Estonia theoretically ready to contain epidemic

Taavet Reimers. Photo: Tairo Lutter

Estonian medical and state agencies stand ready to contain the spread of the novel coronavirus, Minister of Social Affairs Tanel Kiik assured, adding that it is possible the virus that started in China will reach Estonia. A closer look reveals that what Kiik describes as preparedness is largely theoretical, as is the possibility of the virus reaching Estonia in the first place. What does the state’s preparedness stand for?

In short, Estonia’s preparedness for an outbreak of the novel coronavirus means that medical professionals can recognize the virus, know to notify the Health Board and isolate the patient. Next, test results will be analyzed by a laboratory and the patient asked who they have had contact with. The Health Board has guidelines for how to handle patients during an outbreak. Similar guidelines are in effect in Finland and have helped contain the virus there – Finland still only has one diagnosed case of the new virus.

Head of the Health Board’s extraordinary medicine department Martin Kadai says that there is no cause for coronavirus panic either in Estonia or the world. “When a person from China sneezes in the street, it is no reason to run for cover. They are not a danger to anyone,” Kadai says.

“Not every person with a fever or who hails from China carries the virus,” said Pilleriin Soodla from the infection control service of the Tartu University Hospital.

Some hospitals are even reluctant to describe measures to avoid the virus in order to avoid panic. Pharmacies were emptied of masks and respirators last week, with one Tallinn pharmacy saying that elderly people are scared.

The Health Board’s instructions for handling coronavirus patients do not include anything out of the ordinary and consist of everyday practices of hospitals. No protective suits or transport bags other countries use when transporting people with the virus. A patient suspected of having the virus will have to wear a mask during transport.

Are we ready?

Should an epidemic break out, the state will declare an emergency. The actual situation will then dictate whether new rules are in order, for example, boosting available medical staff or procuring special equipment. Estonian medical institutions stand ready for an epidemic in theory, while their practical preparedness remains a mystery simply because the country has luckily not seen an epidemic for a long time.

A member of the board of an Estonian hospital who wished to remain anonymous said that emergency medical teams do not have enough transport capsules for patients and protective suits and that by the time more can be brought in from other countries, spring will have arrived and the epidemic passed. They gave the example of the time of the bird flu pandemic and SARS.

“We were touring Tartu schools in 2010, handing out masks procured for the bird flu panic in 2005 to shop teachers. The masks had a use before period of five years,” they recall.

Only four hospitals are equipped to handle patients with the virus. The West Tallinn Central Hospital, North Estonia Medical Center, Tartu University Hospital and the Ida-Viru Central Hospital. Emergency medical staff will help with transport of patients. Estonia has 12 special transport capsules.

“It is not necessary to use transport capsules with the novel coronavirus. Rather, it is additional equipment to avoid the transport unit being contaminated and make it easier to disinfect,” Martin Kadai says. “If an ambulance responds to a suspected highly infectious disease situation, the staff uses personal protection devices and brings along a transport capsule if necessary.”

Head of operations for Tallinn Emergency Response Taavet Reimers says the Alarm Center does not have the capacity to make that call. “It cannot be done over the phone. The diagnosis needs to be confirmed by a laboratory, that the person is indeed infected and a transport capsule is needed,” he says.

Rather, the capsules are needed when taking patients from one hospital to another. Reimers has not experienced such a situation yet.

For example, should Narva Hospital get a patient with the virus, they should be transported to the Ida-Viru Central Hospital. Emergency response in Narva do not have such a capsule.

What is more, Natalja Metelitsa, who works as a nurse at the infection control unit of the Narva Hospital, was surprised to hear anyone in Estonia has one. “Why do we need one? We can call up an ambulance from Tallinn should something happen. Estonia is not that big. Not every hospital needs to stockpile transport capsules,” Metelitsa says.

The nurse says that the hospital has enough protective suits, goggles and masks for several waves of a possible epidemic. “That much is for sure. I asked the manager. These are major stockpiles. We have 700 staff and nearly 200 patients,” Metelitsa says.

It is impossible to say how long the stockpiles could last because the protective arsenal has never been needed. “It is enough for us. At least that is what warehouse managers and pharmacies are saying,” she explains. Metelitsa also says the hospital has isolators, even though they were last inspected ten years ago.

Special equipment expensive

Special equipment is expensive and has an expiry date. “While special equipment for high-risk situations is seldom used, it has a shelf life,” Martin Kadai from the Health Board explains. “We need to procure this equipment, utilize it and then procure more – it is quite an expense for society.”

How quickly could necessary medicine be procured if necessary? Kadai says that because production volumes are modest, drugs need to be ordered in advance. “An annual procurement plan is given to manufacturers for specific drugs, such as immunoglobulin and antitoxins,” he says.

Should an outbreak of Ebola occur on a scale similar to the flu, Estonia would not be ready – no country can be ready for something like that. “However, such a scenario is virtually impossible as it would not make sense in the world of viruses. A virus tries to maintain a balance to spread and infect as many hosts as possible. It cannot spread after destroying its host,” Kadai explains.

These two things usually do not go hand in hand in the world of viruses – a virus cannot cause a very serious condition and spread rapidly at the same time. Kadai says this is evidenced in Ebola, for example, that has not spread all over the world as a serious disease.