Coronavirus best practices seem to have become the norm in Estonia, says Health Board emergency medicine chief Martin Kadai. To what extent the virus may make a resurgence depends partly on this, as Estonia moves towards a more Swedish model even as that country's approach has met with criticism.
A Swedish-style model is now being applied in Estonia, Kadai says, meaning when restrictions are lifted, individual responsibility comes even more to the fore.
"I have said before that it is a question of the balance between commandments and prohibitions and sensible human behavior," Kadai said on ERR discussion show "Otse uudistemajast" on Wednesday.
"It is clear that such rules will ultimately remain the responsibility of the individual, so good health behavior must be the responsibility of the individual. Neither the Health Board nor any other agency can check up on the beaches or public places, in every single case where three or more people are together - this is inconceivable.
"The individual must behave sensibly and responsibly. The same simple rules apply: Do not leave home when sick, practice handwashing hygiene, practice social distancing where possible. This does require effort in practicing the behavior patterns somewhat."
Part-return to normalcy
Kadai said going out to restaurants and pubs could be regarded as a normal activity once again.
"We need to understand that locking society down is not normal, but it is inevitable. If an individual takes on more responsibility, we can still pursue our normal life in a way which does not endanger ourselves or others," he noted.
Not all restrictions can be lifted at once as there is no knowledge of what might happen in terms of a potential resurgence of the virus.
"There are no magic numbers. Fewer than 50 people converging does not mean that there is no risk of infection, nor does it mean that there will be an extensive infection. But some restrictive framework must be put in place and kept for as long as necessary," he said.
"We should familiarize ourselves with the idea that a backdrop will remain throughout the summer so that we cannot avoid it. On the other hand, an opening up is inevitable because we cannot keep society and the state locked. I would stress that all providers think outside of the box, /.../ Rather, we should steer society in such a way that service providers think alongside themselves and offer solutions, and that customers themselves behave in an infection-safe way."
Not enough data to give true figure for carriers
The presence of viral genetic material, and also the presence of antibodies, have been studied in healthy people, Kadai said.
"It is clear that the figures we have for Estonia today certainly do not paint the full picture. I would venture to say that 1 to 2 percent of the population in Estonia may have been exposed in the first wave of the virus. The proportion of patients who are symptom-less or have mild symptoms has been outlined in various countries, so the fact that the actual morbidity rate may be many times higher may seem daunting, but on the other hand it shows that the incidence has been lower than the severe rates of illness and mortality which were initially feared."
The coronavirus crisis has also shown areas of concerns in the Estonian healthcare system and has made it clear there is plenty of room for improvement.
"We do not require care facilities to follow infection control measures to the extent that they have been doing. An ongoing training system has been set up, where staff are trained by experts on how to use personal protective equipment, how to ensure disinfection and what to do if an incident [of COVID-19] is detected.
"The current crisis plans have not explicitly provided that welfare institutions should stockpile personal protective equipment. These are serious lessons from this crisis. Rather, it should be said that lessons have been learned from this relatively quickly and successfully," said Kadai.
The situation has also been exceptional for hospitals, such as the reorganization of routine medical care, he said. "We have gained experience in how to manage medical institutions in crisis situations."
Coronavirus seems to have season just as flu does
Kadai said that global statistics illustrate that there is no likelihood of the coronavirus disappearing, and in fact is to some extent mutating.
"It is now under 'evolutionary' pressure to adapt more and more to remain in the human body and spread from person to person. It is also known today that new genetic mutations in the virus exist and may at some point give the virus a boost in spreading more effectively. There is no logical reason why the virus should just go away."
The virus is also subject to a pattern of seasonal spread in the northern hemisphere, Kadai said, which means that the more severe period of illness lasts from autumn to spring, the disease recedes from spring to autumn, as with the flu season in Estonia around the same time.
"This knowledge should be taken into account today," Kadai noted.
Given the coronavirus is not only an infectious disease, but also a social and economic one, once the euphoria from initial victories over the virus has subsided but the virus has not completely disappeared, it must be addressed by other means.
Estonia does have some similarities with Sweden
Kadai said that Estonia, and many other places worldwide, shared with Sweden the phenomenon of high mortality rates in nursing homes.
"If we look at mortality statistics in Estonia, almost half of those who have died from causes related to COVID-19 had been in care institutions. This is a problematic point in many European countries, and we have to invest there," he said.
Kadai said Sweden had not made the wrong move by pursuing a different line – that of not imposing wide-scale restrictions or lockdowns – from many other countries, since the alternative is not a solution with a long-term perspective, regardless of whether a vaccine or prophylactic is developed in future or not.
The issue is a philosophical and complex one which will vary from country to country and depends on the nexus between society and authority, the likelihood of populations following best practices on their own initiative etc.
Of other signs for the future, Kadai said that entrepreneurs in Estonia had done well, particularly in the catering sector, in adapting and innovating while ensuring the public feels secure when visiting.
The 2+2 rule looks set to stay, Kadai said, but common sense always applies here too.
"For example, if I organize a big garden party, where I invite people I don't know and don't have a reason to trust. /.../ A person has to understand for him or herself what infection safety means. In terms of distance, this means avoiding close contact with others I do not know and have no reason to come into contact with," he added.
Editor: Andrew Whyte