Coronavirus in Hungary: the painful records of the first wave will be broken in a few weeks

On a risky narrative

According to Prime Minister Viktor Orbán, there are 10,000 free beds available for coronavirus patients and no one will be left unattended. Let’s start with this because it leads to a very important finding. The thousands of ventilators and hospital beds mean, at first glance, that there could be millions of people infected in the country at once, and the epidemic would not cause a tragedy like the one in Italy or New York. Apparently this leads to the fact that the epidemic can actually be released without restrictions (or with the current slight restrictions), there is no economic damage. Also, the country, if it can deal with millions of infections at once, it can get through the epidemic very quickly, a few nasty months, and we’ve gotten through it all.

It would be a big mistake to think that.

There are several problems with this line of thinking:

• It is certainly not the number of beds and fans, but the number of medical staff is the capacity limitation.
• The widespread spread of the virus also does not spare hospitals, and even hospital workers are increasingly exposed to infection, so the epidemic alone severely destroys health capabilities. In this way, the system can ultimately serve fewer patients.
• Rapid reinfection of society, even without overload, means many more deaths than trying to slow the spread of the virus to the vaccine. The compensation dilemma is a well-known one: choose the economic damage (and its human consequences) resulting from foreclosure, or the more serious epidemic with more freedom of movement, more deaths.
• Such a rapid spread of the virus, even without regulations, would lead to greater caution in humans, in extreme cases, something that is already equivalent to a complete shutdown. That is to say, the compensation is not perfect, the economic sacrifice increases without restrictions as the epidemic intensifies.
• Rapid transmission of infection may not be a durable solution, as there is mounting evidence that in many cases immunity does not develop or disappear.
• Recent experience shows that recovery from the disease is not easy either. Residual effects that slowly fade and even permanent damage to health are common: according to our health system information, there are not only Italian but also domestic examples of this.

Therefore, the extent of the epidemic cannot be adjusted to the theoretical maximum of health care carrying capacity.

How are we?

After the above, it is worth taking a snapshot of the epidemic situation in Hungary. Today, healthcare can provide patients with an increasing number of registered coronavirus cases, and this may remain so for some time if the average age of cases does not increase significantly. The average age of coronavirus cases is less than 30 years old, while in the first wave it was more than 70 years, which means that there are still relatively few people hospitalized today. According to various estimates, there may already be more than 100,000 carriers of the virus in Hungary, but a key question is how the average age of those infected will evolve. During the first wave, the disease was mainly transmitted to the elderly (nursing homes and hospital epidemics) and there was no community spread, but now the virus is spreading among the young. They only have milder symptoms, so there is no significant burden on the healthcare system, but older people are also more likely to be hospitalized and die.

Overall, the virus has gained new momentum in Hungary since mid-August, but the number of hospital admissions has only started to rise significantly in recent days. This is due, on the one hand, to the fact that more and more people are active and, although, as mentioned above, most young people have milder symptoms, they also become more seriously ill, requiring hospitalization. That is, the more patients, the more hospital beds will be needed even if the average age does not increase. On the other hand, the disease is already spreading sporadically among the elderly, and international experience so far suggests that full protection of the elderly is not possible in the event of a generalized epidemic. Since the disease generally has a recovery time of at least a week or two, even longer in severe cases, hospital capacity is not released as quickly as the virus is spreading across the country.

Today, “only” 280 people still need hospital treatment, but their number is growing by the day. According to our calculations, within two weeks, 800-1100 people may be hospitalized in Hungary, as much as at the peak of the first wave. If the number of people treated in the hospital exceeds 1,000, then we can already speak of an epidemic that uses the health system more than the first wave. To see numbers better than these, the virus’s reproduction rate should drop substantially in the next period.

In the coming weeks, a substantial increase in all new coronavirus cases can be expected, leading to an increase in the number of active infections (more people are infected than many recover). Once the virus is likely to reach the elderly, as it is unavoidable with the current high level of active infection, hospital capacity will increasingly need to focus on treating coronavirus patients.

Whats Next?

The big question is what would reduce the reproduction rate in the current environment, since restrictive measures are currently very lax in Hungary. It is important to note that it would be a mistake to start from the strictness of the regulation as a whole, since people can behave in many ways, even with unchanged regulations. Maybe we can wait a bit that the restrictions so far (persuading people or sanctioning them) to have more effect can have more impact than we saw at the end of the summer. And we can also be sure that we still don’t see the impact of a number of new steps (extended mask wearing obligations, introduction of penalty items, etc.) and that they may also slow the spread.

However, it cannot be ruled out that the reproduction coefficient (R) estimated at 2-2.5 does not drop to around 1 under current regulation. In addition, it seems more likely (and a good number of experts seem to be in this position) that the current measures will be few in autumn (weighed down by more frequent work, going to school). This uncertainty can cause delays. Each and every day that we spend in the hope that the current measures are sufficient, and therefore we have been or will be reluctant to impose more selective and light restrictions, may bring closer the need for stronger restrictions.

It is clear that the measures taken so far should have been taken a few weeks earlier in order to have a significant impact (especially with regard to border closures and greater internal coherence). This means that we have much less time to “experiment”, to fine-tune.

Therefore, it may be urgent to consider what other selective measures can be taken to avoid blanket closures that cause more serious economic damage. Like for example that

• change the strict testing protocol: test anyone with mild symptoms,
• substantially increase testing capabilities,
• make the use of masks much more widespread than at present,
• the imposition of severe penalties, amounting to hundreds of thousands, for non-compliance with the rules,
• pay more attention to the protection of vulnerable groups, teachers and health workers (regular testing),
• introduce a shopping time zone to protect the elderly,
• the introduction of immediate fever measurement in schools, public bodies, companies and certain public institutions,
• use the home office in both public and corporate spheres, when possible,
• closure of entertainment venues and non-vital but high-risk venues.

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