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The strong fear that the second wave of the coronavirus in our country will be stronger than the first, and cause more hospitalizations and deaths, experts say. Faced with this possibility, with the number of new cases in Attica in the last week exceeding 1,000 and with the increase in demand for intensive care units (ICU) having already put the ANS on general alarm, the Government has taken new restrictive measures . in the Basin that refer to the days prior to the blocking of the first wave in our country.
Thus, starting tomorrow and for 14 days, in addition to the measures that are already in force, teleworking is mandatory for 40% of employees in public and private sector offices, the maximum number of those present in indoor and outdoor gatherings is nine. people and in weddings, funerals and baptisms the 20 people, the concerts are suspended and the cinemas are closed. Although the effectiveness of the measures will be recorded in about ten days in the number of daily cases, and in 20 days in the number of intubated, a possible new deterioration of the epidemiological indicators may even lead to a new limited confinement, a possibility that will not discards it. now the government.
As EKPA Professor of Social and Preventive Medicine Giannis Tountas points out in “K”, the rapid increase in newly diagnosed but also intubated patients and deaths over the past 45 days has created reasonable concerns about the degree of revival. In our country. Newly diagnosed cases increased from 337 in May to 5,994 in August. For young intubated patients, the corresponding numbers were 9 and 35 and for deaths 35 and 60.
“The evolution of epidemiological data clearly marks a second epidemic,” Tountas said, adding that “the extinction of the first wave in May and the few cases in June and July had raised reasonable hopes for a more painless summer.” These hopes were dashed, not so much by tourism but by the delay in the widespread use of the mask and the restriction of meetings. The question now is whether this second wave can be controlled before it overtakes the first. “
According to the professor, the evaluation of the development of the second wave of the epidemic cannot be done based on the diagnosed cases. The analysis of the data carried out by the Institute of Social and Preventive Medicine shows that the three-digit figures in the daily cases registered as of August 1 and that in the last days exceed 300 are mainly due to the increase in tests carried out and they do not correspond to a similar distribution. epidemic. In March, around 800 molecular tests were carried out per day, and in August they exceeded 15,000. Greece conducted 1.61 tests per 1,000 inhabitants in March, when the corresponding rate was 5.81 in Austria and 11.46 in Germany. But also the poorest European countries, such as the Czech Republic and Slovenia, carried out more exams than our country (5.23 and 11.43 respectively).
But then, at the end of August, Greece had carried out a total of 91.8 tests per 1,000 inhabitants, beating Slovenia (76.42), the Czech Republic (85.20) and Italy (85.35). but Germany (147.80) or the United Kingdom (198.08). And as the professor comments, “when more tests are carried out, it is expected that more cases will be registered, especially when one of the peculiarities of this epidemic is the numerous asymptomatic cases”.
Mr. Tountas characterizes as much more reliable indicators of the evolution of the epidemic the number of intubated patients and deaths and especially the rate of their increase or decrease, despite the fact that they reflect the dimensions of the epidemic fifteen days ago. The maximum number of intubated patients was recorded on April 5 (93) and the minimum on July 30 (7). Throughout August there is a steady increase at a steady rate (approximately 12 new patients intubated every 10 days), while from September 1 to 15 they almost doubled (31 new patients intubated in 15 days). The same is observed in deaths. Most were registered in April (91).
We had 35 deaths in May, 13 in June, 14 in July and 60 in August, while 47 deaths were recorded in the first half of September. In the ten days from March 28 to April 7, there were an average of 5.1 deaths per day, while the corresponding figures for August were 0.8 for the first ten days, 2.4 for the second, and 2.8 for the third ten days. In the first half of September we had an average of 3.13 deaths per day. However, Greece still has relatively few casualties, with a total of 25.14 deaths per 1 million inhabitants at the end of August.
Ascending phase
As Mr. Tountas points out, “comparing the epidemiological data of the last 45 days with those of March-April, and especially the increasing rate of intubated patients and deaths, it is concluded that we are in the ascending phase of a second wave of the epidemic. , which is expected to increase in the next period and seems capable of exceeding the size of the spring wave. Suffice it to say that we may have exceeded 100,000 cases in our country, of which at least 10,000-15,000 are active, capable of infecting so many others, with Ro being close to 1. In addition, the opening of schools, the reduction of insolation and the greater use of closed spaces due to autumn, as well as seasonal respiratory infections, are factors that favor a greater spread of the epidemic.
Concluding, the professor points out, “in order not to turn the second wave of the epidemic into a tsunami with tragic consequences, it will be necessary not only to strictly implement the existing measures but also to take even more strict measures, especially with regard to the widespread use of the mask”. and further restrict meetings. However, everyone should also understand that epidemics are not primarily a problem of clinical medicine, but of public health. “Where, unfortunately, our country is far behind.”
Alarm in the NSS, expulsion of several patients in ICU
Faced with the greatest challenge since its inception is the national health system, whose resilience and the response of hospitals to the growing tide of pandemics and patient admissions is estimated “in the red.”
The pressure of the second wave is already being felt particularly in hospitals, with those in charge blocking more and more beds for the treatment of coronavirus patients. The concern is intense, given that the clinics and units of large hospitals with experience in treating COVID-19 cases are already full, at a time when the second wave has not yet peaked and everything shows that it will be stronger than the first.
“The intensive care units in Attica have been under a lot of pressure in recent days and we are constantly trying to add beds for COVID-19 patients, but to the detriment of the general ICU beds. However at this stage we cannot do Nothing else. We have to give it weight there “, points out to” K “the professor of Pulmonology – Intensive Care of EKPA and head of the Coordination and Development Committee of the UCI, Anastasia Kotanidou. It is indicative that in” Evangelismos “on Wednesday night , of the 24 COVID-19 Intensive Care Units, 21 were “occupied”, in total 75 Intensive Care Units are reserved for the coronavirus – there are another 40 these days – of which 53 were already “occupied” last Thursday .
“We are very concerned about the increase in bed coverage,” says Ms Kotanidou, continuing that “there is a possibility at this stage of having more cases in the ICU than we had in the first phase of the pandemic, since that we still have to reach the top of the wave. It is not ruled out that new measures may be necessary in hospitals, such as a further reduction in serious surgeries that usually require the commitment of the ICU. ”Regarding the possibility of seeing in Greece images of hospitals with terrifying pressure from patients, such as those experienced in other countries in the spring, the professor emphasizes that “we are trying to avoid this possibility.” It is up to us. “If we all take ourselves seriously and implement the measures, the wave will stop here. “
The beds are full
The 21-bed COVID-19 clinic at EKPA’s DG Pathology Clinic in “Sotiria” was the only one that did not close at all during the entire pandemic. “In June, we only had one or two incidents. Now the clinic is full.” In “Sotiria” two other COVID-19 clinics of similar capacity were opened, one of which is already full, “says the professor in” K ” and director of the clinic, Konstantinos Syrigos.
As he emphasizes, “at this stage we see an increase in the number of patients and the duration of their treatment, which has an epidemiological explanation. Those receiving treatment now tend to be younger and do not belong to high-risk groups. For these people to develop symptoms and require hospitalization, it means that they have received a very high viral load and need a longer period of treatment. That is why we say that protection measures against the virus must be observed. “This ‘insignificant’ mask reduces the viral load that we receive, which means that if we become infected, we are more likely to be asymptomatic or have milder symptoms.”
“Now there is much more experience in treatment.” Patients receive treatment from day one, in an effort to make their treatment as short and effective as possible, “says Mr. Syrigos, adding that” at this stage it would be a It was a mistake to try to respond to the pressure from NSS to open in each hospital and a COVID-19 clinic. “What you have to do is support the clinics that have experience to develop more beds.” Concluding, he notes: “In addition, it is necessary that the NSS continues to function normally so that we do not have collateral losses of patients with other serious diseases. “Today we see patients who were diagnosed with early stage cancer in January and February and due to COVID-19 they did not treat their problem and now they are being treated for metastasis. “
Health workers
More than 180 public hospital employees have tested positive for SARS-CoV-2 in the past 45 days, according to records from the Panhellenic Federation of Public Hospital Employees. As POEDIN President M. Giannakos told “K”, half of them appear to have been infected during their summer vacation, while more than half (around 100) are asymptomatic. According to him, from the end of February to July, some 600 health workers had fallen ill. Since August 10, when the second wave of the pandemic began to occur, small cases of cases have been recorded in hospitals, with typical examples being the AHEPA hospital, the Larissa hospital and more recently the Giannitsa hospital. As Mr. Giannakos points out, “the monitoring of health workers who returned from leave appears to have” discovered “asymptomatic cases, a fact that shows the need for monthly preventive tests on all personnel”. POEDIN requests periodic tests from NSS personnel, improvement of personal protective equipment and a seven-day quarantine for each employee who has been exposed to the virus.
