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Covid-19 has clearly put strain on nearly all the countries of the world. The preparedness of the Estonian Health Board (HB) for handling the crisis is being increasingly criticized. Some say that the HB has been coping well enough, but others have questioned the director general’s ability to manage the crisis. They ask why wasn’t the hazard taken seriously early enough and why wasn’t the scientists’ advice heeded.
Former Center Party member Evelyn Sepp recommended in a radio broadcast some days ago that Minister of Social Affairs Tanel Kiik should make a public service by dismissing the head of the Health Board. “No general can lead a war if he cannot do his job and war is not the place for practicing,” Sepp said, adding that if Merike Jürilo, Director General of the Health Board, should continue at her post for a single day, she would view it as a total disaster for the state.
A couple of days later, Eno-Martin Lotman, a cardiologist of the North Estonian Regional Hospital, asked Kiik, whose opinions and advice the minister has taken and listed some ideas of curbing the spreading of the virus by tougher restrictions.
The Estonian Dental Association has also been quite critical. And there are others who have questions.
A former HB employee, who worked there until recently as a medium-level executive, contacted Postimees and complained about a hostile atmosphere in the institution. According to the ex-employee the departments cannot get along and meetings degenerating into shouting matches and mutual insults are infrequent. “This is not a constructive atmosphere,” the source said.
The person considered the belated response to the coronavirus and insufficient preparedness the worst mistakes. “This lasted for weeks while Martin Kadai of the HB addressed the public and kept saying that there is no need for concern and that the virus would not reach here. There was a creating of a false sense of security. They made no decisions and allowing the Italian volleyball team to enter Saaremaa was a major blunder,” the ex-official said. The source believed that Kiik had too much confidence in the Health Board while the latter due to its incompetence dared not do anything decisive.
Chemist Marek Strandberg is another person to blame the HB for its insufficient preparedness. “The main shortcoming of the HB is the fact that at the moment when the epidemic broke out in Wuhan they were unprepared to understand what was going on there,” he said.
On February 5 Strandberg asked HB Director General Jürilo in a letter about their intentions. The answer had been vague in Strandberg’s opinion: they would not do anything unless Europe reacts first. As children began to return from the spring holidays, Strandberg had informed the government that quarantining the people returning from foreign travels would be reasonable. The answer was that it would be a highly disproportional measure.
Strandberg claimed to have understood at that moment that the state officials tasked with predicting future risks lack the understanding and sufficient education to imagine exponential growth. They refused to believe that a person without symptoms could infect others. Strandberg claimed that the HB had considered introducing any restrictions disproportionate even at the Tallinn municipal crisis committee meeting on March 2.
The Health Board relayed its terms for the March 5 volleyball game to the local (Saaremaa) sports club, but did not forbid allowing Italians from the very center of the outbreak enter Estonia. “Did the Health Board actually approve the Italians’ entry to Saaremaa? In such a case it is a crime. They cannot say that they could not imagine the consequences. If they did not imagine it, they regrettably breached the statute of the Health Board which stipulates that they must be able to foresee. They must be proactive according to the statute, able to predict risks, but they have been reactive. The Health Board as a competent institution tasked with prediction, prevention and combating hazards has failed to do so and their claims in retrospect that they have done their best… They have not done it,” Strandberg declared.
The ex-official considers the absence of medical background of a number of department heads to be the reason. “This in turn leads to erroneous decisions and slow response,” the source said. The background of Health Board Director General Merike Jürilo has been brought up as well. According to the ex-employee, the management style of Jürilo with her police background has led to concentrating primarily on procedures and meeting the related financial targets. “The institution which should protect public health sets a target to investigate a certain number of physicians every year,” the source said.
Jürilo was unwilling to comment on these claims. The questions sent to the Health Board director general were answered by Martin Kadai, one of the HB crisis staff leaders, who has been one of the main spokesmen during the entire crisis.
Kadai assured that Estonia, including the Health Board, has acted adequately while preventing the spreading of the virus and that they have done everything within the limits of the existing resources to ensure the preparedness and operating capability of the public health services.
“The Health Board has drafted its predictions and hazard assessments according to evidence-based data, including the risk assessments of the WHO and the ECDC (European Centre for Disease Prevention and Control),” he explained.
According to Kadai the introduced restrictions and measures must be proportionate to the known hazard and their implementation must be timed so as to disrupt the operating of the society as little as possible. According to him, the restrictions were therefore imposed at the right moment.
However, the Health Board decided not to share with the public the estimate drafted in February; according to Jürilo in order to prevent panic. It is not clear who were allowed to see it. Kiik told Postimees that he had discussed the estimate with the HB in the beginning of March. Strandberg in turn claims that when he asked Kiik and Mailis Reps on March 12 with 35 confirmed infection cases whether the HB had submitted an infection growth model to the government, both ministers had denied it.
“The Health Board head claimed some days ago that some models had been made since mid-February. This is either a lie or a bluff since government members said on March 12 that it had not been done. If there was a model, I would ask why they didn’t present it to the government,” Strandberg said.
The main amount of public criticism regarding the Health Board concerns the decision to test only the members of the high risk groups.
“They say that we must protect above all the high risk groups. This is correct. But to claim that no one else but the high risk groups will therefore be tested, this claim is totally inadequate. Yes, we must test the people in the high risk groups to know whether some of them need urgent treatment. But first of all we must test the environment around the high risk group,” Strandberg argued and added that since there has been no mass testing, it is also unknown how the infection is spreading in Estonia.
The government did make some changes to the curbing of testing process and decided to open drive-in testing stations in several towns. Yet the Health Board had ordered only a few days before to close the drive-in station at the Kuressaare hospital, considering it a health risk. Local emergency service nurse Angela Siinor responded. “The Health Board’s claim that our work constituted a risk since we were testing healthy people only shows the limited interest of the Health Board in our work. No one we tested was healthy. We closely observed the rules of the Health Board.”
The sudden leap in the number of people diagnosed as positive – 134 – caused considerable confusion on March 25. According to Eike Kingsepp, media advisor of the Health Board, the data of 48 hours had been submitted together since the method of gathering the data had been changed. It results in the labs being able to enter the data in the system more rapidly, but this resulted in a confusion of the statistics of analyzes and results recorded so far.
Arkadi Popov, head of the North Estonian Regional Hospital emergency center, who was appointed the head of the Health Board crisis staff medical branch, hoped in an interview to Postimees that the crisis management will now become more streamlined and the chains of command will be shorter since decisions will be made by medics rather than officials. A common set of instructions will be drafted for all hospitals.
In Strandberg’s opinion the most important thing at present is to provide definite instructions to the general public how to behave in isolation and during the crisis. The restrictions should be tougher, all contacts should be limited to minimum and the rules must be clear for everybody.
“I have no idea what the ministry’s personnel policy is like – maybe it stipulates that the structure must keep working and the people making errors are therefore retained or their errors are not judged, but this is a relatively unfortunate chain of errors disguised by PR, which has kept us away from finding the solution. I cannot rule out that incompetence has reached too high a level in decision-making,” Strandberg said.
The Health Board statements are also criticized by Sass Henno, an author who has been active in PR and crisis communications for 15 years. In his opinion the Health Board has consistently issued insufficient risk assessments and recommendations. “Their talk about washing hands which is a safety measure has contributed to the people still not taking the situations seriously enough and staying home,” he said.