Speaking to ERR on Wednesday, Talving said that overcoming the next wave of COVID will be easier, as many people in Estonia have already either had COVID or been vaccinated against it.

Estonia's hospital system's capacity remains unchanged, as no new hospitals have been built, but its capabilities have improved thanks to funding from the European Social Fund's (ESF) Recovery Assistance for Cohesion and the Territories of Europe (REACT-EU) initiative.

He added that hospital staff skills have improved and the majority of them are vaccinated, and thus healthcare workers are better protected against the virus overall. PERH currently intends to maintain the maximum possible work volumes.

According to the medical director, hospitals currently have an improved frame of reference and tactics, however, as the number of available beds is reduced, that will still cause a treatment deficit due to which ill patients at home cannot be admitted to the hospital for treatment.

The shortage of hospital support staff and nurses will depend on what infection tendencies look like outside of hospitals and how many people are vaccinated. According to Talving, sources of infection tend to crop up in hospitals when background infection levels in society are high and there are outbreaks everywhere — in kindergartens and schools and at workplaces.

Every hospital needs a sufficient number of isolation rooms, he said, noting that PERH, for example, should have around 100. Isolation chambers aren't just necessary for COVID patients either; they are used for nosocomial infections, or healthcare-associated infections (HAI) as well — i.e. infections acquired during treatment.

Nonetheless, many hospitals still don't have enough isolation rooms built yet. The medical doctor explained that Estonia doesn't have many modern hospitals — most were built in the 1970s or even earlier, and have old wings with local ventilation and few isolation rooms. Planning hospital renovations is difficult as well.

"The pandemic actually said that something has been left undone — we can't relocate PERH to Saku Suurhall [arena] as the hospital must continue to operate," he said. "Where will the sick go then?"

Asked about hospitals' level of concern heading into the fall, Talving said that, considering the treatment outcomes of the first half of 2022, it appears as though not as many hospital beds in specialist wards will have to be converted for COVID treatment.

"That is the hope with which we will be heading into this fall, as the virus is less severe and we have better skills," he said.

Joel Starkopf, chief of Estonia's southern medical headquarters and head of research and development at Tartu University Hospital (TÜK), noted that they have no dramatic changes or new facilities to report.

"Construction takes time; we've planned renovations of rooms for spring 2023," Starkopf said. "We have adapted existing rooms at the hospital somewhat — a few isolation rooms specifically — to ensure they have better ventilation. So we have readiness, but no, we don't have more isolation rooms by any sort of order of magnitude."

Hospitals still short-staffed

Still worrying hospitals in Estonia is a significant shortage of medical staff — and not just in rural areas, said Imbi Moks, medical director at West Tallinn Central Hospital (LTK).

"If the amount of COVID patients at [our] hospital begins to rise, our plan is to definitely recruit additional medics from outside of the hospital," Moks said. "Reality has shown that when there are a lot of COVID patients in hospitals, hospitals' other departments have to operate as well; we can use staff from there in part as well."

The Center of Internal Medicine at East Tallinn Central Hospital (ITK), meanwhile, is already short one third of its staff.

"Estonian healthcare is facing a very serious staffing crisis," said Alice Lill, director of the ITK center. "We don't have nurses, and we're starting to run short on doctors. We can set up beds there, but we don't have anyone to treat these patients."

This means that should ITK need to set up a separate COVID department, the hospital would have to pull medical staff from its other departments, which would mean having to cancel planned treatment.

"So if we should see some sort of very serious hospitalization of COVID patients, that will definitely prove more difficult than in previous years," Lill acknowledged.

Hoping to avoid this scenario, hospitals developed a joint plan early this summer, according to which the number of beds at regional infectious disease hospitals would be increased first, and COVID wards would be established at general hospitals last.

"The deal is that LTK, which is a regional infectious disease hospital within the northern medical headquarters' region, will be first to escalate," Talving explained. "And they escalated themselves to 45 beds in July already. And their current occupancy is at 65 percent, i.e. they still have room."

Additional hospital beds for COVID-positive patients were set up at Kuressaare Hospital and Pärnu Hospital as well.

"We've had nearly 20 COVID-positive patients at once already at Pärnu Hospital, and that is likewise the capacity of our infectious disease department," said Urmas Sule, director of Pärnu Hospital and medical chief of the Health Board's crisis headquarters.

Currently, it's up to each hospital to figure out how to protect against the virus at their facility — and that includes mask requirements as well.

"When fall approaches now, then it's likely that we'll have to coordinate and certainly also tighten up these hospital restrictions, as that is the main weapon hospitals have to limit the spread [of COVID]," Sule said.

The crisis medical chief noted that COVID is currently spreading primarily among the elderly, and added that masking in hospitals is one way to avoid the spread of the virus there too.

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