Health Board crisis chief: Hospitalized COVID-19 patients are now younger

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Urmas Sule. Source: Priit Mürk/ERR

Health Board emergency medicine chief Urmas Sule said the general infection trend and hospitalizations have gotten increasingly younger recently. He told ERR that he considers medical staff vacations the most critical preparation for a possible third wave of COVID-19 in fall.

How great is the burden on the Health Board's emergency medicine unit? Does it still exist?

It certainly exists in the Health Board's structure, but since the unit's main function is to coordinate the work of health authorities, then that is what we have been dealing with. We have not praised our actions because the main objective of these actions is to maintain reasonable readiness for intervention, but to also ensure medical workers an opportunity to rest in the summer, which is very important.

And the other side is to help liquidate the deficit of hospitalization that this coronavirus crisis has caused us. We are working on it, but it is not something the unit needs to convene over each week.

Has the emergency situation passed?

We are on the lowest level. The level inherently means that we must be prepared for the situation changing, we must make the respective preparations. That is something we are certainly working on.

How much is your work and your position affected by the Delta strain?

If we are talking about having one virus globally causing us issues, then all the changes to happen are actually important for all healthcare parties, but they are not directly important. It is not like it matters which strain has caused the person to need treatment in hospital. Everyone must receive help in the hospital, the same thing with ambulance calls.

But what does affect us is that when the virus develops, the seriousness of illness for potential patients will be different and that side is very important for healthcare.

We are up to date with things and what is happening internationally is certainly very important, but since it affects all countries and all healthcare systems as a whole, we are not doing much more than gathering information.

But how do you assess the current situation of hospitalized coronavirus patients? Are there some other criteria for admitting patients to hospital than compared to the crisis during winter?

We are not making such exemptions for hospitalization, looking at what the seasonality is and basing our decision if the patient requires hospital treatment or not.

What we have done before and what the Estonian state has done well is that when our number of infections grew consistently in fall, we began preparing to not bring all people from care homes to the hospital. Many people recover from covid easily and if we brought lightly ill patients to the hospital, we would clog up the system.

It has been a tactical choice and a correct one at that, because the results of treatment have been very good.

We see two clear trends currently. We see that infections are slowly growing. And the infection R rate is also very significant. It is swinging between 1.2 and 1.3. Let's hope that number stabilizes, that it does not continue growing. Otherwise, our infections would begin growing significantly.

There is another side. I have not done a large statistical overview, but I can see very clearly from our general numbers that the general infection trend and hospitalization have gotten much younger.

That shows that our strategy to vaccinated older people first has worked well. The people with worse health have not gotten ill as much.

But younger people getting infected is also a great source of danger. On one hand, hospitalized younger people are likely to recover more quickly, but if people are infected and move around, the potential to spread the virus is greater among young people. In that sense, the potential danger of the virus beginning to spread again is actually realistic and that is being worked on.

But when it comes to hospitals, we ensure the readiness and there has been no decrease in treatment standards.

Stemming from the fact that there is no great pressure on the medicine system currently, perhaps patients are held in hospital for longer periods?

No, certainly not.

An ill person is more glad to be ill at home. Hospital treatment does not depend on holding someone in for long, but that hospitalization indicators are extremely stable. Organizing treatment on the hospital side has been directed toward keeping people in for as little as possible.

Urmas Sule. Source: Priit Mürk/ERR

How prepared is the hospital network and the healthcare system for a third wave?

I dare say that the third wave will surprise us in some way. But I do not know what it will surprise us with. But if we are talking about different variants, there will be more.

What is positive is that the coronavirus is a stable enough virus, meaning that there should not be any major head-turning mutations coming. We are all hoping that the stability of the virus ensures that all new variants are also sensitive to vaccines.

Vaccinating is the only true and reliable evidence-based method that can be used to try and maintain normal societal operation.

I am sometimes irritated when people are so critical toward vaccinating. Estonians tend to beat each other down, hoping it will lead to a good result. It is very important in my mind that all members of society understand that individual contribution is the right thing to do to effectively conduct vaccinations.

On the other hand, we must understand that conducting vaccination programs on the state level is an extreme challenge. Producing a vaccine in such a short time, taking it to the people, involving them - it has never been done before.

I would wish the people organizing and conducting vaccinations in Estonia good cooperation and less wisecracks.

Right now is a down time where it is likely possible to make structural changes in the hospital network to prepare for a third coronavirus wave. What are the amendments being done now to better prepare for a situation where there is a sudden need for hospital treatment?

It is a popular thought that if you have a period between two waves, there should be large-scale changes. I dare say we cannot actually make such great structural changes in the organization of hospital treatment.

We must work with the resources we have and must try to use them reasonably. It is not possible to make such large-scale structural changes. At the same time, all hospitals must maintain their contribution. We must also take into account that we must also manage with ongoing construction and development projects.

We must understand clearly that the most important resource in managing the next wave from a healthcare perspective is people. If we want people to be able to operate in an active, intense and emotional situation, the smartest thing to do is allow them to rest up.

We might want to make all kinds of structural changes, but our potential is modest without people. Restoring power is the most critical thing to do today.

How realistic is reaching a vaccination coverage rate of 70 percent before September 22, as the EU's goal states?

It seems a little unrealistic today, but the more important thing is to understand that we are clearing the hump where people who wanted to get vaccinated did so. We are in a slower period now and must convince people that getting vaccinated is the smart thing to do.

Vaccination tempo cannot be at the maximum all the time while depending on vaccine shipments. We have reached the phase where the process slows down some. What is important is that it continues.

There is reason to hope that mRNA vaccines are effective for longer than the six months that was initially thought. There are already whispers of perhaps having to get a third dose in some cases, while others might not need it at all.

Perhaps we should not get stuck in that percentage as much, but the goal to vaccinate 70 percent of the adult population is certainly correct. And each step taken to involve the younger group is also correct.

I do not believe we will reach the 70 percent mark in the planned time period, but I also see no reason to begin tearing out our hair for it. We should instead look forward to see how we can vaccinate everyone we want to vaccinate in this stabilizing tempo.

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Editor: Kristjan Kallaste

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