Lutsar said, when presenting an analysis of the pandemic commissioned by the Health Board, that looking at cases of Covid on the world map, a rather peculiar pattern emerges. While infectious diseases tend to spread more in poorer areas, Covid infections were highest in the wealthiest parts of the world.

"It was a major difference compared to past pandemics, and we do not have a brilliant explanation for why the infection rate remained relatively low in Africa until the very end," she said. "One reason is the very young population, while climatic conditions might be another. Thirdly, testing was less thorough when compared to the developed world."

The virologist pointed out that during the pandemic, between January 30, 2020 and March 5, 2023, Estonia registered 807,000 cases of Covid and 3,001 deaths. Around 23,000 people needed hospital treatment, while 1,734 needed intensive care and 936 were put on assisted ventilation. The average age of people hospitalized was 66.

By June of this year, 2.1 million doses of Covid vaccines had been administered, with 65 percent of adults now vaccinated. A monitoring from January found that over 90 percent of adults in Estonia had coronavirus antibodies.

Globally, 700 million cases were diagnosed and 6.9 million people died for a mortality rate of about 1 percent. But experts believe that both the infection and mortality rates have been underestimated and models suggest Covid may have caused 5.94 million deaths in 2020-2021 alone for a total pandemic death toll of 18.2 million.

Even though the virus turned out less severe than initially feared, Lutsar said it held serious consequences for Estonia. The pandemic years saw the general mortality rate go up and lowered average life expectancy.

One reason was Covid-19 as a serious disease, while a broader crisis in society and the healthcare system and the negative effect of measures taken cannot be ruled out either.

Lutsar pointed out that Estonia's strategy was to try and live with the virus from the first and lay down restrictions society would be able to shoulder. All things considered, Estonia did quite well in the crisis, the virologist believes.

Estonia had less severe restrictions compared to its neighbors until September 2021. The toughest rules were laid down in 2022, which also lasted the longest.

"One lesson is that restrictions must have both a beginning and an end. /.../ I believe it is possible to have a concrete end date for restrictions, which is perhaps something we were not good at this time," Lutsar said.

While the pandemic hiked the mortality rate, Lutsar believes more detailed analysis is required to get to the bottom of the causes. She said that people often ask her why Estonia failed to emulate Sweden which did very well in the crisis. But Lutsar said that there was a tenfold difference in mortality between Estonia and Sweden.

"Their mortality rate was ten times ours at the beginning of the pandemic. The Estonian society would not have withstood such a mortality rate in the spring of 2020. This is why I believe, even though I was not present for the decision, that restrictions introduced in the spring of 2020 were entirely justified. The mortality rate was more or less similar in Estonia and Sweden by the end of the pandemic, while it was still a little higher in Sweden."

Estonia had the lowest Covid mortality rate among Eastern European countries, the virologist pointed out.

Talking about lessons learned, Lutsar said that while a lockdown helps contain the spread of viruses, it is not a sustainable measure – China serves as a good example here as even they gave up in the end.

The role of protective masks is still controversial. Lutsar said that because Covid is an airborne disease, masks should theoretically help, while study results are conflicting and relevant studies are difficult to conduct.

"During periods of peak infection, masks are a good short-term voluntary measure, while we cannot rely on them to make viral diseases disappear from the world," she said.

When it comes to remote learning, international studies have shown it to have a minimal effect on the infection and mortality rates, while it affects psychological disorders and performance of students and contributes to obesity.

"Unfortunately, we did not manage to perform a study in Estonia during the pandemic," she said.

The effects of remote learning and mobility restrictions were also modest based on international data and had no bearing on hospitalization and mortality. However, the virologist referred to vaccines as the success story of the pandemic.

"The effect of vaccines was short-lived when it came to SARS-CoV-2 infection, which is why it is not rare for vaccinated people to have recovered from the disease multiple times. But if we look at preventing serious illness, vaccines have been very effective indeed at 90 percent, whereas the protection they provide lasts for quite a long time," Lutsar said.

She added that a global pandemic is a crisis where countries depend on one another, while every country must still have its own stockpile of medicines and protective devices but also experts as the latter cannot be trained in a matter of days.

"All in all, Estonia managed in the pandemic, whereas the pandemic must now end in our heads. We are on our way," Lutsar said, adding that people need to learn to live with the virus again.

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