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Professor Saulius Čaplinskas, director of the Center for Communicable Diseases and AIDS (ULAC), is convinced that too strict measures used to reduce the development of the coronavirus may have the opposite effect. As an example, he cites the case of signs of overheating of the health system due to the fact that more and more doctors find themselves in self-isolation. That is, by protecting the health system from overheating, we ourselves cause such overheating.
– How do you rate the rapid increase in COVID-19 cases these days?
– This is a concrete example of the spread of infection as predicted. From the beginning it was clear that there are still unidentified cases from which a person is infected. I am not only thinking of Lithuania, but also of other countries in the world.
– Many patients say: I was sick, but I felt almost nothing bad, one day my temperature rose and my head hurt, such an illness reminded me of a vacation. Maybe you don’t need that two-week newsletter?
– Let’s start with the fact that as soon as this new disease appeared, most of the severe clinical cases were diagnosed in China, much of this disease was unclear. The shock was natural: it seemed that many people were seriously ill and many died. However, to date it is estimated that at least 80 percent. People with COVID-19 will have mild or no symptoms. Therefore, they will not need hospital treatment. However, it is very important that these people isolate themselves as soon as possible and do not transmit the virus. Also, take a symptomatic treatment, do not get tired, so that the disease does not progress. That as soon as you feel the symptoms, see a doctor as soon as possible, initially, even by phone.
For some patients, maybe 10 percent, maybe 14 percent. – You may need to stay in the hospital. Some of them may need oxygen masks to make it easier for oxygen to get into the body (because COVID-19 makes it difficult for some people to breathe and begins to lack oxygen, and then other organs get stuck). For an even smaller part, maybe around 5 percent. – may require intensive care, can be found in these rooms, also known as resuscitation. They may need to use artificial lung ventilation. There are few such people, and so far there are enough beds of this type in Lithuania. Unfortunately, a small percentage, and perhaps a significant proportion, of those who need artificial lung ventilation may not survive.
The question is how strict self-isolation should be. Because if people use medical masks correctly, people do not get infected with this virus.
– In your opinion, is COVID-19 ready to spread in Lithuania?
– Prepare constantly. Everyone should take care of their own health and that of their loved ones. And society and government should create the conditions for that. When we saw earlier this year that a large number of people were dying in China when they built a hospital in 10 days because there was nowhere to treat patients, when there was also a huge mortality from this disease in Italy, the world took something. without precedents. This is done to prevent the healthcare system from burning out. It was understood that there were no beds in the hospitals, no artificial lung ventilation equipment, no doctors. The quarantine was necessary for this: for the public, medical and social services to prepare. It was immediately clear that this is a very crude and temporary infection control tool that works well in controlling this and other similar infections, but also causes very serious side effects. These are closed kindergartens, parents who have not gone to work, the slowdown in the economy, social problems and deteriorating mental health. As a result, measures such as quarantine can only be applied in exceptional cases, very deliberately and only for a limited period of time. As a result, it has been suggested from the outset that specific containment measures are needed.
It was clear from the beginning that the virus would spread in particularly good conditions when the cold season arrived. And maybe mistakes were made when communicating with the public if the virus started to spread so quickly. Therefore, not everything was done.
– Was one of the problems probably unmanaged chimneys and a large number of unidentified cases?
– If the chimneys continue to expand, then they have not been controlled. Although a message was sent to the public that they were in control. However, it is not enough to know what a person has been infected with. It is bad that it has not been established where the virus came from in these hotspots and, worse, what continued to spread in those hotspots. The epidemiological review has not been carried out from the beginning and has not been done until now, and the percentage of those who are not clear about what has been infected has not been published.
Thus, it has been clear from the beginning that we are not managing the epidemiological situation or we are not managing it sufficiently. That the cases brought from abroad were identified, well, but have we always been able to diagnose, track and isolate the people who had contact with those patients? However, to think that we would trace each person’s contacts in order to isolate people was more than naive. It was clear that the virus would continue to spread. 10 and 400 new cases a day are different things. After all, the number of National Public Health Center employees who will call the infected will not increase infinitely without a border. As for the organization of work, it was the Stone Age. It was clear that there was an immediate need to introduce new digital technologies, as was being done in other countries. In addition, it was necessary to educate people why it is important to use that IT technology, to complete the applications themselves, where it was, who they contacted. However, we are still trying to ride the same carriage, but since it is slow to drive, it is suggested to hitch more horses, rather than make it clear: let’s switch to a modern truck.
– Is it reasonable to require that a person who has had a mild form of COVID-19 can return to normal life after 10 days, but a person who has been in contact, even if they are not ill, must remain isolated for a longer time , 14 days?
– The same laws apply to all communicable diseases. Another thing that the time interval can vary: depending on the disease, depending on the person. In medical and scientific terms, the problem with this virus is very interesting. That is, one prescription will not apply to all people with COVID-19. In the sense of time, in the sense of medicine. There are no specific data on the drug yet. Studies have shown that if a person is infected with the coronavirus and has no symptoms, the person will no longer spread the virus on the seventh day after being infected with the infection, although in some cases the PCR test was still positive. This means that the PCR test does not always show whether a person may still be infected with COVID-19. As a result, scientists have long suggested that, although a person does not develop a clinic, it may be enough to isolate him for 10 days. It no longer spreads the virus, although the PCR is positive.
Another question about contacts with other people. The main incubation period that should be sufficient to prevent further spread of the virus is 14 days. Although in exceptional cases and after 14 days it can still become infected.
– So for those who have had contact, 14 days of isolation is a logical requirement?
– Based on current scientific knowledge of COVID-19, this is a logical requirement. The only question is how strict the self-isolation should be. Because if people use medical masks correctly, people do not get infected with this virus. Respirators provide even stronger protection, although medical masks are sufficient. Naturally, this begs the question: can’t a disciplined caring person take a dog for a walk, buy food at a store, or vote in his neighborhood? Maybe, but similar restrictions still apply.
So now we have contradictions in the statements themselves. And when that happens, when the requirements are too strict, when people don’t fully explain themselves, some people take it or they don’t follow the self-isolation rules, or they avoid saying who they’ve been in contact with, or they just aren’t going to get tested. of the illness. And we certainly have those cases.
We will achieve nothing through coercion, orders only, quarantines, bans and penalties. In this way, we can only achieve a short-term effect, which will only delay problem solving.
– Currently, COVID-19 chimneys have not been extinguished in several hospitals in Kaunas. There is a shortage of doctors working in the Kaunas clinics, because they are forced to isolate themselves after contact with COVID-19 patients. Maybe doctors working with non-COVID-19 patients shouldn’t isolate themselves after contact with them?
– I do not believe that doctors should isolate themselves after such contacts at work. After all, someone already is and doctors know how to wear and use protective equipment. And a truly exaggerated and absurd requirement seems to isolate a doctor who has had contact with another doctor who has treated a patient with COVID-19. It seems that all other health problems no longer exist, the only target has become COVID-19. But now, fearing that the health system will not be burned by COVID-19, we are now burning it by the fight against COVID-19. There are many examples, many countries in Europe and the American continent where there are no such requirements for doctors. There, some doctors even say: if I do not feel any symptoms, I, while working with COVID-19 patients, will not be tested for the disease. However, these doctors realize that, even without research, you must protect yourself, your patients, and your family. Because one is a means of protection at work and the other is when you return home.
– Would you suggest that doctors who have been in contact with COVID-19 patients are not isolated at all?
– Infection control mechanisms and standards should be considered in light of the evolving situation. And if we see that there is a case, we must allow some flexibility or change the recommendations. They must respond to the changing situation. If we do not discuss, we do not seek the best solutions in a collegial way, specialists in various fields together, we will simply be left behind. We are constantly thinking about how to hit more horses instead of changing vehicles. People need to change their behavior. Through coercion, mere orders, only quarantines, bans, fines, we will achieve nothing. In this way, we can only achieve a short-term effect, which will only delay problem solving. Local quarantines meet the expectations of those who were convinced that strict measures were needed. However, there are those who understand that we will not stop the virus in this way, we will only stop it for a while, but at the same time we can ruin the economy, the psychological and spiritual life of people. We will feel the consequences for a long time.
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