Concerns health services could buckle and, in some countries, democracy could be further undermined

On the face of it, the map of Europe’s struggle with coronavirus suggests the prospects for the eastern half of the continent are much less grim than for the western half.

The combined death toll to date across more than a dozen countries is less than the number of fatalities on any given recent day in Italy. The highest numbers of infections are in the Czech Republic and Poland, with 2,541 cases and 1,638 cases respectively, still a fraction of the numbers in most western European countries.

Partly this could be down to lockdown measures introduced at an early stage in the outbreak. The Czech Republic imposed a strict lockdown two weeks ago, while at the same time Poland cancelled almost all flights in and out of the country. Polish authorities were also quick to close bars, restaurants, cinemas and schools. Police vehicles with mounted loudspeakers blare recorded messages urging people to stay at home.

But there is also a worry that the figures in some countries are deflated by a much lower testing rate than in western Europe. Hungary, for example, has conducted less than a quarter of the number of tests that neighbouring Austria has, despite having a slightly larger population. Britain, where lack of testing is also a serious concern, has conducted many more tests per capita than most countries in eastern Europe, with a few exceptions, notably the Czech Republic which has tested widely.

“Of course, the low number of confirmed cases has to do with the low amount of testing. I have a colleague who has symptoms, he has stayed at home for the past five days and he hasn’t been tested yet,” said one doctor at a Budapest hospital who asked to speak anonymously.

If and when the expected surge in cases does come, there is a fear that struggling and underfunded health services across the region could buckle. While concerns over outdated facilities and a lack of protective equipment are certainly not unique to central and eastern Europe, they could be particularly acute here.

“We still don’t have enough protective equipment,” said the doctor in Budapest. Although there had been only 343 confirmed cases in Hungary, she said there was already a shortage of equipment for doctors working with coronavirus patients.

Regulations have recently changed in her hospital, she said, meaning that only those doctors spending an hour or more with coronavirus patients are eligible to wear FFP2 masks offering high levels of protection. Those who spend less than an hour with patients receive only a simple surgical mask.

Similar issues have been raised across the region, especially outside capital cities.

“Help us, we don’t have gloves, masks, overalls, disinfectant or the money to pay for them,” Barbara Gąsiorowska, the director of a hospital in a small town south of Warsaw, pleaded in a Facebook post last week.

In one disastrous case in Suceava, Romania, the city’s hospital was closed after nearly 100 medical staff contracted the virus. Romania is particularly vulnerable to a health crisis: the country has faced a chronic shortage of doctors for years, with thousands leaving for better paid jobs abroad.

To help with shortages of equipment, governments across the region have turned to Beijing. Over the past week the Czech and Hungarian prime ministers have personally met planes carrying equipment from China on the airport tarmac in Prague and Budapest.

On Thursday a plane containing 150 respirators, 600,000 medical masks and more than 250,000 medical overalls arrived in Warsaw. On Friday the Bulgarian prime minister, Boyko Borisov, announced he had struck a deal with China to purchase 50 respirators and 1.1m masks.

There have also been promises to scale up testing, with Serbia’s president, Aleksandar Vučić, pledging the country will move to a model of mass testing on the advice of Chinese medical experts. But increasing the number of tests requires laboratory capacity that may not be present.

“Even if we had more tests, we don’t have the people to do them,” Grażyna Cholewińska, a Polish consultant specialising in infectious diseases, told the Polska Times this month. Romania’s health minister resigned on Friday, two days after making the implausible promise that the government would test the entire 2 million population of Bucharest. So far Romania has carried out 12,000 tests.

Authorities have tried to silence medics who raise concerns in public. In Poland, a nurse was dismissed by the director of her hospital for publishing an angry account on Facebook in which she described a chronic shortage of essential equipment and other irregularities.

In Bulgaria, four doctors who complained about a lack of resources were reprimanded by the police for speaking out and “spreading panic”. In Hungary, several doctors contacted by the Guardian said they had been warned by their hospital bosses in the strictest terms against speaking to the media.

There is also a fear that emergency coronavirus measures across the region could lead to the further erosion of democratic norms in the long term. Legislation due to be passed in Hungary on Monday will give the far-right prime minister, Viktor Orbán, the potential to rule by decree with no time limit or sunset clause. It also introduces jail terms for people who spread false information, and there are fears the law could be used to stifle critical reporting of the government response to the crisis.

In Bulgaria, the leader of the opposition Socialist party, Kornelia Ninova, lamented the suspension of parliament during the state of emergency as “the first step towards dictatorship”.

In Poland, the government has insisted it will go ahead with presidential elections on 10 May despite the pandemic. In the early hours of Saturday morning, the Polish parliament passed an amendment to the electoral code allowing senior citizens and anyone in quarantine to use postal voting. The opposition has called for a postponement, saying it will be impossible to campaign during a pandemic.

Amid the political manoeuvring, the region is nervously awaiting the inevitable rise in cases and hoping the early lockdowns will help avoid Italian-style carnage. One positive is that like elsewhere, people have come together like never before to support beleaguered medics.

“I’ve never received this many messages of warmth and gratitude and this amount of love throughout my career,” said the doctor in Budapest, who has been working for several decades. “I feel like this time our work is really appreciated.”

Additional reporting by Flora Garamvolgyi and Martin Dimitrov

• This article was amended on 31 March 2020, to add information about the Czech Republic testing widely for coronavirus.