The COVID-19 coronavirus Science Council (Koroonaviiruse teadusnõukoda) has published a report which says over a hundred people might need intensive care in Estonia in two weeks' time.
The COVID-19 coronavirus Science Council report
The Science Council finds that human behaviour is the most critical factor in preventing the spread of the virus. The team of virologists and physicians consider the restrictions imposed in Estonia to be timely and adequate.
Consequently, the Science Council recommends that in order to prevent further spread of the virus, it is necessary to strengthen the isolation rules and the functioning of the home regime and to reduce unnecessary presence of people in public spaces and outside the home.
The effects of the restrictions imposed in order to slow down the spread of the virus
- The objective of the restrictions is to slow down the spread of the virus, prevent overloading the health care system and set the groundwork for countering the virus.
- The full effect of the measures will become apparent 10-14 days after implementation.
- Since the introduction of the restrictions, the epidemic has been relatively stable without exponential growth.
- Restrictions imposed in Estonia are adequate and implementation must be continued; some restrictions, however, need to be strengthened.
Prognosis evaluating further spread
International data might not be compatible with the conditions of Estonia, that is why a cautious approach should be adopted towards the results. The actual spread of the epidemic depends on various factors, such as the effectiveness of the restrictions imposed.
- In a week, the number of patients in need of hospitalization might grow to 200 and more, with around a quarter of them needing intensive care.
- In two weeks' time, the number of patients in need of intensive care might rise to 100 and in three weeks' time be between 200 and 300.
Predicting mortality rates is very complicated and depends on how well the spread is prevented among the oldest population groups.
- Mortality rate among people aged 60 and under is between 0,2-1 percent, for patients aged 70 and over it can reach 10-15 percent as shown by studies conducted in Italy and China.
The scientists aim to agree on a common prognosis model by this Friday.
Overview of treatment options in different countries
- Establishments providing accommodation for quarantine, pre-hospitals and hotels for people with mild symptoms - Austria, Spain, Portugal.
- Portugal is using hotels to accommodate employees.
- Out-patient care and vaccinating of children has been stopped - Bulgaria
- Ongoing recruitment of medical workers (special licences for residents, undergraduates working in the medical system and retired doctors called back) - Spain, Italy, Austria.
- Spreading infected across the country according to vacant hospital beds - the Netherlands.
- Testing medical workers for seven days after being in contact with infected people - Lithuania.
- Testing all people who have symptoms characteristic to a viral infection and who have been in close contact with diseased people - Norway.
- Locating, monitoring and testing of contacts - Israel calls on people for testing using geolocation services.
- An application for people to monitor themselves - South Korea. Might be feasible in Estonia for monitoring home care.
Possible additional restrictions in order to protect the health of the elderly in Estonia
- Informing the elderly of precautionary measures through all feasible channels.
- Abstaining from using services still on offer.
- Cancelling the sessions of prayer groups, visiting cemetaries etc.
- Cancelling other gatherings taking place in fresh air.
- Avoiding using public transport if necessary.
- Improving the efficiency of delivering medicine and food to reduce the need of visiting malls.
Proposals to the government for organizing efficient intensive care
Pneumonia and respiratory failure that need intensive care and in most cases a breathing apparatus are apparent in five percent of people infected with the novel coronavirus. Those five percent need level 3 ICU treatment.
Level 3 ICU capabilities in Estonia:
- 157 level 3 hospital beds.
- 49 percent of level 3 hospital beds are currently occupied, so 80 hospital beds are open resource for coronavirus patients.
- 193 level 2 hospital beds; if equipped with nurses and doctors, it is possible to partially turn them into level 3 hospital beds.
- 50 level 2 hospital beds could be turned into level 3 hospital beds nationwide.
In conclusion, it is possible to have 130 level 3 ICU hospital beds during an emergency situation. It might be possible to increase the number of hospital beds but finding skilled workforce might become an issue.
Projection of mechanical breathing machine requirements in Estonia
- 239 working ventilators in the intensive care departments of hospitals.
- 50 ventilators in reserve to extend the capabilities of intensive care.
- Ventilators do not guarantee treatment as personnel, monitors, medicine etc is needed.
- 75 extra ventilators have been ordered, but using them requires retraining the medical personnel.
In addition to Professor Irja Lutsar of the Institute of Biomedicine and Translational Medicine at the University of Tartu, Senior Research Fellow at the Institute for Health Development Kristi Rüütel, Chief Medical Officer of the North Estonian Regional Hospital and Professor of Surgical Diseases at the University of Tartu Peep Talving, doctor of Infectious Diseases at the University of Tartu Pilleriin Soodor and Professor of Research of practical virology at the University of Tartu Andres Merits are members of the Science Council.
The strategy bureau of the Government Office organizes the work of the Science Council.
Editor: Anders Nõmm