German, Czech, Italian virus records deepen Europe worries

October 15, 2020

BERLIN (AP) — Record daily infection figures in Germany, the Czech Republic, Italy and elsewhere added to fears on Thursday that Europe is running out of chances to control its latest coronavirus outbreak. France has set a 9 p.m. curfew for many of its biggest cities as governments across the continent take increasingly tough action.

New infections have surged across Europe over recent weeks as the fall kicks in, prompting authorities in many places to start reimposing restrictions that were relaxed over the summer. The Czech Republic, Belgium, the Netherlands, Spain, France and Britain are among the countries causing particular concern.

While Germany, the European Union's most populous nation, is still in comparatively good shape, alarm bells have started ringing there too. On Thursday, the country's national disease control center reported 6,638 cases over 24 hours — exceeding the previous record of nearly 6,300 set in late March, although testing in the country of 83 million has expanded greatly since then.

Chancellor Angela Merkel and Germany's 16 state governors agreed Wednesday night to tighten mask-wearing rules, make bars close early and limit the number of people who can gather in areas where coronavirus infection rates are high. Merkel, who stressed the importance of keeping contact-tracing efforts on track, said “we must stop this exponential rise, the quicker the better.”

Lothar Wieler, the head of the Robert Koch Institute, Germany's national disease control center, said "we can still repress the spread, the exponential growth” of the virus. But officials made clear that more efforts may be necessary.

“Yesterday's decisions are an important step, but they probably won't be enough,” Merkel's chief of staff, Helge Braun, told ARD television. “So now it is up to the population that we don't just look at ‘what am I allowed to do now,’ but basically we must do more and be more cautious than what the governors decided yesterday.”

Merkel noted that neighboring countries are having to take “very drastic measures.” This week has seen the Netherlands close bars and restaurants and the Czech Republic and Northern Ireland close down schools. The Czech Health Ministry said the country, with a population of over 10 million, confirmed 9,544 new cases on Wednesday — over 900 more than the previous record, set less than a week ago.

The government says hospitals could reach full capacity by the end of October, and announced Thursday that the military will set up a hospital at Prague's exhibition center to treat COVID-19 patients.

“We have to build extra capacity as soon as possible,” Czech Prime Minister Andrej Babis said. “We have no time. The prognosis is not good.” In France, President Emmanuel Macron announced on Wednesday night that 18 million residents in nine regions, including Paris, will have a 9 p.m. curfew starting Saturday until Dec. 1.

Aurelien Rousseau, director of the Paris region’s public health agency, said that nearly half of intensive care beds are now occupied by coronavirus patients, with other hospital beds filling rapidly too.

“It’s a kind of spring tide that affects everybody simultaneously,” Rousseau said. “We had a blind spot in our tracking policies. It was the private sphere, festive events.” Paris restaurant, cinema and theater owners are fuming at the new curfew rules. Tighter local restrictions in northern England and Northern Ireland have prompted the same emotions from business owners there. London Mayor Sadiq Khan said he expects the British government to announce Thursday that the capital is moving to a higher level of restrictions.

Health authorities across Europe are urging people to obey the new restrictions. The head of the World Health Organization’s Europe office, Dr. Hans Kluge, urged countries to be “uncompromising” in attempts to control the virus and said most of the spread is happening in homes, indoor spaces and communities not complying with protection measures.

“These measures are meant to keep us all ahead of the curve and to flatten its course,” Kluge said. “It is therefore up to us to accept them while they are still relatively easy to follow instead of following the path of severity.”

Just as Macron's government tackles the resurgence of infections, French police on Thursday searched the homes of the former prime minister, the current and former health ministers and other top officials in an investigation into the government's pandemic response. It was triggered by dozens of complaints over recent months, particularly over shortages of masks and other equipment.

One of Belgium’s main universities said it is moving to online education whenever possible. Ghent University said the measure will begin Oct. 26 and the Dutch-speaking Free University of Brussels said it already prepared its staff and facilities to do likewise if necessary.

Italy, which so far has been spared the worst of the second wave, on Wednesday also recorded its biggest single-day jump in infections since the start of the pandemic. It added another 7,332 cases amid a resurgence that is straining the country’s contact-tracing system.

Poland registered a record of nearly 9,000 new cases on Thursday. Masks have been required outdoors since Saturday and strict limits imposed on the size of gatherings. Slovakia and Croatia also announced record daily case numbers. Slovakia was imposing new restrictions Thursday, once again making it mandatory to wear masks outdoors and shutting fitness centers, public swimming pools, theaters and cinemas.

Associated Press writers around Europe contributed to this report.

Germany agrees to tighten virus rules as infections rise

October 14, 2020

BERLIN (AP) — Chancellor Angela Merkel and the governors of Germany’s 16 states agreed Wednesday to tighten mask-wearing rules and make bars close early in areas where coronavirus infection rates are high, an attempt to avoid tougher restrictions now being introduced elsewhere in Europe.

The meeting came hours after the country reported more than 5,000 infections in one day for the first time since mid-April. Germany is still in better shape than many other European countries, but infections have accelerated rapidly in recent weeks.

“We must stop this exponential rise, the quicker the better," Merkel said. "If we don't, this won't end well.” So far, German authorities have called for districts to take action when they report 50 new infections per 100,000 residents over seven days. Many major cities have exceeded that mark recently, including Berlin, Cologne, Frankfurt, Stuttgart and Munich.

Wednesday's agreement — reached in eight hours of wrangling with state governors, who are responsible for imposing and lifting restrictions — called for action once infections hit 35 per 100,000 people.

Officials recommended that mask-wearing -- already required since April on public transport and in shops -- should also be made obligatory in public places where people are packed closely together when infections hit 35 per 100,000. They also called for bars and restaurants in those districts to be closed early.

In areas where infections top 50 infections per 100,000 people, gatherings in public and private parties should be limited to 10 people, and bars and restaurants closed at 11 p.m. If those measures don't halt the rise in infections within 10 days of being imposed, “further targeted restrictions are unavoidable,” with only five people allowed to gather in public, federal and state governments said.

They appealed to people to refrain from non-essential domestic journeys to and from places where infections top 50 per 100,000 people. But Merkel said she was “not entirely satisfied” that officials failed to reach an agreement on the merits of barring hotels from hosting people from those areas. Many German states have instituted such rules, creating a confusing and unpopular patchwork of regulations across the country, but discussion on a more coordinated approach was put off until next month.

“Whether this is enough is still open in my opinion,” Bavarian governor Markus Soeder, a leading advocate of tighter restrictions, said of Wednesday's decisions. “We are much closer to a second lockdown than we want to believe.”

As virus surges anew, Milan hospitals under pressure again

October 14, 2020

MILAN (AP) — Coronavirus infections are surging anew in the northern Italian region where the pandemic first took hold in Europe, putting pressure again on hospitals and health care workers. At Milan’s San Paolo hospital, a ward dedicated to coronavirus patients and outfitted with breathing machines reopened this weekend, a sign that the city and the surrounding area is entering a new emergency phase of the pandemic.

For the medical personnel who fought the virus in Italy's hardest-hit region of Lombardy in the spring, the long-predicted resurgence came too soon. “On a psychological level, I have to say I still have not recovered,’’ said nurse Cristina Settembrese, referring to last March and April when Lombardy accounted for nearly half of the dead and one-third of the nation’s coronavirus cases.

“In the last five days, I am seeing many people who are hospitalized who need breathing support," Settembrese said. “I am reliving the nightmare, with the difference that the virus is less lethal.” Months after Italy eased one of the globe’s toughest lockdowns, the country is now recording well over 5,000 new infections a day — eerily close to the highs of the spring — as the weather cools and a remarkably relaxed summer of travel and socializing fades into memory. Lombardy is again leading the nation in case numbers, an echo of the trauma of March and April when ambulance sirens pierced the silence of stilled cities.

So far, Italy's death toll remains significantly below the spring heights, hovering recently around 50 per day nationwide, a handful in Lombardy. That compares with over 900 dead nationwide one day in March.

In response to the new surge, Premier Giuseppe Conte’s government twice tightened nationwide restrictions inside a week. Starting Thursday, Italians cannot play casual pickup sports, bars and restaurants face a midnight curfew, and private celebrations in public venues are banned. Masks are mandatory outdoors as of last week.

But there is also growing concern among doctors that Italy squandered the gains it made during its 10-week lockdown and didn’t move quick enough to reimpose restrictions. Concerns persist that the rising stress on hospitals will force scheduled surgeries and screenings to be postponed — creating a parallel health emergency, as happened in the spring.

Italy is not the only European country seeing a resurgence — and, in fact, is faring better than its neighbors this time around. Italy’s cases per 100,000 residents have doubled in the last two weeks to nearly 87 — a rate well below countries like Belgium, the Netherlands, France, Spain and Britain that are seeing between around 300 to around 500 per 100,000. Those countries have also started to impose new restrictions.

This time, Milan is bearing the brunt. With Lombardy recording more than 1,000 cases a day, the regional capital and its surroundings account for as many as half of that total. Bergamo — which was hardest hit last time and has been seared into collective memory by images of army trucks transporting the dead to crematoria — hovers closer to 50.

The resurgence has so far been most strongly linked to vacations, both at home and abroad, as Italians flocked to beaches and crowded islands this summer. “The lockdown is a treasure that we scraped together with great effort and great sacrifice. We risk losing the results from a summer that in some ways was rather reckless,’’ Massimo Galli, the director of the infection disease ward at Milan’s Sacco Hospital, told The Associated Press. “The whole country acted as if they infections never existed, and was no longer among us.’’

His hospital is on the front lines of the pandemic, but he declined to say how many beds were occupied with coronavirus patients. Dr. Anna Carla Pozzi, a family physician in a Milan suburb, said she feared that fatigue is weakening the public's response to the virus's resurgence. That's creating a situation similar to the one in January and February, when the virus was circulating undetected in Italy, and nothing was being done, she said.

Dr. Pozzi sees her own patients acting surprisingly casually: Some disregard instructions to only come to her office with an appointment. One high school student called her on Tuesday to get a medical certificate to go back to school, saying she had spent a week at home recovering from flu-like symptoms. “Great that you’re feeling better,” the doctor told her, but she still needed a test before returning to class.

Dr. Pozzi was pleasantly surprised that she was able to book the patient in for one the next day -- something unheard of in the winter and spring. Testing is helping Italy stay on top of the curve. On Thursday, at least 100 cars were lined up for on-demand drive-through testing at the San Paolo hospital where Settembrese works.

Dr. Guido Marinoni, the head of the association of general practitioners in Bergamo, where 6,000 people died in one month, said people in the province were sufficiently frightened by what happened in the spring to continue to follow the rules. But that may not be so in other parts of Lombardy or the country.

“Six-thousand in one month. Do you know how many dead there were in five years that Milan was bombed during World War II, and it was targeted a lot: 2000,’’ Dr. Marinoni said. “What is worrying to see in other areas is the nightlife, people who are gathering in bars and partying. This is very dangerous."

Associated Press journalist Luca Bruno contributed to this report.

Northern Ireland closes schools in effort to combat COVID-19

October 14, 2020

LONDON (AP) — Northern Ireland introduced the tightest COVID-19 restrictions in the United Kingdom on Wednesday, closing schools, pubs and restaurants in a effort to slow the spread of the virus. The restrictions include a two-week closure for schools and a four-week shutdown of pubs and restaurants, except for takeaway orders. The announcement came after talks among political parties that stretched from Tuesday night into Wednesday morning.

“This is not the time for trite political points,'' First Minister Arlene Foster told lawmakers at the regional assembly in Belfast as she announced the decision. “This is the time for solutions.'' The move came as the U.K. government debated whether to extend tough new social restrictions to more parts of England as its three-tier plan for slowing the spread of COVID-19 takes effect.

U.K. health officials are meeting Wednesday to discuss whether to add other areas of northern England — including Manchester and Lancashire — to the country's highest virus risk tier, meaning additional measures such as closing pubs could soon be imposed there.

Only the northern city of Liverpool was placed in the highest risk category when the plan was unveiled Monday. British Prime Minister Boris Johnson is being criticized by all sides two days after announcing his three-tier approach that seeks to curtail a fall resurgence of the virus. A report released Tuesday showed that the government’s science advisers had urged his government to install much tougher measures, including a two- to three-week national lockdown.

The opposition Labor Party has called for that advice to be followed, while some members of Johnson’s Conservative Party say the measures already in place go too far and are damaging Britain's virus-damaged economy.

Britain already has Europe's deadliest outbreak, with over 43,000 confirmed deaths.

Extra safety scrutiny planned as virus vaccine worries grow

October 14, 2020

(AP) Facing public skepticism about rushed COVID-19 vaccines, U.S. health officials are planning extra scrutiny of the first people vaccinated when shots become available — an added safety layer experts call vital.

A new poll suggests those vaccine fears are growing. With this week's pause of a second major vaccine study because of an unexplained illness — and repeated tweets from President Donald Trump that raise the specter of politics overriding science — a quarter of Americans say they won't get vaccinated. That's a slight increase from 1 in 5 in May.

The poll from The Associated Press-NORC Center for Public Affairs Research found only 46% of Americans want a COVID-19 vaccine and another 29% are unsure. More striking, while Black Americans have been especially hard-hit by COVID-19, just 22% say they plan to get vaccinated compared with 48% of white Americans, the AP-NORC poll found.

“I am very concerned about hesitancy regarding COVID vaccine,” said Dr. William Schaffner, a vaccine specialist at Vanderbilt University who says even the primary care doctors who'll need to recommend vaccinations have questions.

“If the politicians would stand back and let the scientific process work, I think we’d all be better off,” he added. The stakes are high: Shunning a COVID-19 shot could derail efforts to end the pandemic — while any surprise safety problems after one hits the market could reverberate into distrust of other routine vaccines.

On top of rigorous final testing in tens of thousands of people, any COVID-19 vaccines cleared for widespread use will get additional safety evaluation as they're rolled out. Among plans from the Centers for Disease Control and Prevention: Texting early vaccine recipients to check how they're feeling, daily for the first week and then weekly out to six weeks.

Any vaccine before Election Day is extremely unlikely. Over Trump’s objections, the Food and Drug Administration issued clear safety and effectiveness standards that shots must meet -- and Commissioner Stephen Hahn insists career scientists, not politicians, will decide each possible vaccine's fate only after all the evidence is debated at a public meeting.

Dr. Anthony Fauci, the top U.S. infectious diseases expert, says that should be reassuring because it means scientists like himself will see all the evidence. “So the chances of there being secret hanky-panky are almost zero, because everything is going to be transparent,” he told The AP.

Here are some things to watch as vaccines get closer to the finish line.

THERE’S STILL NO GUARANTEE

Furthest along in final-stage testing in the U.S. are a vaccine candidate made by Pfizer Inc. and Germany’s BioNTech, and another developed by Moderna Inc. and the National Institutes of Health.

Fauci says “the best bet” is that data about whether one or both work will emerge sometime in November or December. How soon depends on an independent Data Safety and Monitoring Board -- the only group that can peek at the data before the study’s finished. At pre-set time points, the board can analyze the number of infections occurring so far among participants and decide if the study should be stopped early because of strong evidence the vaccine works, or if it’s failing, or that it’s too soon to know.

EFFECTIVENESS IS ONLY HALF THE STORY

The DSMB also watches for side effects. Many vaccines cause temporary side effects like fever, chills and other flu-like symptoms. Two other vaccine candidates in final-stage testing in the U.S. have been temporarily halted to investigate additional safety questions. Johnson & Johnson paused its study this week after learning of “an unexplained illness” in one participant, and the company expects it will take a few days to learn if the problem is a side effect or a coincidence.

But testing of AstraZeneca's vaccine has been on hold in the U.S. for over a month after news emerged of neurological illnesses in two British participants. Regulators let AstraZeneca's study resume in Britain and several other countries, but FDA still is deciding.

Stopping those studies “shows you that the system that we have in place to monitor the safety of the vaccines and the rigorous conduct of the trial is in place and it's working,” Schaffner said. Looking back at vaccines for other diseases, side effects show up within two to three months, said FDA vaccine chief Dr. Peter Marks.

So FDA told COVID-19 vaccine makers: If they seek “emergency use authorization” to get their shot to market faster than normal, they still would have to track half the participants for two months after the last dose.

Then it would take FDA several weeks of breakneck work to decide if a COVID-19 vaccine really was suitable for emergency use, Marks said. In contrast, evaluating an application for full approval could take months, as FDA officials comb through fuller records of how participants fared.

EXTRA SAFETY STEPS

Even large final tests won't catch a side effect that happens in, say, 1 in 100,000 people. So there's an early warning system that monitors every vaccine sold in the U.S. to spot unsuspected side effects.

“It’s a system that has served us very well,” said Dr. Bruce Gellin of the Sabin Vaccine Institute, who once directed the government’s National Vaccine Program Office. “But for this unprecedented vaccination campaign, we need to expand” that monitoring.

Once the FDA clears a vaccine, health workers and other essential workers are expected to get the first doses — and they'll have to sign an agreement to do so that includes their cell number and email. The CDC will use those registrations to check how the vaccinated are feeling.

Any health complaint bad enough that they missed work, couldn’t do a normal activity or had to seek medical care gets a follow-up probe, said CDC’s Dr. Tom Shimabukuro. Separately, the FDA will be checking giant databases of insurance claims and electronic medical records, to see if people who received vaccine also have an uptick in health care.

And states including New York, Rhode Island and Virginia are forming advisory committees to review the safety of any COVID-19 vaccines that pass FDA.

AP writer Candice Choi and video journalist Federica Narancio contributed to this report.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

More masks, less play: Europe tightens rules as virus surges

October 14, 2020

GENEVA (AP) — Governments across Europe are ratcheting up restrictions to try to beat back a resurgence of the coronavirus that has sent new confirmed infections on the continent to their highest weekly level since the start of the pandemic.

The World Health Organization said Tuesday there were more than 700,000 new COVID-19 cases reported in Europe last week, a jump of 34% from the previous week. Britain, France, Russia and Spain accounted for more than half of the new infections.

The increasing caseload is partly the result of more testing, but the U.N. health agency noted that deaths were also up 16% last week from the week before. Doctors are warning that while many of the new cases are in younger people, who tend to have milder symptoms, the virus could again start spreading widely among older people, resulting in more serious illnesses.

Italy and France are restricting parties and putting limits on restaurants and bars. The Netherlands went further and ordered the closing of all bars and restaurants, And to discourage partying at home, it banned the sale of alcohol after 8 p.m.

The Czech Republic is closing all schools until Nov. 2, while Latvia is ordering teenagers to switch to distance learning for a week. And Britain unveiled a three-tiered system for deciding what restrictions to impose, based on how severe the outbreak is in certain areas.

Those moves reflect a new approach to containing the virus among governments wary of hurting already fragile economies. Officials are eager to avoid the total lockdowns they imposed in the spring that resulted in heavy job losses. Instead, they are relying on a patchwork of regional or targeted restrictions that have sometimes caused confusion and frustration by those affected.

The U.N. health agency appeared to support the new approach, with WHO spokesman Tarik Jasarevic saying lockdowns should be a “last resort.” German Chancellor Angela Merkel told a European Union advisory body Tuesday that she is watching the rising infection figures “with great concern.”

“We must not squander now what we achieved through restrictions in recent months,” Merkel said in a video address. “None of us found it easy to impose those restrictions,” she added. “Many people lost their lives, and so it is all the more important that we ensure now that a further lockdown won’t be necessary, that our health system isn’t overstrained again.”

Italian Premier Giuseppe Conte ordered bars and restaurants to close at midnight and banned pickup sports games among friends and parties in enclosed spaces. Private gatherings at homes with more than six people who don’t live together are also discouraged.

“Our objective is clear: We must prevent our country from plunging back into a generalized lockdown," Conte said. Italy reported more than 5,900 people tested positive over the past day and 41 people died, bringing the country's official COVID-19 death toll to more than 36,200, the second-highest in Europe after Britain.

The outbreak has spread to the annual Giro d’Italia, which was thrown into chaos after several top riders withdrew from the cycling race following positive tests for the coronavirus. Italy made masks mandatory outdoors last week, a requirement already in place in Spain, Turkey, India and a few other Asian countries. Elsewhere in Europe, such mandates are in effect in many places in Poland and hot spot cities like Paris and Brussels, and are being introduced in several German cities.

In France, which has seen a rapid increase in infections, Paris, Marseille and seven other large cities have been placed under maximum alert, resulting in the closing of bars, gyms and swimming pools. Public parties are banned, and restaurants have to maintain at least 1 meter (3 feet) between tables, with groups of diners limited to six people.

Polish Prime Minister Mateusz Morawiecki urged the country’s citizens to observe social distancing and wear masks as he himself went into quarantine following contact with someone who later tested positive for COVID-19. He said in a video message that his government was working as usual and that he had no symptoms.

Poland, a nation of about 38 million, has seen a sharp spike in newly recorded infections, with close to 5,100 cases and 63 deaths reported Tuesday. Over the summer, new daily cases were around 600. Some doctors are warning that Poland's chronically underfunded health care system may collapse if the current rate of new cases continues.

In Britain, which has suffered the deadliest outbreak in Europe, with a toll of more than 43,000, officials defended their new system as striking the right balance. Under the plan unveiled this week, Liverpool is in the highest-risk category, and its pubs, gyms and betting shops have been shut.

"The prime minister has to balance protecting people’s lives and the NHS (National Health Service) from the virus while also prioritizing things that matter to us as a society, like education and keeping as many people in employment as possible,” Communities Secretary Robert Jenrick told the BBC.

Britain’s number of newly confirmed COVID-19 cases has more than tripled in the last three weeks, with infection rates rising across all age groups and regions. In an effort to keep people and goods moving throughout the European Union, member countries approved a color-coded system Tuesday.

The countries agreed to not restrict people traveling between green areas — where infection numbers are low — but EU governments will continue to set their own restrictions, such as quarantines or mandatory testing upon arrival, for people coming from orange or red zones.

Associated Press writer Jamey Keaten reported this story in Geneva and AP writer Frank Jordans reported from Berlin. AP writers around Europe contributed to this report.

Lithuanians to choose new parliament amid virus tensions

October 10, 2020

VILNIUS, Lithuania (AP) — Lithuanian voters will choose a new parliament Sunday for a nation that has seen a recent surge in COVID-19 cases and whose center-right coalition government has faced strong criticism over soaring virus-related unemployment.

The Lithuanian Farmers and Greens Union, the party that leads a majority coalition with three smaller partners, hopes to remain in power in the southernmost Baltic republic. Pre-election polls showed they are marginally ahead of the opposition conservative Homeland Union-Christian Democrats, the Social Democrats, the populist Labor party and the center-right Liberal Movement.

Five or six parties are expected to cross the 5% threshold to enter the 141-seat Seimas parliament but none is likely to get more than 20% support, so horse-trading talks to form a coalition are expected after the election.

The recent sharp rise in virus infections and new restrictions may force many voters to stay at home, affecting turnout among Lithuania’s 2.4 million registered voters. A second round of voting has been set for Oct. 25 in constituencies where no candidate gets a majority.

Many Lithuanians complain that government did not do enough to help companies during the nation's coronavirus lockdown, as the unemployment rate jumped from 9% in February to more than 14% in October. Others say the strict health regulations focused on fighting the virus left thousands of other patients without proper access to health services.

Supporters of the ruling coalition say this coastal Baltic country was among the lucky ones that suffered relatively lightly in the pandemic. So far Lithuania has seen 5,500 confirmed coronavirus cases and and just above 100 deaths.

Lithuania has kept strong democratic traditions since regaining independence from the Soviet Union in 1990. It has also played a major role as the protests in neighboring Belarus unfold against that nation's authoritarian leader.

Lithuania has granted shelter to Belarus opposition figure Sviatlana Tsikhanouskaya, who fled Belarus after challenging President Alexander Lukashenko in the country's Aug. 9 presidential vote. Officials said Lukashenko won a sixth term in office but opposition members say the election was riddled with fraud.

Together with its Baltic neighbors Estonia and Latvia, Lithuania swiftly imposed sanctions against Belarusian leaders, and the European Union — a 27-nation bloc that includes the three Baltic nations — eventually followed suit with sanctions. Belarus is not an EU member.

Lesson not learned: Europe unprepared as 2nd virus wave hits

October 10, 2020

ROME (AP) — Europe’s second wave of coronavirus infections has struck well before flu season even started, with intensive care wards filling up again and bars shutting down. Making matters worse, authorities say, is a widespread case of “COVID-fatigue.”

Record high daily infections in several eastern European countries and sharp rebounds in the hard-hit west have made clear that Europe never really crushed the COVID-19 curve as hoped, after springtime lockdowns.

Spain this week declared a state of emergency for Madrid amid increasing tensions between local and national authorities over virus containment measures. Germany offered up soldiers to help with contact tracing in newly flaring hotspots. Italy mandated masks outdoors and warned that for the first time since the country became the European epicenter of the pandemic, the health system was facing “significant critical issues” as hospitals fill up.

The Czech Republic’s “Farewell Covid” party in June, when thousands of Prague residents dined outdoors at a 500-meter (yard) long table across the Charles Bridge to celebrate their victory over the virus, seems painfully naive now that the country has the highest per-capita infection rate on the continent, at 398 per 100,000 residents.

“I have to say clearly that the situation is not good," the Czech interior minister, Jan Hamacek, acknowledged this week. Epidemiologists and residents alike are pointing the finger at governments for having failed to seize on the summertime lull in cases to prepare adequately for the expected autumn onslaught, with testing and ICU staffing still critically short. In Rome this week, people waited in line for 8-10 hours to get tested, while front-line medics from Kiev to Paris found themselves once again pulling long, short-staffed shifts in overcrowded wards.

“When the state of alarm was abandoned, it was time to invest in prevention, but that hasn’t been done,” lamented Margarita del Val, viral immunology expert with the Severo Ochoa Molecular Biology Center, part of Spain’s top research body, CSIC.

“We are in the fall wave without having resolved the summer wave,” she told an online forum this week. Tensions are rising in cities where new restrictions have been re-imposed, with hundreds of Romanian hospitality workers protesting this week after Bucharest once again shut down the capital’s indoor restaurants, theaters and dance venues.

“We were closed for six months, the restaurants didn’t work and yet the number of cases still rose,” said Moaghin Marius Ciprian, owner of the popular Grivita Pub n Grill who took part in the protest. “I'm not a specialist but I'm not stupid either. But from my point of view it’s not us that have the responsibility for this pandemic.”

As infections rise in many European countries, some — including Belgium, Netherlands, the United Kingdom, Spain and France — are diagnosing more new cases every day per capita than the United States, according to the seven-day rolling averages of data kept by Johns Hopkins University. On Friday, France, with a population of about 70 million, reported a record 20,300 new infections.

Experts say Europe's high infection rate is due in large part to expanded testing that is turning up far more asymptomatic positives than during the first wave, when only the sick could get a test. But the trend is nevertheless alarming, given the flu season hasn’t even begun, schools are open for in-person learning and the cold weather hasn’t yet driven Europeans indoors, where infection can spread more easily.

“We’re seeing 98,000 cases reported in the last 24 hours. That’s a new regional record. That’s very alarming,” said Robb Butler, executive director of the WHO’s Europe regional office. While part of that is due to increased testing, “It’s also worrisome in terms of virus resurgence.”

It’s also worrisome given many countries still lack the testing, tracing and treating capacity to deal with a second wave of pandemic when the first wave never really ended, said Dr. Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine.

“They should have been using the time to put in place really robust ‘find, test, trace, isolate’ support systems. Not everybody did,” McKee said. “Had they done that, then they could have identified outbreaks as they were emerging and really gone for the sources.”

Even Italy is struggling, after it won international praise for having tamed the virus with a strict 10-week lockdown and instituted a careful, conservative reopening and aggressive screening and contact-tracing effort when summer vacation travelers created new clusters. Anesthesiologists have warned that without new restrictions, ICUs in Lazio around Rome and Campania around Naples could be saturated within a month.

As it is, Campania has only 671 hospital beds destined for COVID-19, and 530 are already occupied, said Campania Gov. Vincenzo De Luca. Half of Campania’s 100 ICU virus beds are now in use. For now, the situation is manageable. “But if we get to 1,000 infections a day and only 200 people cured, it’s lockdown. Clear?” he warned this week.

The ICU alarm has already sounded in France, where Paris public hospital workers staged a protest this week to demand more government investment in staffing ICUs, which they said haven't significantly increased capacity even after France got slammed during the initial outbreak.

“We did not learn the lessons of the first wave,” Dr. Gilles Pialoux, head of infectious diseases at the Tenon Hospital in Paris, told BFM television. “We are running after (the epidemic) instead of getting ahead of it.”

There is some good news, however. Dr. Luis Izquierdo, assistant director of emergencies at the Severo Ochoa Hospital in Madrid said at least now, doctors know what therapies work. During the peak of the epidemic in March and April, doctors in hardest-hit Spain and Italy threw every drug they could think of at patients — hydroxychloroquine, lopinavir, ritonavir — with limited success.

“Now we hardly use those drugs as they hardly have any effect,” he said. “So in this sense we have had a victory because we know so much more now.” But treating the virus medically is only half the battle. Public health officials are now dealing with a surge in anti-mask protests, virus negationists and residents who are simply sick and tired of being told to keep their distance and refrain from hugging their loved ones.

The WHO this week shifted gears from giving medical advice to combat infections to giving psychological advice on how to nudge virus-weary Europeans to keep up their guard amid “COVID-fatigue” that is sweeping the continent.

“Fatigue is absolutely natural. It’s to be expected where we have these prolonged crises or emergencies,” said the WHO’s Butler. The WHO this week put out new advice for governments to consider more social, psychological and emotional factors when deciding on lockdowns, closures or other restrictions — a nod to some in the field who say the mental health toll of lockdowns is worse than the virus itself.

That data, Butler said, “is going to become more important because we have to understand what restrictions we can put in place that will be sustained and adhered to, and acceptable to our populations.”

AP reporters across Europe contributed.

Soldiers, experts to help German cities as virus cases rise

October 09, 2020

BERLIN (AP) — German Chancellor Angela Merkel announced Friday that the federal government will offer German cities the help of soldiers and public health experts to battle a sharp rise in coronavirus cases.

Merkel said she and the mayors of 11 large cities have agreed on measures to slow the spread of the virus by ensuring that social distancing and hygiene rules are respected and contact tracing can continue — despite the growing number of infections Germany is now experiencing.

“We all feel that the cities, the metropolitan areas, are the places that will determine whether we can keep the pandemic in Germany under control, just as we managed to do for months, or whether we will lose control,” Merkel told reporters in Berlin. “That's precisely the point we're at now.”

Germany has won wide plaudits for slowing the spread of the coronavirus when it first broke out but is grappling with what to do now that it seems to be picking up again. The country’s disease control center, the Robert Koch Institute, reported 4,516 new cases of coronavirus overnight Friday, and many cities have now reached the critical warning level of 50 new infections per 100,000 residents.

Berlin’s mayor Michael Mueller told reporters Friday that large gatherings had to be avoided and people need to take precautions on public transport, among other things. “We need to prevent a lockdown,” he said.

Berlin's figure was at 51 per 100,000 residents, while Bremen was at 53.9, and Cologne and Essen were close, with 49.8 and 48.4 per 100,000 respectively, according to the Robert Koch Institute. Overall, German has counted 314,660 coronavirus cases, with 9,589 deaths, a toll one-fourth that of Britain and one-third that of Italy.

The measures agreed upon after a video call between Merkel and the mayors include for the Robert Koch Institute to send advisers to cities that see more than 35 new cases per 100,000 residents in a week. Above that threshold, the German army will also provide soldiers to assist cities that request help, for example with contact tracing.

Once the number of new cases reaches 50 per 100,000 in a week, cities will impose further requirements to wear face masks in public, introduce curfews, restrict the sale of alcohol or limit the number of people who can take part in private events.

“These days and weeks will decide how Germany copes with the pandemic in the winter,” Merkel said. She added that the experience of last spring, when Germany managed to flatten the curve of infections quickly, showed that “we are anything but powerless.”

“My top priority is to avoid, if at all possible, to power down economic and public life again the way we had to in spring,” she added.

David Rising contributed to this report.

UN: New daily record as COVID-19 cases hit more than 350,000

October 09, 2020

GENEVA (AP) — The World Health Organization has announced a new daily record high in coronavirus cases confirmed worldwide, with more than 350,000 infections reported to the U.N. health agency on Friday.

The new daily high of 350,766 cases surpasses a record set earlier this week by nearly 12,000. That tally includes more than 109,000 cases from Europe alone. In a press briefing on Friday, WHO emergencies chief Dr. Michael Ryan acknowledged that even as COVID-19 continues to surge across the world, “there are no new answers.”

He said that although the agency wants countries to avoid the punishing lockdowns that have devastated economies, governments must ensure the most vulnerable people are protected and numerous measures must be taken.

“The majority of people in the world are still susceptible to this disease,” Ryan warned. He said countries should focus not just on restrictive measures, but also on bolstering their surveillance systems, testing, contact tracing and ensuring populations are engaged.

As the virus continues to surge across Europe and elsewhere, Ryan acknowledged that restrictive measures might be warranted at some point. British scientists reported this week that the COVID-19 outbreak is doubling every few weeks, French hospitals are running out of ICU beds, Germany may enlist the army to help contain its outbreak and Spain declared a state of emergency in Madrid as coronavirus cases soar.

Ryan said lockdowns “may be unavoidable where the disease has got out of control again, but we shouldn’t accept that in every country, the return of cases should be seen with an immediate return of the need for lockdown restrictions.”

Globally, more than 36 million cases of COVID-19 have been reported, including more than 1 million deaths. Experts say the tally far underestimates the real number of cases and Ryan said on Monday that the WHO’s “best estimates” were that one in 10 people worldwide — or roughly 760 million people — may have been infected.

Spanish govt imposes state of emergency in virus-hit Madrid

October 09, 2020

MADRID (AP) — Spain’s government declared a state of emergency in Madrid on Friday, wresting control of efforts to fight the spread of COVID-19 from local authorities in a region that is experiencing one of Europe’s most significant coronavirus outbreaks.

The step, which took immediate effect and lasts for two weeks, forced Madrid authorities to restore restrictions on travel that had been introduced by the national government but were struck down the previous day by a Madrid court ruling.

That successful legal challenge by Madrid officials was part of a long quarrel between the country’s main political parties over their coronavirus response. Those differences, and the changing rules, have often dismayed and confused local residents.

“Well, it is all very nauseating,” Vicente de la Torre, a 22-year-old Madrid mechanic, told The Associated Press. “We have no idea what we should do or what we shouldn’t do.” The government announced the state of emergency after a hastily arranged Cabinet meeting in the wake of the court ruling. Health Minister Salvador Illa said the previous measures would come back into force and that only the legal framework for them was changing.

He told a press conference it was “undeniable” that there is community transmission in the Madrid region, not just isolated outbreaks, at a crucial juncture as winter approaches and respiratory problems increase.

“Action is needed, and today we couldn’t just stand by and do nothing,” Illa said. “It’s very important that this doesn’t spread to the rest of the country.” The Madrid region’s 14-day infection rate of 563 coronavirus cases per 100,000 residents is more than twice Spain’s national average of 256 and five times the European average rate of 113 for the week ending Sept. 27.

The central government’s measures prohibit all nonessential trips in and out of the capital and nine of its suburbs, affecting some 4.8 million people. Restaurants must close at 11 p.m. and stores at 10 p.m.. Both must limit occupancy to 50% of their capacity.

The national government had ordered police in Madrid to fine people if they left their municipalities without justification. More than 7,000 police officers will now be deployed to ensure the restrictions are observed, Interior Minister Fernando Grande-Marlaska said.

But Madrid's conservative regional government opposed those restrictions, saying they were draconian and hurt the economy. Madrid’s regional president, Isabel Díaz Ayuso, said her own, more moderate measures were enough to fight COVID-19.

A Madrid court on Thursday upheld the regional government’s appeal, saying the national government’s imposition of restrictions violated people’s fundamental liberties. The spat has taken place against a backdrop of political differences: Spain’s national government is led by the center-left Socialist party, while the Madrid region is run by the country’s main opposition party, the conservative Popular Party.

“It seems to me like an ideological war that is trying to show who has more power,” said 18-year-old student Marta Illo. “They (the Spanish government) don’t really like the regional government of Madrid. And we the people of Madrid are paying the price for a fight that is really political and has nothing to do with us."

Hatton reported from Lisbon, Portugal. Joe Wilson in Barcelona contributed to this report.

As virus fills French ICUs anew, doctors ask what went wrong

October 09, 2020

PARIS (AP) — During a single overnight shift this week, three new COVID-19 patients were rushed into Dr. Karim Debbat’s small intensive care ward in the southern French city of Arles. It now has more virus patients than during the pandemic’s first wave and is scrambling to create new ICU beds elsewhere in the hospital to accommodate the sick.

Similar scenes are playing out across France. COVID-19 patients now occupy 40% of ICU beds in the Paris region, and more than a quarter of ICUs nationwide as weeks of growing infections among young people spread to vulnerable populations.

Despite being one of the world’s richest nations — and one of those hardest hit when the pandemic first washed over the world — France hasn’t added significant ICU capacity or the staff needed to manage extra beds, according to national health agency figures and doctors at multiple hospitals.

Like in many countries facing resurgent infections, critics say France’s leaders haven’t learned their lessons from the first wave. “It’s very tense, we don’t have any more places,” Debbat told The Associated Press. The Joseph Imbert Hospital in Arles is converting recovery rooms into ICUs, delaying non-urgent surgeries and directing more and more of his staff to high-maintenance COVID-19 patients.

Asked about extra medics to help with the new cases, he said simply, “We don’t have them. That’s the problem.” When protesting Paris public hospital workers confronted French President Emmanuel Macron this week to demand more government investment, he said: “It’s no longer a question of resources, it’s a question of organization.”

He defended his government’s handling of the crisis, and noted 8.5 billion euros ($9.3 million) in investment promised in July for the hospital system. The protesting medics said the funds are too little and too slow in coming, after years of cuts that left France with half the number of ICU beds in 2020 that it had in 2010.

ICU occupancy rates are considered an important indicator of how saturated the hospital system is and how effective health authorities have been at protecting at-risk populations. And France’s numbers aren’t looking good.

It reported a record daily count of more than 20,300 new virus cases Friday, and COVID patients now occupy 1,439 ICU beds nationwide — a figure that has doubled in less than a month. France’s overall ICU capacity is 6,000, roughly the same as in March, according to national health agency figures provided to the AP.

In comparison, Germany entered the pandemic with about five times as many intensive care beds as France. To date, Germany’s confirmed virus-related death toll is 9,584 compared to 32,521 people in France.

Getting ICU capacity right is a challenge. Spain was caught short in the spring, and has expanded its permanent ICU capacity by about 1,000 beds. Britain expanded ICU capacity by building emergency field hospitals. They were mothballed because they were barely used, but the government says they can be utilized again if required.

France added extra makeshift beds in the spring and transported patients by plane and high-speed train from hotspots to less saturated areas. The health agency said French hospitals could eventually double their ICU capacity if needed this fall.

Compared to March and April, doctors say French intensive care wards are better armed this time around, both with protective equipment and more knowledge about how this coronavirus works. Medics put fewer patients on breathing machines now and hospitals are practiced in how to rearrange their operations to focus on COVID-19.

The number of virus patients in the ICU quickly doubled last month in the New Civilian Hospital in Strasbourg, but the atmosphere is surprisingly calm. An AP reporter watched teams of medics coordinating closely to manage the trajectory and treatment of each patient according to strict protocols they’re now accustomed to.

But that extra practice doesn’t mean managing resurgent virus cases in ICUs is easy. In addition to extra breathing machines and other equipment, adding temporary ICU beds also takes time and labor – as does treating the COVID-19 patients in them.

“The work is harder, and takes longer” than for most other patients, said Pierre-Yves, head of the intensive care ward at the Laveran Military Training Hospital in Marseille. He was not authorized to be identified by his last name because of military policy.

Seven or more of his 47 staffers are needed each time they slowly and carefully rotate a patient from back to stomach or vice versa. Entering and leaving the ward now involves a lengthy, careful dance of changing full-body gear and disinfecting everything they’ve touched.

Dr. Debbat in Arles said training ICU staff takes several months, so he’s relying on the same personnel levels as in the spring, and he worries they could burn out. “I’m like a coach and I have just one team, with no reserve players,” he said.

He also worries about non-virus patients, who were already put on the back burner earlier this year. And he worries about the upcoming flu season, which sends about 2,000 patients to ICUs in France every year.

The head of emergency medical service SOS Medecins, Serge Smadja, doesn’t think France will again face the situation it saw in the spring, when more than 7,000 virus patients were in intensive care at the peak of the crisis, and some 10,000 infected people died in nursing homes without ever making it to hospitals. But he said the French public and its leaders were wrong to think “the virus was behind us."

"There aren’t enough beds ... and there is especially a lack of personnel,” he said. And with his service seeing a steady uptick in cases and the pandemic wearing on, he warned, “what’s missing is an end date.”

Jean-Francois Badias in Strasbourg, France, Aritz Parra in Madrid and Pan Pylas in London contributed to this story.

Paris hospitals on emergency footing as virus cases rise

October 08, 2020

PARIS (AP) — Paris region health authorities ordered hospitals to activate emergency measures starting Thursday to cope with fast-rising numbers of COVID-19 patients, who now fill 40% of the region’s intensive care units.

The French health minister is expected to announce new restrictions for areas where hospitals are facing strain and infections are mounting, after shutting down bars in Paris and several cities and limiting private gatherings in recent weeks.

The director of the Paris region public health agency, Aurelien Rousseau, tweeted Thursday that he ordered hospital directors to activate a special emergency plan to free up resources and protect medical staff. The move was necessary, he said, “given the pressure on intensive care units and on conventional hospital activity.”

Each hospital’s emergency plan can include such measures as adding hospital beds, postponing non-urgent surgery, transferring non-COVID-19 patients to other facilities or sending them home, recalling staff from vacation and soliciting help from volunteers, according to the health agency. Such measures were taken in March and April as the pandemic first swept across Europe.

While some regions are seeing infections slow after new virus rules were imposed, French President Emmanuel Macron on Wednesday urged more restrictions in areas where the epidemic is still spreading rapidly.

“We are not in a normal time, and we won’t be for several months,” Macron said on national television. As countries across Europe face resurgent virus cases, the French government is trying to avoid new blanket lockdowns and focusing on more targeted restrictions instead.

France reported a record daily count of 18,700 new confirmed cases Wednesday, and COVID-19 patients now occupy a quarter of ICU beds nationwide. France has reported 32,445 virus-related deaths since the pandemic began, among the highest tolls in Europe.

As leaders set fresh climate goals, Biden pledges US support

December 12, 2020

PARIS (AP) — U.S. President-elect Joe Biden pledged Saturday to rejoin the Paris climate accord on the first day of his presidency, as world leaders staged a virtual gathering to celebrate the fifth anniversary of the international pact aimed at curbing global warming.

Heads of state and government from over 70 countries took part in the event — hosted by Britain, France, Italy, Chile and the United Nations — to announce greater efforts in cutting the greenhouse gas emissions that fuel global warming.

The outgoing administration of President Donald Trump, who pulled Washington out of the Paris accord, wasn't represented at the online gathering. But in a written statement sent shortly before it began, Biden made clear the U.S. was waiting on the sidelines to join again and noted that Washington was key to negotiating the 2015 agreement, which has since been ratified by almost all countries around the world.

“The United States will rejoin the Paris Agreement on day one of my presidency,” he said. “I’ll immediately start working with my counterparts around the world to do all that we possibly can, including by convening the leaders of major economies for a climate summit within my first 100 days in office.”

Biden reiterated his campaign pledge that his administration will set a target of cutting U.S. emissions to net zero “no later than 2050.” Experts say commitments put forward by the international community in the past five years have already improved the long-term outlook on climate change, making the worst-case scenarios less likely by the end of the century. But wildfires in the Amazon, Australia and America, floods in Bangladesh and East Africa, and record temperatures in the Arctic have highlighted the impact an increase of 1.2 degrees Celsius (2.2 Fahrenheit) since pre-industrial times is already having on the planet.

“If we don’t change course, we may be headed for a catastrophic temperature rise of more than 3 degrees (Celsius) this century,” U.N. Secretary-General Antonio Guterres said, urging world leaders to declare a “climate emergency.”

The Paris agreement aims to cap global warming at well under 2 C (3.6 F), ideally no more than 1.5 C (2.7 F), by the end of the century. Meeting the temperature target will require a phasing-out of fossil fuels and better protection for the world's carbon-soaking forests, wetlands and oceans.

The U.N. chief called the announced U.S. return to the Paris accord “a very important signal." “We look forward for a very active U.S. leadership in climate action from now on,” Guterres said. "The United States is the largest economy in the world, it’s absolutely essential for our goals to be reached.”

Biden insisted that the dramatic economic shifts needed would be positive for American workers. “We have before us an enormous economic opportunity to create jobs and prosperity at home and export clean American-made products around the world, harnessing our climate ambition in a way that is good for American workers and the U.S. economy,” he said.

American representatives at the virtual meeting included Michigan Gov. Gretchen Whitmer, Gov. Charlie Baker of Massachusetts and U.S. business leaders, such as Apple chief executive Tim Cook. Also absent from the event were major economies such as Australia, Brazil, Indonesia, Mexico, Russia and Saudi Arabia. Most have offered no significant improvements on their existing emissions targets lately.

Environmental campaigners singled out Brazil's recent announcement that it will stick to its target of cutting emissions by 43% over the next decade compared with 2005 levels and aim for net zero by 2060 — later than most other countries.

By contrast, an agreement Friday by European Union members to beef up the continent’s 2030 targets from 40% to at least 55% compared with 1990 levels was broadly welcomed, though activists said it could have aimed even higher.

China, the world's biggest emitter, also surprised the world in September by announcing a net zero target of 2060, with emissions peaking by 2030. In his speech Saturday, Chinese President Xi Jinping provided further details on his country's medium-term goal for improving energy efficiency and ramping up electricity generated from renewable sources of power such as wind and solar.

But Xi also cautioned that “unilateralism will lead us nowhere” — a veiled reference to discussions in the EU to impose tariffs on goods imported from countries that have less stringent emissions standards than the 27-nation bloc. The issue is likely to dominate discussion between China, the EU and the U.S. in coming years.

The Maldives, an Indian Ocean nation made up of low-lying islands that are particularly vulnerable to sea level rise, announced Saturday that it will now aim to achieve net zero by 2030, one of the most ambitious goals worldwide. Bhutan and Suriname claim to have already achieved that goal.

The 189 countries that are party to the Paris agreement are required to submit their updated targets to the United Nations by the end of the year. This would normally have occurred at the annual U.N. climate summit, but the event was postponed for a year because of the pandemic.

The gathering, now scheduled to take place in Glasgow, Scotland, in November 2021, will see haggling over financial support for poor countries to cope with climate change, and fine-tuning the rules for international markets in emissions trading. Britain, next year's host, announced this month that it's aiming to cut emissions by 68% over the next decade and end state support for fossil fuel industry exports.

Former U.N. climate chief Christiana Figueres, who was a key player at the Paris negotiations, said leaders had a duty to be optimistic about their ability to curb global warming. “Because if we don’t, the alternative is unthinkable,” she said. “None of us adults alive today want to have on our shoulders the responsibility of turning over a world that is a world of misery for generations to come.”

Frank Jordans reported from Berlin.

Armenians, Azerbaijan trade blame over breach of peace deal

December 12, 2020

YEREVAN, Armenia (AP) — Armenian officials and Azerbaijan on Saturday accused each other of breaching a peace deal that ended six weeks of fierce fighting over Nagorno-Karabakh, and Azerbaijan's leader threatened to crush Armenian forces with an “iron fist.”

The new clashes mark the first significant breach of the peace deal brokered by Russia on Nov. 10 that saw Azerbaijan reclaim control over broad swathes of Nagorno-Karabakh and surrounding lands which were held by Armenian forces for more than a quarter-century.

Separatist officials in Nagorno-Karabakh said the Azerbaijani military launched an attack late Friday that left three local ethnic Armenian servicemen wounded. Russian peacekeepers deployed to the region to monitor the peace deal reported a violation of the cease-fire in the Gadrut region on Friday. The report issued Saturday by the Russian Defense Ministry didn't assign blame.

Later in the day, the Armenian Defense Ministry also charged that the Azerbaijani army mounted an attack in the south of Nagorno-Karabakh on Saturday. Azerbaijani President Ilham Aliyev reacted on Saturday by blaming Armenia for the new clashes and threatened to "break its head with an iron fist.”

“Armenia shouldn't try to start it all over again,” Aliyev said during a meeting with top diplomats from the United States and France who have tried to mediate the decades-old conflict. ”It must be very cautious and not plan any military action. This time, we will fully destroy them. It mustn't be a secret to anyone."

Azerbaijan's Defense Ministry said in a statement late Saturday that its forces thwarted Armenian “provocations” and restored the cease-fire. Armenian officials said the fighting raged near the villages of Hin Tager and Khtsaberd, the only settlements in the Gadrut region that are still controlled by Armenian forces. They noted that the two villages have been fully encircled by the Azerbaijani army, which controls the only road leading to them.

Nagorno-Karabakh lies within Azerbaijan but was under the control of ethnic Armenian forces backed by Armenia since a separatist war there ended in 1994. That war left Nagorno-Karabakh itself and substantial surrounding territory in Armenian hands.

In 44 days of fighting that began in late September and left more than 5,600 people killed on both sides, the Azerbaijani army pushed deep into Nagorno-Karabakh, forcing Armenia to accept last month's peace deal that saw Azerbaijan reclaim much of the separatist region along with surrounding areas. Russia deployed nearly 2,000 peacekeepers for at least five years to monitor the peace deal and to facilitate the return of refugees.

Azerbaijan marked its victory with a military parade on Thursday that was attended by Turkish President Recep Tayyip Erdogan and involved more than 3,000 troops, dozens of military vehicles, and a flyby of combat aircraft.

The peace deal was a major shock for Armenians, triggering protests calling for the resignation of Prime Minister Nikola Pashinyan, who has refused to step down. He described the peace agreement as a bitter but necessary move that prevented Azerbaijan from taking over all of Nagorno-Karabakh.

Associated Press writers Vladimir Isachenkov in Moscow, and Aida Sultanova in London, contributed to this report.