Toomas Hendrik Ilves: Let us keep our distance during coronavirus outbreak

Toomas Hendrik Ilves.
Toomas Hendrik Ilves. Source: Anna Aurelia Minev/ERR

Self-isolation helps slow down the spread of the virus. It might not save us individually, while it allows hospitals enough time to give patients the attention they need, Toomas Hendrik Ilves writes.

Disclaimer: I am not a doctor, while I know mathematics and read specialist literature.

The government's decision to declare an emergency situation to block the virus was the right move – it makes it possible to close schools, ban public events and monitor and limit entry into Estonia. That said, it might not be enough unless complemented by people acting responsibly and deciding to limit close contact with others.

The collapse of the healthcare system is the second most severe threat after war for any country. A situation where not all patients can be treated and where decisions need to be made who to treat. In more serious cases, it means having to decide who gets to live and will die. That is the situation China faced in Wuhan and Italy is currently facing in Lombardy.

We do not want a similar disaster in Estonia.

Conclusions drawn a hundred years ago from the Spanish flu show that a massive demand for intensive care will topple the healthcare system. Intensive are and relevant equipment – round the clock observation, respirators, special ventilation – exist for solving standard situations.

No country is ready to offer it on a mass scale. This fact is what necessitates triage. Those who keep an eye on foreign media have read doctors in Italy are saying that patients over 60 will have to wait for younger people to be treated first. If they are to be treated at all.

The coronavirus is special for two facts: contagiousness and mortality. The virus that causes COVID-19 seems to be both extremely contagious and lethal. It spreads like the common cold that can be treated with goose fat and mustard plasters but is 20-30 times as lethal as the flu.

While SARS and Ebola had even bigger mortality rates, they were less contagious. It is the novel coronavirus' unique combination of contagiousness and mortality rate that makes it so dangerous.

Hence decisions to close schools, theater, movie theaters and recommendations for people to work from home. Because it is this kind of self-isolation that helps slow down the spread of the virus. It might not save us individually, while it allows hospitals enough time to give patients the attention they need and spare doctors from having to decide who gets treated and who doesn't.

Epidemiologists have known this for a century based on two examples. What follows is from an article published in the Quartz magazine.

When World War One ended in September 1918, 2.8 million soldiers returned home to the United States. There was great joy and jubilation. The city of Philadelphia decided to hold a grand parade to mark the occasion. Joy overshadowed warnings of a disease for the 200,000 spectators.

Three days later, Philadelphia's 31 hospitals were full of sick and dying patients who had all contracted the Spanish flu that claimed some 100 million lives globally.

A parade held to celebrate something joyous ended up killing thousands. By the week's end, 4,500 people were dead. By the time the leaders of Philadelphia decided to close the city, it was too late.

The other example comes from St. Louis that lies just 900 miles away. And yet, this story is completely different. Two days after the first case was confirmed, the city closed all schools, playgrounds, libraries, courthouses and even churches. Places of work introduced shifts and use of public transport was restricted. Public gatherings of more than 20 people were banned.

These extreme measures, now called social distancing, self-isolation and recommended by health agencies all over the world to curb the spread of the coronavirus, limited the number of deaths per capita in St. Louis to half of what was experienced in Philadelphia.

This behavior, dubbed "flattening the infection curve," has become a textbook example of how to react to epidemics, including COVID-19. If the virus can no longer be contained, its spread needs to be slowed down.

Exponential growth of infection puts healthcare systems in a situation where they can no longer handle the workload. However, if fewer people are sick at the same time (as well in total), it keeps healthcare institutions from having to tackle excess workload and keep the number of deaths down. It gives doctors the time they need to treat people and scientists to develop vaccines and drugs.

That is why we – those who can– must stay home, avoid public gatherings, work remotely, not go to school, sports clubs. Avoiding each other as best we can, we can help make sure that even if we do get sick, Estonia's brilliant healthcare system is not overburdened and can make us better again.

For those who wish to delve deep in the subject, allow me to recommend Tomas Pueyo's article "Koroonaviirusega võitlemise õppetunnid" in Postimees (link in Estonian).


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Editor: Marcus Turovski

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