Has Estonia survived the health crisis?

Yes, we have overcome this particular coronavirus crisis and can say the epidemic is over for now. We are addressing isolated aftershocks, smaller regional outbreaks.

There is no epidemic spread of the virus in Estonia, looking at WHO indicators.

Do you trust the World Health Organization?

One of the lessons of this crisis is that one must be able to locally analyze and critically review assessments by international experts.

Which is to say you do not trust the WHO?

That is not what I said. The WHO has repeatedly been accused of overreaction in the past, that it regarded the situation too serious, overdramatized things regarding the flu and SARS. Now, people are saying the WHO underestimated things. And it did, as both the WHO and the European Center for Disease Prevention and Control (ECDC) downplaying the situation caused many countries to underestimate contagion rates and the possibility of the virus spreading.

The consequences are far more serious today than they could have been had we known to react in February.

What did I learn in terms of whether the Estonian social minister trusts the WHO or not?

I believe the WHO gets it right nine times out of ten.

But we must stand ready as employees and experts of the World Health Organization are only human and can also make mistakes, especially when dealing with a new disease and an uncertain situation.

In other words, we cannot blindly trust any organization, we need to be able to locally assess indicators and risks and always keep in mind that even the biggest and most experienced international organizations can be wrong.

Looking back to March – was the government too late in declaring an emergency situation?

The government declared the emergency situation on precisely the right day. That is when we received confirmation that the virus was spreading inside Estonia. The WHO had referred to it as a global pandemic the previous day.

Did the government get carried away with restrictions?

I do not think so. We can hear people saying today that casualties and the number of people infected are modest. However, very few people consider how big they would have been had we simply allowed the virus to spread.

Several European countries that also laid down tough restrictions but did so later or started out slow have seen more than ten times our number of casualties and infections.

We have made a simple calculation that had the rest of Estonia suffered the same infection rate as Saare County, we would have seen 20,000 COVID-19 cases and 1,000 deaths.

To what extent were European countries each other's hostages in March as chaotic border closures and countries locking themselves away left no choice but to follow suit?

There are those in the EU who chose a different path.

Sweden?

It is up to each country to decide. As far as I know, 16 EU countries have declared a state of emergency as things stand.

Steps and measures differ from one country to another, as do risk of infection, local cultural and demographic traditions, understanding of risk management on the state, local government and individual levels.

Countries taking measures one after the other proved beneficial in the end. Had they been postponed or had we seen regional differences, it would have taken that much longer to overcome the epidemic.

It was all rather chaotic.

It could have been better coordinated. The EU definitely has a lot to learn from this.

I remember when EU health ministers met in mid-February and it was decided to keep calm, that there is no crisis and that the virus might not become widespread in Europe.

By the time we met again in March, the situation had changed completely and countries were making preparations for declaring a state of emergency or taking other kinds of measures. The situation was changing so quickly that there was very little time for coordination between 27 countries.

You told TV3 a few days ago that if we can react quickly to the virus next time, nationwide restrictions might not be needed. What would be an appropriate reaction?

We know more about the disease, we have boosted our testing capacity, we are in the process of stockpiling protective gear and medicines, we have learned from spread patterns and complemented various IT solutions, interagency cooperation.

All these activities and preparations for autumn give hope or the expectation that should the coronavirus start spreading again in Europe, provided it disappears or subsides in the summer, we will be able to keep it in check to an extent where we would not have to close shopping centers, limit planned treatment or greatly reorganize the work of educational institutions as was necessary this spring.

That a school on the island of Kihnu could remain open if there is an outbreak in a Tallinn apartment building?

That efforts will concentrate on the right floor and stairwell of that particular apartment building. That decisions that affect tens or hundreds of thousands would not have to be made in a situation where the virus is not countrywide.

Still, are you ready to return to all recent restrictions and decisions come fall?

I did not say that. Back when we knew little about the disease, had modest testing capacity, limited knowledge of treatments…

What about in light of what we know today?

Today, should a new outbreak occur, we can make decisions much more flexibly, look at different education institutions separately, different regions; take different measures when it comes to shopping malls as concerns use of personal protective gear, limiting the number of customers and ensuring access to disinfectant… To achieve the same result using different means and to put less strain on commerce.

This would have been impossible now, while we hope it will be possible come fall.

And shopping centers will remain open?

Forecasting the future is a thankless job. What I tried to express was hope that if we can stick to precautions that we have recently agreed on…

The Ministry of Social Affairs will put the plan for preparing for another [coronavirus] outbreak on the government's desk in the near future. I believe we will be able to avoid closing down society.

We didn't completely shut it down recently either. It would have been wrong to order everyone to stay home for two or three weeks. No society can function like that.

Tallinn was relatively empty when the emergency situation began.

All manner of activities that can be avoided should be avoided or at least limited at times like these. However, we cannot shut the country down for several weeks.

Estonia was shut down.

No, it was not.

Okay, the government remained operation, as did journalism…

There you go. (Laughs)

No sector was shut down completely. We can say that most shops were closed in malls, there were certain medical care limitations and students had to study remotely – but no sector was stationary. Commerce continued, students kept learning and healthcare remained available…

Hotels were closed.

But it was not the government that closed them. Tourists simply disappeared because of travel and movement restrictions. Occupancy plummeted drastically.

In your opinion, could the Estonian society withstand another closure like that?

The strength of the Estonian state and society lies in our ability to stick together in crises. It was especially evident in the beginning when difficult choices and decisions had to be made and the people were on board.

We are still not seeing major protests against restrictions as people understood their necessity and were even quite exacting in terms of the need to maintain them.

They were also quite impatient as concerned lifting them.

When the government was following the course of new restrictions and the virus was still in the growth phase, people were more understanding across the board. As the people see the virus is in retreat, we can conclude the epidemic and start gradually opening up sectors, there will naturally be pressure to open things up faster.

Such closures hurt society – domestic violence spikes, old people locked in nursing homes, fathers not allowed to see their babies born, parents forced to work and help children study while stuck at home, decisions to postpone planned treatment until God knows when…

Undoubtedly, this is a very serious crisis. That is why we have allocated additional resources for psychosocial help, victim support, nursing homes…

As concerns the example of fathers being present for their children's birth, I can relate as I could not have imagined missing the birth of my daughter 18 months ago.

You would have stood behind the window holding daffodils?

I understand all the families, mothers and fathers who were miserable. This [restriction] did not come from the government but was the result of doctors' foresight, the wish to protect mothers, newborns and healthcare workers.

It will take time to return to normal life – it will be possible to attend births and stay together in family rooms after the emergency situation ends. However, we need to be careful when lifting these measures because while the infection rate among medical workers has remained modest in Estonia, over 100 have nevertheless caught the virus and one died.

Will nursing homes be locked down should such crises occur again?

We have over 20 nursing homes where clients or care workers took ill and there are countries in Europe where half of coronavirus victims were clients of nursing homes. They are clearly the biggest risk group and need to be protected, for which purpose they have to suffer inconveniences and correspond with loved ones over the phone or in writing if possible.

Is it easier to lay down restrictions than it is to lift them?

That is what the experience of countries suggests.

At the same time, lifting of restrictions is popular and ministers are keen to deliver the good news before the orders have been typed up.

(Pauses)

Rather, we can say there is great pressure, also from the media, to get that information. Journalists wrote to me, asking for interviews, during the government committee sitting today. I respectfully declined because the sitting concerned my administrative area and I felt my place was there and at the cabinet meeting that followed, instead of giving interviews on decisions fresh out of the oven or still in it for that matter.

But you are counting on a second wave hitting us come fall?

We need to prepare for it, while that does not mean there will be a second wave.

It is said that the novel coronavirus is here to stay and that we must learn to live with it. Are we really forced to get used to such a coexistence?

If we look at various coronaviruses, we see that some of them have disappeared and some have stayed. The same goes for the flu and its various strains – some reappear regularly, while others have disappeared from the face of the Earth. Of course, we hope that SARS-CoV-2 will subside eventually and hopefully permanently, but the commonsense approach is to make preparations for living with it. We will develop the best treatments, trust measures, sooner or later, also a vaccine that we will use to protect people most at risk from the virus.

Do you recommend traveling this summer?

Depends on the destination. If someone wants to drive to Latvia, Lithuania of Finland in the summer, the risks are not that great.

It is sensible to keep an eye on the global situation, number of infections in different countries and consider stops when planning one's route. Of course, it would also be good for people to discover beautiful places in Estonia of which there are plenty – from Saaremaa and Hiiumaa to Southeastern Estonia, Ida-Viru County, Pärnu County and all other places.

The virus came to Estonia from around 20 countries in March.

Indeed, we know of 118 cases from a total of 20 countries in March-April.

The most came from Austria, followed by Italy and then a number of different European and other countries.

In your reply to a question asked in the Riigikogu, you emphasized that "health advice, especially in a field as crucial as infectious diseases control, needs to be capable and independent." Is there a hint hidden in there somewhere?

It is a sensible principle to be followed both during and after the crisis.

To what extent have you felt impatience on the part of politicians to assume the role of medics, experts and scientists during the crisis?

I believe it is sensible and necessary to exchange arguments, have a debate between politicians and healthcare professionals, together. Looking at how the crisis progressed and the spread of the virus, it affects many sectors – health, social, economy, enterprise, foreign policy, culture and defense. Discussion and debate are necessary.

Medical decisions – whether we're talking about treatment, where to put patients, restrictions to planned treatment, use of protective equipment – will naturally be made by healthcare professionals based on their own expert analysis.

We cannot take seriously a situation where the minister is Googling coronavirus quick tests.

(Smiles) Ministers looking for information outside their administrative area and getting up to speed on details is understandable.

We are dealing with a new disease, a new situation, and looking at the experience of other countries, practices differ to a great degree. Some countries adopted rapid tests only to return them to the manufacturer because they turned out to be of poor quality. Others avoid them altogether and suggest people do the same. Estonia is somewhere in the middle.

We are in the process of trying out different tests as we want to make sure they are trustworthy, verified and of high quality and show credible results.

Could we use the expression "political virologists"?

(Pauses)

The free press can use whichever expressions it wants.

Why do some coalition politicians dislike you?

Who?

Tarmo Kruusimäe from Isamaa recently said in the Riigikogu when referring to you, even though he refrained from naming you, that "a time will come when we have a minister who can see the actual problem, dares admit it and make decisions."

There are a lot of problems I dare admit and am addressing in healthcare and the social domain. I believe Mr. Kruusimäe was referring to a specific decision, an area where our opinions differ.

Had it been up to you, heated tobacco products, which Tarmo Kruusimäe supported, would not have been allowed in Estonia?

As I've told our coalition partners, I have been greatly surprised to find that I'm the most conservative minister when it comes to alcohol and tobacco policy, while I am often accused of being too liberal in other matters. However, concerning alcohol and tobacco products, I believe it would be sensible to avoid or only consume them minimally.

Talking about new products on the market, it's better to measure twice and cut once, instead of risking having more consumers of unhealthy products. Our goal is to reduce their number to protect people and their loves ones.

Who said: "I hope minister Kiik will be removed from office anyway"?

(Pauses) I believe it was… (smiles) someone who has an extremely high opinion of themselves… Let's say they are a member of the European Parliament.

Yes, it was Conservative People's Party (EKRE) politician Jaak Madison who feels you have not been up to the task and have been the most problematic member of the government.

Mr. Madison is also critical of his own party. But it is difficult for me to analyze the contents of his criticism as he has not spent any time fighting the coronavirus.

Alas, I do not remember reading EKRE leaders Mart and Martin Helme having said Madison is wrong and that Tanel Kiik is a good social minister who takes rapid and precise action in a crisis.

(Laughs) I do not base my actions on the utterances of coalition or opposition politicians.

Have they forgotten it was the Center Party that invited them to be a part of this government last spring?

I believe all three coalition parties remember those talks that took over six weeks.

There is no place for gratitude in politics?

A coalition is not something where one is expected to be grateful or cross with someone. A coalition also means responsibility, long hours, difficult decisions and debates. And as evidenced by such utterances, also differences of opinion.

What about the health of the coalition? Is someone coming down with a cough?

The coalition is in good health. We have been working on containing the coronavirus together and have done a rather good job. Cooperation has been close under the prime minister. We have no reason to be ashamed of our cooperation or decisions.

When will you be replacing the heads of the Health Board?

(Pauses)

That's like asking someone when they'll stop drinking cognac in the morning.

I have never suspected you of being a morning drinker.

The Health Board has done a lot of good work during the crisis. Of course, as with any agency in charge of a crisis, their actions have included mistakes as concerns exchange of information, individual decisions. However, we need to keep in mind regarding many of those decisions that assessments in hindsight, knowing all the facts and calmer analysis could produce entirely different conclusions than those drawn in a crisis.

Once the emergency situation ends, we will have to calmly consider which decisions were right and which were wrong, as well as what kind of structural and organization changes are needed for the agency to be better prepared for the virus come fall.

Mine was a simple question – when will you be replacing the heads of the board?

And mine was a more comprehensive answer.

We could, of course, quote your dear coalition partner Peeter Ernits who referred to the board as a "Moloch" when speaking in the Riigikogu and opined its leaders would be replaced, ranks cleansed and truly capable executives found. Why is the board creating such conflicting emotions in politicians?

The reason has been communication rather than specific decisions.

A lot more work is done in healthcare than can be seen from the outside. For example, ambulances respond to around 300,000 calls every year. The public learns of isolated cases where the ambulance fails to arrive on time, while we do not talk about those 299,900 and more times people get help on time and make it to the hospital. Similarly, hospitals do not issue press releases every time a surgery is successful or family doctors every time they help someone… Instead, we hear about times when something went wrong or decisions proved unfortunate in hindsight.

The work done by the Health Board and hundreds of people in establishing close contacts of people [infected], informing people, drawing up guidelines for local governments and companies, advising state agencies, communication – these efforts have been extensive and largely professional. Individual decisions that proved mistakes either immediately or in hindsight have cast a shadow on that work.

You gave the board good marks in the media. Are you still of that mind?

I am looking at everything they've done. Many politicians and the public are making judgments based on a few decisions, while my marks are for the whole three months.

Did you tell the prime minister he is mistaken?

The prime minister is not mistaken. He said that he has criticism for the work done by the board in certain matters. And we can be critical of the board in some areas, while I see that most of the work has been done well.

Perhaps we should ask where and how should the board be made more effective?

One of the main lessons of this crisis is that we need better provision for joint action in healthcare and the social domain. The Health Board, Social Insurance Board, dozens of local governments, the private sector… We now know our risk groups and where they are, if only thinking about nursing homes. More effective cooperation is definitely in order.

The Health Board is relatively small, considering the sheer scope of this crisis. It is over 15 times smaller than the Police and Border Guard Board. However, this crisis required nationwide activities in different fields, counseling for dozens and hundreds of companies and also local governments, professional support for the government. The agency was clearly overextended compared to its daily activity.

Is the government united in its desire to end the emergency situation at midnight on May 17?

The emergency situation does not have to be ended. It will expire on May 18.

Is the government united in its desire not to extend the emergency situation?

When we made the decision to extend the emergency situation until May 17, it was consensual and everyone in the government knew the emergency situation would end on May 18 unless very serious circumstances arose to change that.

The daily case rate – off the top of my head – has remained below ten for the past 12 days and totals 90 for the past two weeks, having come down eight times since the crisis began. I see no objective reasons for extending the emergency situation.

I have also not heard any other member of government deem it necessary.

Which is when the Health Board will be in charge of the emergency?

That depends on what will happen with amendments to the Emergency Act and the Communicable Diseases Prevention and Control Act that await their third reading in the parliament. (The Riigikogu passed the amendments on May 13 – ed.) If the bill is passed into law, individual decisions – such as whether to close a school or an apartment building – would according to the most logical scenario be made by the board, while major decisions that concern entire counties or fields would be made by the government.

It is a sensible balance. We will not put an agency in a position where it is expected to make decisions that concern tens and hundreds of thousands of people, such as regulating the work of shopping malls countrywide or reorganizing schoolwork. The latter decisions and corresponding responsibility will fall to the government.

What would have happened had Estonia adopted Sweden's approach?

(Pauses)

We would have seen hundreds of deaths, if not more.

In Sweden, the mortality rate per 100,000 people is almost ten times higher than it is in Estonia. There are more infections while fewer tests have been administered, which is why the actual number of cases is much higher than statistics suggests.

It would have been very painful for society and something people would not have understood. It would have been… the wrong path, looking at the Estonian healthcare system and social welfare institutions.

Every country must proceed based on its local circumstances, means, customs and threat assessments and make its own decisions. That such a path would have been wrong for Estonia does not mean it was necessarily wrong for Sweden. Every country must make its own decisions, which is not something other states should dictate or call into question.

Will you go on vacation this summer?

I don't know. I hope so.

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