Much of Central Europe locked down quickly in the spring, before the coronavirus took root, and largely avoided widespread infection during the first wave of the pandemic. But now — from the Polish port city of Gdansk on the Baltic to the ancient fortress town of Kotor on the Adriatic in Montenegro — the virus is sweeping across the region.
Hospitals beds are filling up in Poland; doctors in Hungary are issuing dire warnings about a lack of medical workers; the authorities in Romania are struggling to track new cases; and health care workers are falling ill in Bulgaria. The Czech Republic has the highest coronavirus transmission rates in Europe.
Everywhere, new infections are setting daily records, and deaths are slowly but steadily rising.
The increases are part of a second wave of the coronavirus spreading across Europe.
But there is particular concern about the damage it could sow in the former Communist countries of Central Europe, some of which have weak health care systems, critical shortages of doctors and nurses, and inadequate testing programs.
Many Central European countries also struggle with a deep distrust of government among their citizens stemming from years of systemic corruption.
The region is home to a large older population at high risk of suffering serious illness. At the same time, older people in the region tend to live within large family groups, according to a survey by the Pew Research Center, increasing their risks of contracting the coronavirus.
“These multigenerational living arrangements would be an important risk factor for accelerating transmission from younger to older adults, placing these countries at higher risk for hospitalizations and mortality,” said Jennifer Dowd, a professor of demography and population health at the University of Oxford.
Petr Smejkal, the chief of infectious diseases and epidemiology at the Institute of Clinical and Experimental Medicine in Prague, said the limited spread of the virus during the first wave in the spring — viewed widely as a success at the time — was likely a factor in the explosion of cases this fall.
Antibody tests in the Czech Republic show far lower levels of exposure than have been documented in hard hit places like London, meaning there could be less natural resistance.
But Dr. Smejkal said deeper societal dynamics were also driving the epidemic now.
This part of Europe, he said, is still plagued by what was thought to be an advantage in the spring — the legacy of communist rule and the willingness of people to follow state directives.
The early lockdowns in many of these countries had a distinctly militarized feel. It worked, but at a cost.
“What it did was made the public a passive player in the game,” Dr. Smejkal said.
As the crisis in the spring faded, he said, messages from governments became confused and misinformation about the coronavirus took root in societies that already had a bent toward conspiratorial thinking.
“We can now clearly see the effect of people’s attitude and the behavior and the culture itself,” he said.
For example, by the end of June, many in the Czech Republic believed they had weathered the worst of the pandemic. In celebration, some 2,000 revelers gathered for a feast of homemade Czech delicacies, including roast pork, dumplings and apple pie, spread across a table that stretched a third of a mile on Prague’s Charles Bridge.
That declaration of victory was premature.
On Wednesday, the death toll in the Czech Republic reached 1,158, with more than half the deaths — 731 — coming since September. Schools were closed, as were all bars, restaurants and clubs. Places serving takeout food could do so only until 8 p.m., and just through windows.
The most pressing concern in the Czech Republic, and elsewhere, is a shortage of doctors and nurses, many of whom left as part of the broader emigration of skilled workers to wealthier European and other countries over the past two decades.
Mr. Smejkal said most health care facilities also lack physician assistants, respiratory therapists and other specialist workers.
In Poland — where the prime minister is self-isolating after coming into contact with an infected individual — there are just 238 doctors per 100,000 inhabitants, the lowest ratio in the European Union. At University Hospital in Krakow, the intensive care unit is filled.
“We don’t have any places for patients with coronavirus who require the use of ventilators,” Marcin Jędrychowski, the hospital’s director, told the Polish daily Gazeta Wyborcza. “We can’t admit anyone.”
The president of the Supreme Doctors’ Councils, a physicians group, on Wednesday called for the immediate establishment of military field hospitals to deal with the flood of patients.
But the pandemic has been caught up in the maelstrom of Polish politics.
Jaroslaw Kaczynski, the deputy prime minister and head of the ruling party, threatened to veto any European Union budget and coronavirus relief package if it was tied to concerns about the state of the nation’s judiciary.
“We won’t let them terrorize us with money,” he said in an interview this week with Gazeta Polska Codziennie, a pro-government tabloid.
Prime Minister Viktor Orban of Hungary made a similar threat this summer but has grown quieter on the issue as the virus surges in his country.
As Hungary’s underfunded health care system buckles under the weight of the pandemic, the government passed sweeping legislation to increase pay for doctors, the largest increase in a decade.
Ferenc Falus, Hungary’s former chief medical officer, said the government had failed to build a proper testing and tracing system.
“To intents and purposes, there is practically no contact tracing in Hungary,” he said.
In Romania, authorities not only have a problem managing the crisis, but are also having trouble agreeing on how many people live in different areas of the country in order to implement policies.
On Tuesday, the National Institute of Public Health announced that the positivity test rate in Bucharest, the capital, had reached 3 per 1,000 residents over the last 14 days — a red line that was meant to trigger the closing of all schools.
But a different government agency put the figure at 2.69 cases per 1,000, below the threshold, based on a higher calculation of residents in the city.
The institute went with the higher number of residents, avoiding tighter restrictions — for now.
Klaus Iohannis, the Romanian president, warned the nation on Tuesday that more action would likely be needed.
“Let’s not delude ourselves,” he said. “This stage will not pass by itself.”
In Bulgaria, the only pulmonologist in the municipal hospital in the small town of Aytos, in the east of the country, is being treated for Covid-19 in her own facility, where the beds in the coronavirus ward are nearly filled. On good days, she cares for the other patients.
Another public hospital in the southern town of Gotse Delchev lost its only anesthesiologist to the coronavirus in September. Unlike most other European nations, Bulgaria does not plan to impose new national restrictions.
“We will intervene wherever we see a problem,” said Angel Kunchev, the chief state health inspector.
Marc Santora reported from London, and Hana de Goeij from Prague. Reporting was contributed by Boryana Dzhambazova in Sofia, Bulgaria; Kit Gillet in Bucharest, Romania; Anatol Magdziarz in Warsaw; and Benjamin Novak in Budapest.