This chapter provides an initial assessment of the impact of COVID‑19 and the resilience of European health systems to the pandemic, bearing in mind that the pandemic is ongoing and so any definitive assessment would be premature. As of 31 October, over 7 million people were infected and 220 000 died from the virus across EU countries, Iceland, Norway, Switzerland and the United Kingdom. During the first wave, the virus had a much more adverse impact on a number of Western European countries, notably Belgium, France, Italy, Netherlands, Spain and the United Kingdom, as well as Sweden. Since August, COVID‑19 also started to spread more widely across Europe. The virus has disproportionately hit older people, and there has been a clear social gradient in COVID‑19 deaths.Countries that were better prepared and acted quickly to reduce the spread of the virus through rapid scaling-up of testing, tracking and tracing strategies, were more able to avoid the most stringent and costly containment and mitigation measures. In terms of treating COVID‑19 patients, policies to temporarily boost hospital beds and equipment have helped deal with surges in demand. However, a lack of health personnel has been more of a binding constraint, putting health workers under intense pressure. Further, many non-COVID‑19 patients were unable to access needed care during the peak of the pandemic in Spring 2020. Health system resilience therefore also requires strengthening primary health care and mental health services to minimise delays and forgone care for all health care needs. Note that figure 1.8 was revised on 26 November 2020 to correct a miscalculation.