Scientists: Estonia's virus peak will be long and flat

People are urged to observe strict safety measures as outbreak estimated to drag on.
People are urged to observe strict safety measures as outbreak estimated to drag on. Source: Siim Lõvi/ERR

Scientists say that Estonia has managed to avoid exponential growth of new cases of coronavirus, which is why the peak of infections will likely be long. International statistics suggests between a quarter and half of people who are hospitalized end up in intensive care, of whom around half recover from the virus.

Efforts by doctors, scientists and the government to stretch the infection period out as long as possible in Estonia have succeeded, virology professor and member of the government's coronavirus task force Irja Lutsar says. However, this also means that the peak period will not pass in a few days like it did in China and will rather progress gradually as it has in Italy, Slovenia and Norway.

"The measures are working to an extent. Had we allowed the virus to spread uncontrollably, we would have that peak today, while the entire country's efforts have been aimed at flattening the curve," Lutsar says. "Indeed, the curve in Estonia will not be a sharp one like in China, rather, it will be like what we are seeing in Italy where some days bring more new cases and some days fewer, with the first signs of abatement on the horizon. That peak will be long for us."

Lutsar says that compared to Italy, where she cautiously estimates the peak of new cases has already happened, Estonia is also forecast to get there in four weeks. If we consider March 10 as the start of the epidemic, the outbreak should peak a week from now.

Lutsar says that measures Estonia has taken can be considered to have been successful today.

"We have not seen exponential growth, it has not happened. There was no way for measures to ward off the virus and the epidemic will take its time everywhere."

Lutsar considers Italy the only European country where a downward trend can be guessed at.

"All of it will take time," she emphasizes.

Lutsar says that nothing will change in Estonia in terms of restrictions before Easter. The current forecast can be reevaluated a week from now and a look taken at strategies employed by other European countries.

She finds, however, that restrictions should be handled on a regional basis. Because the epicenter of the disease in Estonia is Saaremaa that has produced 40 percent of all confirmed cases of COVID-19, stricter measures are justified there. She does not consider the same approach to be necessary everywhere in Estonia.

"We will not be issuing new recommendations today. People should stay home and avoid going outside. It is only allowed to go grocery shopping and to the pharmacy. I believe our restrictions are sufficiently strict, while it is another matter to what extent people are complying," the professor says.

An equation with several variables

Modeling the coronavirus outbreak is quite literally an equation with several variables. Because the virus is new and unpredictable, as are people even after being asked to comply with severe measures, forecasts are difficult to make.

Professor of mathematical statistics from the University of Tartu, member of the government's research council Krista Fischer has been leading a team of mathematical modelers made up of a lot of Estonian scientists, ranging from virologists to mathematicians.

"We are trying to predict an unknown future," Fischer finds. "We have reached a point where we need another week's worth of data to see whether measures have been effective and whether we can start thinking about how we're going to come out of this thing or whether we need a few more weeks of this regime."

It is still unclear how long a person remains infectious or how many people never exhibit symptoms, while the spread of the virus depends on how many contacts a person has with others. That is why forecasts need to be treated very carefully and no scenario can be ruled out completely, she admits.

International statistics suggests half of people recover after needing intensive care

"All scenarios suggest we may see additional growth in the number of hospitalized patients and those needing intensive care inside the next week, while those figures are not expected to explode. We cannot rule out new deaths caused by the virus. The positive scenario could see a slight decline in the number of new cases a week from now," Fischer says.

The optimal scenario would see the number of hospitalized coronavirus patients peak at 125, somewhere between 100 and 150, Fischer says. Ninety people are in hospital with COVID-19 right now in Estonia.

"Once it hits that level, the question is whether it could start coming down," Fischer explains.

International statistics suggests between a quarter and half of people who are hospitalized need intensive care. This means that Estonia could have up to 50 people in need of intensive care at one point.

International experience also suggests around half of patients who need intensive care die. Whether this will be true for Estonia remains to be seen as the outbreak is still in the growth phase. It is encouraging that some patients who have required intensive care have gotten better in Estonia.

This also depends on whether the virus spreading to risk groups can be avoided because older people with more severe chronic conditions are more at risk also from intensive care. That is also why aiming for herd immunity is not a good strategy because it could mean more people in risk groups could die as a result of the disease.

Danger of infection will not pass by May 1

Nowhere in the world can people answer the question of how long this pandemic will last.

It is difficult to decide also in Estonia when the outbreak could be considered finished. For as long as it remains uncontained elsewhere in the world, the possibility of the virus being brought back to Estonia remains. That is why Estonia needs a smart exit strategy.

The same goes for easing up on emergency situation restrictions. Giving people back too much of their freedom too soon could see the number of cases spike again.

The emergency situation to remain in effect until May 1 is also a broad concept.

"We cannot go back to business as usual right away on May 1. We need to talk about prevention, how we could be more cautious in our everyday lives. The danger of infection will not pass by May 1. The disease will continue to rage abroad, even if it is over in Estonia. The chance of the virus being brought back here will remain. These are very serious and major questions," Fischer admits.


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Editor: Marcus Turovski

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