At the height of the pandemic in the spring, all eyes in Europe were on Italy and the stark images of over-run hospitals as the death toll rose.

Six months on, Italians remain vigilant, and cases have increased, but life is fairly normal with bars and restaurants all open and children back in school.

Now, the headlines about rising cases are being dominated by the UK, Spain and France as lockdown restrictions are re-introduced.

To date, there have over 2.9 million confirmed cases of the virus in Europe and over 186,000 people have died, data from the European Centre for Disease Control and Prevention shows.

In order, Spain, France, the UK, then Italy and Germany have seen the highest numbers of infections during the pandemic, so far.

Yet right now, there is a huge difference between the countries seeing the most rampant outbreaks of Covid-19.

Countries with the highest rate in Europe

The latest weekly coronavirus infection rates in Europe show that Andorra has the highest rate of coronavirus cases reported in the previous seven days in Europe at 348 cases per 100,000, as of Thursday, September 24.

Montenegro and Spain have recorded approximately 334 and 168 cases per 100,000 people respectively in the past week.

The current rate in France is 94.2, compared to 90.5 in Belgium and 47.4 in the UK.

In comparison, Germany has only had 14.8 cases for every 100,000 people in the last week and Italy 18.4. Norway has only had 14.5 cases and Finland 8.7, over the last week when adjusted for population.

Across the whole of Europe, the coronavirus has so far been responsible for 225,448 confirmed deaths as of September 21, with 41,777 of the deaths occurring in the United Kingdom.

Figures from www.statista.com.

The figures led to Labour MP Ben Bradshaw asking in the Commons this week if Germany and Italy had far lower covid rates, with "life more or less running normally", because they have more locally, and publicly-run test and trace services.

The Prime Minister angrily dismissed this suggestion saying the continued attacks on test and trace are "undermining" and "unnecessary", before adding that the way forward was to "follow the guidelines" and seemed to indicate British people were not very good at doing that.

He said: "There is an important difference between our country and countries around the world.

"That is our country is a freedom-loving country and if you look at the history of this country over the last 300 years, virtually every advance from free speech to democracy has come from this country and it is very difficult to ask the British population uniformly to obey guidelines in the way that is necessary.

"What we're saying today is that collectively, and I'm answering his question directly, collectively, the way to do this is for us all to follow the guidelines which we will strictly enforce, and get the R down. That's the way forward."

Back to Italy, and a prominent virologist there believes the country is in a better situation than other countries because they were among the first in the world to "face the Covid hurricane".

Fabrizio Pregliasco, who works at the University of Milan, told the Financial Times the health system and government have had more time to plan its post-lockdown response and the lifting of restrictions has been more gradual, allowing the government greater agility in reintroducing restrictions when needed.

Ferdinando Luca Lorini, director of intensive care at a hospital in Bergamo, believes the clarity of the rules from the beginning have been a massive help.

He told the paper: “We have gone from the most affected country to one of the virtuous countries in the management of the pandemic thanks to the clarity of the rules from the very beginning, and the willingness of everyone to respect them.”

Public health officials cite the high public acceptance of restrictions, such as compulsory mask wearing in shops and on public transport.

As in the UK, visitors to bars and restaurants must write down their names and numbers, a measure largely complied with during the summer.

According to a survey conducted by Imperial College London, 84 per cent of Italians surveyed said they would be “very or quite willing” to wear a face mask advised to by their government. This compares to 76 per cent in the UK.

Prime minister Giuseppe Conte has also kept on reminding Italians to remain vigilant as restrictions are lifted, and people arriving from hotspots areas look set to be tested on arrival.

Under Italy’s Covid-19 state of emergency he has the power to rule by decree, meaning his government was able to react swiftly to an increase in new cases over the summer.

Discos in Rome were also closed last month, face masks must be work in all crowded places between 6pm and 6am, and fines are being handed out. On Monday this week police checked 50,602 people and 4,939 businesses, sanctioning 227 individuals and ordering the closure of three companies.

How contact apps are working around the world

England and Wales are set to be the latest nations to embrace an app in the hope of better tracing the coronavirus.

The NHS Covid-19 app will be available from Thursday and follows a number of countries who have already turned to technology.

But feedback has been mixed with limited information about each nation's success, in part due to the focus on privacy.

Here, the PA news agency looks at contact tracing apps across the world:

Singapore

The first country to launch a Covid-19 app back in March called TraceTogether and has achieved 2.4 million downloads.

One of the issues faced by the voluntary app is that it needs to be running in the foreground on iOS to work.

Apple and Google came together to devise a shared framework that would make it easier for health authorities to create tracing apps after Singapore's effort was launched, but the country has decided to stick with its own approach despite the limitations on iOS.

According to Vivian Balakrishnan, minister-in-charge of the country's smart nation initiative, "technology is only a supplement, not a replacement for the humans". 

In September Singapore also began distributing Bluetooth tokens, which can be worn on a lanyard or carried, as an alternative for older people without a smartphone.

Australia

The voluntary app is based on the same system developed by Singapore, therefore suffering some of the same iOS limitations.

COVIDSafe was launched in late April and notched up more than a million downloads within the first 24 hours - however, the Government has refused to reveal how many active users it has had.

Officials in Australia have also defended not opting for the Apple-Google approach, with only a limited number of cases where the app successfully managed to identify previously unidentified close contacts reported.

Defending their decision not to change course, Australia's deputy chief medical officer Nick Coatsworth said: "The Apple-Google offering, apart from being released only once the global case numbers exceeded nine million, substantively diminishes the role of the disease detective in the process.

"By their own admission, these tech giants will not allow public health officials access to the details of contacts."

India

The Aarogya Setu app uses both Bluetooth and GPS location to track users, the latter of which has been avoided by most other countries and has raised questions about privacy.

  India's app is required to be used more widely than in other countries too, with all workers, both private and public, expected to have it installed.

France

France's StopCovid app has been running for three months now but a recent report suggests that it has had little success. 

According to the Covid-19 control and liaison committee, less than 200 notifications have been sent since the app launched.

Ireland

Ireland's Covid Tracker app, which uses the Google-Android framework, appears to have fared slightly better, with a total of 370 notifications sent out to close contacts between June when the app was launched and mid-August, according to reports.



Since the start of the pandemic, Germany has been held up as a beacon of how the crisis should be handled. The country has had more than 277,412 cases, but reported fewer than 10,000 deaths. This is compared to more than 404,000 cases in the UK, and 41,825 deaths.

Cases are rising, particularly in the cities of Munich and Hamburg, and it has been reported that Chancellor Angela Merkel has called a crisis summit with her regional governors next week, and testing has been increased as a result.

It is a testing regime that has been continuously praised. Back in April, the country had carried out far more diagnostic swab tests than other major European countries. They were already averaging 54, 314 swab tests per day in the first week of April.

Widespread testing at the start of the outbreak meant many positive cases were identified at an early stage.

And that gave the authorities the chance to trace anyone who had been in contact with infected individuals, to try to slow the spread of the virus.

The strength of the German pharmaceutical and biotech industries have been cited as a reason why testing there has been so effective.

Many of the private laboratories being used for testing in Germany are associated with universities and other medical facilities rather than with big business.

The country's federal political system is also thought to have been a big factor, with health issues, including testing, being devolved to a more local level.

Instead of looking to these countries, UK Health Secretary Matt Hancock has praised the model used in Belgium for getting coronavirus under control, despite a sharp rise in the number or daily infections there.

He used their example as a way of explaining strict new laws on social gatherings in England, including the so-called rule of six people, limiting the size of social groups.

But hospital admissions in the country are on the rise and the number of infections is increasing.