Europe, still in the grip of the coronavirus pandemic, faces two million Covid-19 deaths by March, the World Health Organisation has said.
The grim warning came as the number of daily deaths rose to almost 4,200, double the daily fatalities reported at the end of September.
Reported deaths from the virus have already passed 1.5 million for the 53 countries that make up the WHO European region, the global health agency said.
Covid-19 is the number one cause of death across Europe and Central Asia, and the WHO said it expected there to be “high or extreme stress on hospital beds in 25 countries, and high or extreme stress in intensive care units in 49 of [the] 53 countries between now and March 2022".
Cumulative reported deaths are projected to reach more than 2.2 million by spring next year, based on current trends, it said.
“In order to live with this virus and continue our daily lives, we need to take a 'vaccine plus' approach,” said Dr Hans Kluge, WHO regional director for Europe.
“This means getting the standard doses of vaccine, taking a booster if offered, as well as incorporating preventive measures into our normal routines.
“Taken together, wearing a mask, washing hands, ventilating indoor spaces, keeping physical distance and sneezing into your elbow are simple, effective ways of gaining control over the virus and keeping societies going.
“All of us have the opportunity and responsibility to help avert unnecessary tragedy and loss of life, and limit further disruption to society and businesses over this winter season.”
According to the WHO, the three main factors driving the high case numbers in Europe are the spread of the Delta variant, which is highly transmissible; people being unvaccinated and waning immunity; and the fact many “countries have indicated to their populations that Covid-19 no longer represents an emergency threat and have eased measures such as mask-wearing and physical distancing in crowded or confined spaces".
Now that the weather has turned colder, people are also more likely to gather indoors, it said.
“As we approach the end of 2021, let's do everything we can by getting vaccinated and taking personal protective measures, to avoid the last resort of lockdowns and school closures,” Dr Kluge said.
“We know through bitter experience that these have extensive economic consequences and a pervasive negative impact on mental health, facilitate interpersonal violence, and are detrimental to children's well-being and learning.”
The head of AstraZeneca, Pascal Soriot, said the continuing crisis on the continent may be linked to countries choosing the wrong vaccine for their elderly populations.
Speaking to the BBC, Mr Soriot said he believes this may be the result of waning antibody responses, particularly in vaccines that use mRNA technology.
Following its approval, the Oxford-AstraZeneca vaccine was used to inoculate older people in Britain, but concerns over possible blood clot side-effects led to its use being curtailed in much of the EU.
“When you look at the UK, there was a big peak of infections, but not so many hospitalisations relative to Europe,” he told the BBC's Today programme.
“In the UK, this vaccine was used to vaccinate older people. Whereas in Europe, initially, people thought the vaccine doesn't work in older people.”
The grim prediction comes after German Health Minister Jens Spahn said on Monday that citizens there would be “vaccinated, cured or dead” by the end of this winter.
The WHO said vaccinations had saved “hundreds of thousands of lives” but it was essential to drive up vaccination rates among all those who were eligible for one.
“Today, the Covid-19 situation across Europe and Central Asia is very serious,” Dr Kluge said.
“We face a challenging winter ahead but we should not be without hope, because all of us — governments, health authorities, individuals — can take decisive action to stabilise the pandemic.”
Robb Butler, executive director for the WHO in Europe, told Sky news that he and his colleagues were “very alarmed” at the current Covid trajectory on the continent.
“It looks like we’re going to have a worrisome season ahead,” he warned.
“Of course, public health costs, the cost to our economies, the stress on our hospitals and communities and our ICUs”, he added.
The more transmissible Delta variant, he said, accounts for “around 99 per cent of the cases in Europe today”, adding: “That’s why this is happening.”
He said just over half of the population of Europe is fully vaccinated against the coronavirus “so there’s so much work to be done still, we’re not there yet”.
Mr Butler declined to be drawn on the comparison of different Covid vaccines, putting the rising cases and deaths down to waning immunity and low vaccination uptake among some populations.
He also reiterated the health agency’s advice on wearing face masks in indoor and crowded settings, saying if mask use increased the knock-on effects would be reductions in infections and fatalities.
“If we saw 95 per cent universal mask use we could project that we could save about 160,000 lives”, he said.