The Head of the Institute of Health Policies (IZP) at Slovakia's Health Ministry, MARTIN SMATANA, completed his education at Imperial College London, gaining a degree in Health Management. In the interview, he discusses:
- if Slovakia can avoid the Italy scenario,
- whether hospitals could manage to look after 3,000 patients in critical condition,
- under what conditions Slovakia would impose a lockdown on towns, and
- when Slovakia will return to normal.
Is the fear of, sooner or later, becoming infected with SARS-CoV-2 and dying a justified concern given all the precautionary measures currently in place? What does your data project?
It is more of a medical question. Our model is mathematically set on the premise that everyone will get infected at some point. This will certainly not happen in real life, quite the opposite. Measures taken by the government have made the situation in Slovakia manageable and things are under control. But we had to look at the worst-case scenario within our model to be able to calculate the theoretical limitations of our system. In practice, we believe we can and will manage just like Singapore and South Korea.
Based on recent precautions, our model shows the onset of the virus infection is gradual. This means that whenever someone in the vulnerable group is infected, they will have enough human or technical capacity available to them to be taken care of and to not have their health worsen.
This is the resulting impact of the measures taken, which restrict the movement of the population. The increase will be under more control and slower under the current conditions. However, if there is no vaccine, drug or complete isolation, most of Slovakia will get infected at some point.
What does it mean for most of Slovakia?
Our model extends over a period of two to three years. We assumed that if the above-mentioned precautions were not met, everyone would be in contact with the infection sooner or later. They would either become immune to it or they would spend some time in bed to recover, or if they needed medical care, it would be provided.
Your model, which takes into consideration current coronavirus disease-related precautions in Slovakia, says that 10 percent of the population should be infected on the 100th day.
On that day, it should be 10 percent because some will have already recovered by then. Nonetheless, this is a scenario that does not take into account the introduction of further measures and changing conditions such as the distribution of masks and higher outside temperatures. That is why we are updating the model every two to three days to give the crisis management staff the best information that they can act upon if required. The numbers will certainly be lower and will be corrected on Friday, March 20, based on the current situation.
Of these 10 percent, over 3,000 people could be in a critical condition…
Based on a study from Monday, March 16, 60 percent of patients have symptoms. Of these, 7 percent need to be hospitalised and of these, 13.5 to 14 percent need intensive care.
When you say intensive care, what should we imagine?
Patients will need either an extracorporeal membrane oxygenation (ECMO) machine or invasive ventilation. This is just one part of the equation because we also need staff. Today, we have 550 such machines at our disposal. This means we would not be able to handle 3,000 patients. Since this situation is projected to come in a hundred days, or a critical level is said to occur in 60 days, we have enough time to prepare all the groundwork for the crisis staff. They will either purchase machines or adopt further targeted measures.
Would we be able to buy the missing machines in less than 100 days?
Absolutely. We can do it in two weeks. As the epidemic is in decline in Asian countries, firms from there have got in contact and could pass these capacities on to us.
Does that mean Slovakia can avoid the Italian scenario where, according to some reports, they are having to decide who will get artificial ventilation and who will not?
I believe so. I am convinced that by introducing strict measures in time, we have prevented a sharp increase in the disease.
If we even managed to have 3,000 such machines delivered to Slovakia straight away, would we have enough staff to run them?
Unfortunately, I am not able to answer that. But the mobilisation of medical staff has been made possible. Hence, in the event of a critical situation, I believe, the staff would be moving around in a way that we could provide health care. Today’s machines are almost fully automatic, which means that one person could operate more than one machine. It takes time, however, for a competent worker to learn how to use them. Moreover, they are not suitable for every patient.
Who is the most vulnerable group in terms of SARS-CoV-2 infection?
Older people. The latest data, which we have from Monday, shows over 70s are at a significantly higher risk. This is also true for hospitalisation and complications within this age group.
If the peak occurs on the 100th day, which is sometime in mid-June, how long will it take to get people back to their workplaces and students back to schools?
This is the big question that we cannot, unfortunately, answer today because neither China nor South Korea, where the virus is already retreating, can predict what will happen next. Until we have, at least, data collected over 14 days and all the epicentres mapped, and until the incubation period of those returned from Italy before the borders were closed is over, we will not able to recommend any change in the adopted precautions on a data basis.
Is there a risk, based on the data, that some places and communities could be locked down as in the Czech Republic?
If we obtain data from mobile operators, we will be able to say exactly which municipalities and segregated groups have a higher morbidity or are more at risk. And if it turned out that the virus spreads faster than the average there, the best measure is a temporary lockdown.
How long will it take to get access to this data?
We have already asked for it. We hope it could be delivered to us this week or at the start of the next.
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19. Mar 2020 at 9:00 | Ján Krempaský