The Health Board (Terviseamet) is working on a new set of restrictions which, while they are likely to be stringent, the board's acting director general Mari-Anne Härma says, may set a precedent of only having one set of strict measures annually, as winter approaches, rather than the multiple rounds of restrictions at different times.
Härma has also confirmed that the triaging of emergency patients may be required later on this month if the situation worsens while, at the same time, the harsher restrictions may not see large events canceled – mainly due to good organization and adherence to coronavirus vaccination proof checks at most events so far.
The distinction between vaccinated and unvaccinated individuals may also recede in the face of more pressing matters in the healthcare sector and in education, Härma says.
The new package of restrictions, which Härma and health minister Tanel Kiik (Center) had already telegraphed earlier in the week, must be ready by end of business next Friday (i.e. November 12), Härma told ETV politics show "Esimene stuudio" Thursday evening, but also has to be effective, which in turn means it is likely to be stringent.
She said: "This package has to be one that works 100 percent; there is no more time to test things out here and there, or hope that finding out whether it works out or not is interesting. It has to work 100 percent. And, most likely, it'll be tough."
Härma: Winter restrictions may be a regular feature next few years
Winter restrictions may be a regular feature over the next few years also, Härma went on.
"We will most likely see other European countries, whose vaccination rates are significantly higher than ours, reintroducing restrictions at some point. It is a fact that this will not be the last winter when we get to talk about these types of restrictions. Perhaps, it would even be wise to think in terms of the next three to four years, meaning we need some paradigm shift, so that when we see clear and present problems – be it in children's education, be it dispersal at events, the wearing of masks etc. – then maybe it makes sense to incorporate it into the national development plan for the next three or four years, where some fundamental changes in the life of society during the viral season must occur in order for everything to work, so to speak, normally," Härma said.
As for the current round of restrictions under discussion, Härma said that some areas would see lock-down again.
"We have clear issues with currently unknown infections, we are looking at family contacts who are spreading the virus, we have a problem with children, and with schools. So the proposals and measures need to be directed towards these areas," she said.
Härma: Keeping schools on in-class learning important goal, but may not be viable in all cases
Keeping schools open is currently a major goal, but it is not certain whether this will ultimately be possible, she added; this will hinge on the restrictions introduced at the start of this week and their effectiveness.
"It all depends on whether the existing measures work. We will get to see this in two weeks. If they prove not to be working, then most likely another measure will have to be applied for children and schools also," she went on, stressing the importance of avoiding the bleakest scenarios in the healthcare system.
Regarding schools, full, across-the-board remote learning may not be necessary, taking into account different situations in different schools and areas, she added, particularly since vaccination rates among school staff and pupils over the age of 12 are running as high as 80 percent, all the more effective since most under-18s were vaccinated recently.
"However, we have a lot of schools in areas where vaccination rates are low, are low in schools also, and where there are major inter outbreaks inside," she continued, noting that in these scenarios the schools in question will have to go on remote learning.
Major events not main issue, smaller ones are
Major events in fact may still go ahead – with coronavirus vaccination checks – she continued, thanks in part to responsibility on the part of organizers and attendees in most cases.
"In fact, it's absolutely amazing how well the private sector has managed to organize events right now, even big events. These have been very well thought-through, and you can feel reassured when taking part," she went on.
Of greater concern is smaller, more informal events, Härma said.
"The boundaries have not been very clear. In general, large events, which require a special government permit, are very well planned and in that sense I am not very worried," adding that while the idea was also to send a signal to society, the fact regulations are being adhered to is still encouraging.
Härma: Let's keep perspective on vaccinated versus unvaccinated
Universal restrictions applying both to vaccinated and unvaccinated people alike are also not ruled out, Härma said.
"At some point, we'll be faced with the choice of whether or not people who have had a heart attack or stroke will get hospitalized, and I think those priorities, i.e. whether or not a vaccinated person should be able to party at the bar in the evening, puts that into perspective," she said.
This does not mean that all bets are off, vis-a-vis vaccinations, however, Härma went on.
"In order to get rates down quickly, effective restrictions are required, but this must go hand-in-hand with the public getting vaccinating more and more, as that will ensure that the next time we would have to talk about restrictions might perhaps be the next winter." he spoke.
At the same time, strict, universal restrictions are not usually long-lasting and are not intended to be, she added. "If we carry on with these semi-soft restrictions, we will have to maintain them longer."
South Estonian hospitals already conducting triaging in some cases
If the situation worsens even after the next round of restrictions, triaging in hospitals may follow at the end of the month, Härma said, though this will very much require playing things by ear.
"This would entail those hospitals that still provide scheduled treatments today, and have the capacity to provide scheduled treatment, would have to cease doing so," she said, even if in principle they may have the capacity to carry out some scheduled treatments.
In the worst case, triaging would involve some people being denied emergency treatment on the spot.
"Simply to be ready to deal with emergency care, plus the other aspect, where all hospitals are already delivering only emergency care but that capacity is exhausted, then triage decisions will have to be made as to which patient in need of emergency care will be hospitalized, and which cannot."
The South Estonian region is already partly implementing the triage guidelines in any case, Härma said, on an unofficial level and not as a mandatory practice - even ditching all scheduled treatments is not a mandatory requirement in that region at present, she said.
Härma and Kiik announced that a new round of restrictions was under preparation on Wednesday. The deadline for them to take effect would be November 15, in other words, they would be passed by the government next Friday.
Editor: Andrew Whyte