You have recently finished a medical summary of the COVID-19 pandemic. Which key points would you highlight?

It has two parts. The first looks back at all five coronavirus waves, describing what happened with each one of them as well as providing a critical or hindsight look at what should have been done differently and what was done right.

The second part goes beyond the waves to sum up the entire pandemic. In it, I have tried to analyze the pandemic in general, give a very short summary of what happened over three years, how our hospitals coped, the mortality rate, vaccination, as well as some of the restrictions that were ordered and their effects. It relies on all studies done in Estonia, while it also draws comparisons with international studies and attempts to put things into perspective.

The document does not contain "the truth" about the coronavirus as no such thing exists. While a lot of studies were conducted during the pandemic, there are myriad loose ends still.

I am also thankful for the critique provided by Health Board employees, Ministry of Social Affairs officials and others.

In early 2020, when the virus reached Estonia carried by a coach passenger, we didn't know what to make of it. We are three times wiser now. Looking back, talking about vaccines and restrictions, which are the things people most care about, did we make the right calls?

The first so-called lockdown – we need to realize that Estonia was never locked down completely in the international sense, even though loud voices were calling for it at the time. Luckily, the government had enough common sense. Yes, schools were closed and we worked from home office in 2020, while you could still go to the shops or the woods as often as you liked, spend the entire day outside in the street. Therefore, Estonia was not locked down in the traditional sense.

I conclude in my summary that the first lockdown, even though we only had 50 infected, not even sick, was the right decision at the time. We needed time to understand what we were dealing with and prepare our system for the pandemic.

The lessons part states that all manner of restrictions, lockdowns or what have you – all of it needs to serve a purpose. It is not right to shut down society without good cause. But the first lockdown was in order.

We can probably also consider the spring of 2021 restrictions to have been warranted, when Tallinn hospitals especially were completely full. Restrictions on activities, or severe restrictions came too late, but they were justified at the time.

There were no more sweeping restrictions after that, while individual measures were deployed to handle the pandemic.

What we need to understand is that we could not have known how some of the restrictions would work – it was also a test, and we are wiser now in terms of what might work next time and what probably wouldn't.

Vaccination?

Talking about vaccination, I'm convinced vaccines have brought us where we are now. The vaccines turned out very well, while we must also admit that vaccines are not ideal. In other words, SARS-CoV-2 is a rapidly mutating virus and neither recovery, not to mention vaccines can give us lifelong immunity.

But they allowed many of us to avoid a severe case of the disease and prevented 1,400 deaths, according to professor Krista Fischer.

Let me also be clear in that every thing that has an effect also produces side-effects. And we fully realize that vaccines did cause side-effects. They were minute, while I'm sure this does little to console people who suffered from them. I can also assure people that why these side-effects are created is being studied.

It seems we are all but out of the woods with this virus, even though vaccination must continue. Does your analysis also cover things that went completely wrong?

In hindsight, I was perhaps very critical in 2021 when interviewed by ERR in December, while I was also in a very bad place emotionally at the time. But looking back and compared to the rest of the world, Estonia did well. We didn't have complete failures... I mean in terms of restrictions or measures having made life considerably worse – I cannot say.

But what I would do differently, which many have surely gathered from my previous statements, is remote learning in schools. It needs to be revisited in terms of weighing the benefits against the damage. Perhaps it could have been avoided.

I also find that coronavirus passports, domestic Covid certificates in the case of such a widespread disease... They worked at first, motivated people to get vaccinate, while I would not use Covid certificates next time if the disease is widespread and everyone in society will end up getting it sooner or later.

Such certificates work well, for example, in the case of the yellow fever – they work well in the case of diseases that occur in only a few countries and do not affect the majority of the world's population. But in the case of the coronavirus, or such a widespread virus, I believe they did not serve their purpose.

What are the lessons to take with us should we ever suffer another such pandemic?

One major lesson for me is that while we absolutely need to keep an eye on the recommendations of international organizations and the conduct of other countries, we need our own expert knowledge. And no one becomes an expert in two days or even two years. Perhaps we need to look at long-term things that cannot be done overnight. And creating domestic expert knowledge in a field cannot be done overnight. That is something the University of Tartu, Health Board, Ministry of Social Affairs and all other agencies must address. We need to make our own decisions.

My late mother always said that others jumping into the flames does not mean you have to follow them. I believe it brilliantly sums up how we need to look at the best know-how that's out there, while we still need to put it in domestic context – where people live, how they live and the nature of our medical system. The situation in London is one things, while it can be completely different in Võru.

We definitely need to consider these aspects. That has been a major lesson for me.

What should people do when exhibiting the first symptoms? Should we still test ourselves for the coronavirus or put on a mask?

A person exhibiting symptoms should not go to work if possible, irrespective of whether the test is positive or negative. Temporary conditions that pass in a matter of a few hours might be the exception. But a person showing symptoms of an upper respiratory system infection should stay home.

It makes no sense to test yourself if you don't have symptoms, and you also don't need to stay home if the test result is positive in that case. The Health Board has said – and I very much agree – that testing positive if you feel ill helps people in risk groups make vaccination decisions. But people who have recently recovered from the disease probably shouldn't get vaccinated as it does no good and might cause side-effects.

There is no need to frantically test yourself. Both doctors and patients need to think about what they want the test result for. While people can test themselves simply out of curiosity, it does not change having to stay home if there are symptoms, even if the test result is negative. That would be my recommendation.

I cannot recall the name of the epidemiologist who said that the pandemic will end when it ends in our heads, and it seems to me that the pandemic is not over in that case, nor are viruses going anywhere. We cannot avoid every viral infection out there and we probably don't need to. Viruses also work to stimulate our immune system.

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