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Kadai: There could be a period where no cases will be discovered for weeks

Former Health Board chief of emergency medicine Martin Kadai.
Former Health Board chief of emergency medicine Martin Kadai. Source: Priit Mürk/ERR

Martin Kadai, director of the Health Board's (Terviseamet) Infectious Disease Monitoring and Epidemic Control Department, said despite the low number of new cases of coronavirus, it is still reasonable to maintain restrictions on public events because infection rates around the world are still on the rise and an unfortunate set of factors could cause a second wave in Estonia.

The most recent information tells us there are only 16 active cases of COVID-19 in Estonia. How likely is it that Estonia could be infection-free next week?

It is not reasonable to predict it in such a way that Estonia is completely free [of the virus]. We must be prepared that the summer period brings a low rate of infection and that's how it will stay.

We can't certainly exclude that the infection rate will decrease even further and there could be a period where no cases will be discovered for days or even weeks. But we must also be prepared that a low rate of infection will likely stay for the summer months.

What are the sources of this low rate of infection?

If we are looking at recent cases, then they are often related to family and being in contact with them. It is likely that if someone in the family has already been infected, then the rest of the family will also be.

Another trend we are seeing is related to groups of employees. In the same vein, people are in close contact, an infected person is at work and another group of cases is discovered.

What if a situation arises where all the people that are sick will become healthy, where would new cases come from? Will it be tourists or other people visiting from other countries?

Yes, theoretically it is possible that there is no infection happening in Estonia currently.

But if we are looking at the bigger picture, we can see in the rest of the world the pandemic is still picking up speed. There is an increasing trend of infections in the world currently.

Right now, before anything else, Latin American countries are prevalent, the U.S.A. also doesn't have it under control. Europe is one of the calmest regions, I can't tell what is trustworthy regarding Africa. But there are countries in Southeast Asia and the Middle East where infection rates have also increased.

The virus, as it is, has not disappeared. Infection rates around the world are increasing.

In Europe, luckily, the virus has been on a downward trend and rates stay low. We must be prepared that since people move, and the virus moves with people, then the virus can also still move.

Currently in Estonia, if I am not mistaken, the spread of the virus is very low according to the Health Board. What kind of reality does this bring us, considering the restrictions still imposed? Should anything be checked, eased?

If we are looking at the last two weeks, then it has been the lowest infection rate in quite some time. Statistically, we are talking about one case per 100,000 people. That truly is a low infection rate. If we are looking at restrictions, then it must be emphasized that responsible hygiene must stay. If we give this virus a chance to spread, it will do so.

It is reasonable to maintain the mitigation of certain risks that are related to the exposure of many people in one place. We are talking of large public events. Even in bad conditions in terms of the infection, it might happen that there is someone carrying the virus at a public event who will infect others. And from there we could get a large outbreak. That risk should be mitigated throughout the summer.

And there are certainly people who are not aware of their infection and we are also not aware of it. A kind of caution and vigilance must remain.

I understand that if we look at the situation in Estonia, which has a rather good outlook, infection rates are low, and if we compare Estonia with the rest of the world, where the virus is still spreading, are the best methods to control the spread closing borders and travel restrictions?

Unfortunately, that isn't necessarily true. A political view about solving the problem and an epidemiological view collide in this situation. For example, the European Centre for Disease Prevention and Control (ECDC) is arguing with countries' representatives and is certain in its stance that travel restrictions are not an adequate method to reduce infection spread after all.

If there is an outbreak locally, it is not a logical solution. If there is no local spread, then it must be taken into consideration that discovering someone with symptoms at border control is not likely and that is something we've seen in Estonia and most scientific groups agree with it. The symptoms of the disease may have not manifested when someone enters the country.

Secondly, symptoms do not always manifest in the form of a fever. Health checks on borders are not an efficient method, and will never be an efficient method, in the case of this particular virus.

There is something to be said about travel warnings and recommendations. If there is a location with a high infection rate, then people shouldn't travel there.

The political decision is whether we restrict travel, close borders, limit border crossings, impose restrictions. That is largely a political decision and countries mostly took that decision during the crisis. It is certainly not an epidemiological decision, but we must consider what are the possible negative side effects of these decisions.

Right now, we all agree that one battle is fighting the spread of the virus itself, but another battle is fighting it on a larger scale. The tourism sector has dried up, people are unemployed and the effects of this virus affect our entire society. Not only in Estonia, but everywhere. Balanced, calculated decisions must be made to keep living with the virus.

Are you still recommending Estonians to avoid travelling or is this a unique situation where a trip can be taken before a second wave arrives?

In the context of Europe, the exceptions are Sweden, Portugal, Great Britain, and Bulgaria, where the average infection rates are higher than that of Europe. In terms of European countries, we can trust the data that they submit. Monitoring systems are mostly up to date and we can trust the data.

In terms of travel, people should certainly prepare themselves better. It can't just be that I can find a cheap ticket and go. You have to look at the situation in the country. You have to look at the restrictions the country has imposed. Will the trip be comfortable and enjoyable. You have to do your homework and take into account certain risks.

The situation regarding the virus is volatile and can change quickly. The risk will remain. If you book tickets and travel a month from today, the situation could be completely different. You have to take that into account.


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Editor: Kristjan Kallaste

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