the 2030 EU national emission reduction targets. The health sector itself can contribute to achieving this objective by implementing various measures to minimise its own environmental footprint. Through multi-sectoral approaches, public health authorities can also contribute to environmentally friendly urban and transport policies, which may also promote greater physical activity.