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The spread of COVID-19 hit a new milestone in Estonia on Thursday when record 414 cases were diagnosed inside 24 hours. The number of people in need of hospital treatment is also growing rapidly and now stands at 112. However, this is just the beginning as scientific models suggest the situation is about the get worse in the near future.
For the spread of the virus to slow down, the basic reproduction number R should fall below 1. It was estimated at roughly 1.4 on Wednesday of last week and currently hovers around 1.2, according to professor of mathematical statistics Krista Fischer.
What this means is that if currently a little over 100 people are hospitalized with the virus, that figure could stand at 500 by Christmas and exceed 700 by the end of the year. The worst-case scenario treats with over 1,000 occupied hospital beds and the capacity of the healthcare system collapsing.
Head of medicine for the Health Board’s crisis headquarters Dr. Arkadi Popov said that authorities are counting on 200 people needing to be treated in the hospital in ten days’ time. “But the figure could be even higher,” he said.
Krista Fischer said that what comes next depends on how quickly the virus will continue to spread. “We can say with confidence that the number of hospitalized people will reach 200. Whether it will go beyond that depends on coronavirus figures in the coming days and weeks. Should 400 daily cases become commonplace, there is cause for concern.”
Popov said that hospitals currently have 185 general and 30 intensive care beds for COVID-19 patients, while it is clear that will not be enough should recent trends persist. Hospitals are switching to the A3 scenario that prescribes creating more coronavirus beds that should number 237 plus 37 ICU beds in ten days’ time. However, everything must come at the expense of something. “This will result in certain treatment volumes being dialed back. Especially planned treatments,” Popov said, adding that hospitals will make their own choices.
The medical emergencies chief said that it would be possible to talk about a widespread crisis in Estonia in a situation where 300-400 people need hospital treatment for COVID-19. Forecasts suggests it could be a realistic future. “That would result in a very serious need for staff and resources, as well as risk of infection for medical staff,” Popov said.
Mario Kadastik, senior research fellow with the National Institute of Chemical Physics and Biophysics who is studying possible crisis models, says that the reproduction number first and foremost depends on contact with other people that is tied to mobility. “The spring emergency situation had a clear effect here and measures such as the 2+2 proximity rule, closing of shopping centers and entertainment establishments worked,” Kadastik explained. Right now, only the 2+2 measure has been restored, with the activities of entertainment providers limited.”
Professor of virology Irja Lutsar said she does not believe tougher measures could result in a breakthrough. She says that everything starts with people’s attitudes. “There is no single measure that would work in isolation. Only the full set helps that includes wearing a mask, avoiding parties and working from home.” This requires people to be on board as the state cannot require anyone to work from home. That said, Lutsar agrees that some additional measures are in order. “We need to look at where the virus is spreading the fastest – Ida-Viru County, Tallinn and Harju County. Perhaps local measures would suffice. But we only have a few so-called soft measures left to introduce,” she admitted.
Minister of Social Affairs Tanel Kiik (Center) said that local measures will be discussed. “It is legally possible to have county-level restrictions. This can be done by local governments, the central government or the Health Board, depending on the measures.” The social minister added, however, that any regional measures would need to be carefully considered as they might bring negative consequences instead. “For example, it would be insensible to close malls in a certain region as people would simply go shopping somewhere else. This could render the situation worse. That is why the government is not planning on closing malls or restricting their opening hours.”
Limiting hobby education is one measure the government is weighing following the Health Board’s recommendation as the infection rate among young people is growing. Kiik hints that it might be one regional measure introduced. Regional restrictions for hobby schools and entertainment might be justified as we expect that children living in Northern Estonia will not travel to another part of the country for hobby lessons.” The minister remains against a nationwide ban.
“Our main concern is how to ensure continued education and hobby education in the conditions of the virus. We do not want to rob kids of the chance to go to practice and clubs, while we also cannot allow the current trend to persist. Flexible solutions are in order,” Kiik said. The minister said that a situation where young people from all parts of the city come together for an activity is a far greater risk than a dozen kids from the same school meeting for practice. He added that the regional approach can also be applied to wearing masks.
“Several countries have chosen that path. We also have examples where masks are mandatory in certain boroughs, while it would probably not make sense to be that specific in Estonia. County-level or nationwide restrictions should be preferred.”
While Latvia declared an emergency situation on November 9, the Estonian government has chosen to go another way. Nevertheless, Tanel Kiik said that it could prove unavoidable should worse scenarios manifest. “It cannot be ruled out. It is possible Estonia will find itself in a situation where we have no other choice. But it is our goal to avoid that happening. All manner of closures bring negative effects for the economy and people’s physical and mental health,” the minister emphasized.
Kiik said that an emergency situation would linger. “The difference from spring is we are now looking at a six-month period. We could opt for short-term solutions in spring as we knew that summer would very likely end the virus spreading and the emergency situation.
The social minister disagrees with people who say the government is too late in laying down restrictions.
“There are plenty of measures in effect in Estonia today: the public events occupancy ceiling that should be lowered further, isolation obligations, sale of alcohol restrictions, entertainment establishments’ activity restrictions. Quite a few measures in all. I do not agree that tough measures and an emergency situation are the only solution. We need a social compromise,” Kiik said, once more urging people to behave responsibly.
It is clear that efforts to combat the virus must be maintained at least until spring. This is also reflected in the fact that changes to the sick days compensation system will be in effect between January 1 and April 30. The new system will see the employer cover 70 percent of the employee’s salary on sick days two to five and the Health Insurance Fund take it from there.
Experts who talked to Postimees agreed that the situation will not improve much before spring.
Weather is the main reason why the virus cannot be defeated sooner. “Temperature of negative 20 degrees could slow it down. Cold and sunny weather and high barometric pressure would hinder the virus. However, if we’ll have a winter similar to last year’s with warm and wet weather, it will only contribute to the virus spreading,” professor Lutsar said.