A crisis is not a time to be looking for culprits – a maxim that is both right and wrong. We find ourselves in a very bad situation together. A national witch hunt is unnecessary. However, the question of what we should learn from all this remains – what should be done differently today and in the long term.
The actions of Estonia’s crisis managers over the past two weeks can also be commended. The prime minister’s messages have become clearer. Minister of State Administration Jaak Aab was put in charge of procurement and Dr. Arkadi Popov has been appointed Estonia’s emergency medical chief. They will likely continue to serve as the public faces of the coronavirus crisis for some time. The decision, while still half-complete in practice, to involve Estonian scientists beyond virologists is also welcome.
We need more strategic initiative, politicians and other experienced people consulted by Postimees said. We need to share and delegate responsibility. Ministers should not be mediating individual offers but act as leaders on the strategic level. As put in today’s editorial, ministers need to keep their heads as their primary tools.
Clarity of messages and the Health Board
The Health Board is not equipped to handle crises; running such a crisis is not its purpose and it is clearly failing in the task. Complementing the crisis team in certain areas might not be enough. Questions are being asked by the coalition and the opposition.
We need bolder replacements and changes that do not necessarily have to mean firing someone, rather they should stand for more effective use of the state’s resources.
Everyone’s eyes are on the Health Board and with good reason. The agency’s statutes put it in charge of monitoring, preventing and combating infectious diseases. Additionally, crisis management in Estonia puts relevant agencies in charge. How could the rest of society have known the agency is short on necessary know-how to say the least?
It has somewhat shockingly turned out as concerns the Estonian Health Board and through it the social ministry that the system lacked the ability to predict the course of the epidemic using models, which caused threat assessments to come in too late, meaning neither the government nor the people were warned in time. It serves as a general warning in that knowing what an agency has to do is no guarantee that the tasks in question are actually being performed.
Family physician, medical expert and former head of the Health Board’s monitoring department Dr. Peeter Mardna highlighted as one problem the fact the board employs people with no medical background. “I noticed it when I was still working as head of the control department. I had four or five doctors on my team, while there were none by the time I left.” It is understandable that doctors do not respect it when people from other walks of life give orders in their area of expertise. The lesson to take away from this is probably that many state agencies see themselves as inspectorates rather than institutions that are fundamentally responsible in certain fields.
We have spent the past week asking about the forecasts the Health Board allegedly had by mid-February and what they were based on. We have not received a concise and clear answer to this day. Why does it matter? Not just for hindsight or to lay blame – rather, the aim is to understand where we have (had) systematic gaps in knowledge.
It is doubtful to say the least whether a serious model-based forecast even existed. In other words – the people tasked with convincing the government of the seriousness of the situation themselves lacked a realistic idea of what could happen. Minister of Social Affairs Tanel Kiik told Postimees last week that the government discussed forecasts with the Health Board in early March.
The pace at which new cases of COVID-19 were being diagnosed reached the public a few days before Estonia declared an emergency situation. Physicist Mario Kadastik, mathematician Jaan Aru and Tallinn University of Technology professor Jaan Kalda wrote about what could happen based on scientific models on the pages of Postimees. We also translated and published text and graphs by Tomas Pueyo that were making the rounds faster than the virus at the time. For some reason, those in charge of the situation in Estonia chose to ridicule similar warnings by chemists Marek Strandberg and Katrin Idla. Unfortunately, the latter were right.
The board along with its voluntary spokespeople were busy telling people not to panic, without providing any indication of what that panic would entail. Obviously, without having previously considered whether there was anything of the sort at the time. We know in hindsight that goods were stockpiled more actively starting from the last week of February. People were doing what internal security agencies had been recommending for years: that families should have enough to last a week in various crisis situations, such as an extensive power outage. Again, it was chosen to make light of this, saying there would be no quarantines.
Based on what we know today, countries with experience from the SARS epidemic of 2002-2003, mainly close neighbors of China, have done better than others in terms of containing the spread of the virus. It likely stood for much better preparedness in terms of both know-how and fears on the level of the government and the population. It is true that the entire world is in trouble and that most countries underestimated the danger. However, this does not mean we should discount our own mistakes and the opportunity to learn from them.
It has been written about at length how the Health Board failed to communicate to Saaremaa that it would have been wise to cancel a planned volleyball game with a team from Italy. True, it has also been claimed that the islanders simply chose to ignore the board. Postimees has asked the heads of a lot of major institutions whether they were warned against what might be coming over the past weeks. Unfortunately, the typical answer is that even questions asked by institutions themselves largely went unanswered. Places were masses of people gather every day, like universities, were left in the dark.
This is not about blaming individual inspectors or even the public servant head of the Health Board.
The thing that needs to be taken away from this is that the person in charge of a complex field needs to have knowledge of the field and the preparedness to understand the dangers and solutions. In other words – being the spokesperson for epidemiology and running a footwear factory are not one and the same.
Perhaps it could have been possible to notify the public sooner. The first information leaflets arrived last Monday. In a situation where the elderly are a major risk group and the Russian-speaking part of society seems not to be taking the virus seriously, agreeing on a text and mailing letters or leaflets to people cannot take two weeks in an emergency situation. It took a little over two weeks now. While restrictions on movement seem more important, raising awareness cannot be overlooked.
What needs to be realized even more clearly is that the attempt to avoid a hypothetical panic by presenting half-truths turned out to be a very bad decision. Naturally, it is sensible to tell people not to trample each other to death in shops and refrain from other types of folly. Unfortunately, however, the message to avoid a panic meant society was left less time for preparations.
For example, Jaak Aab’s message from yesterday’s press conference that a signed contract means nothing before the goods actually arrive in Estonia is worth far more than attempts to “soothe” people with talk of common procurements etc. Dr. Arkadi Popov is also a calming sight on television as we can hope he knows what he is talking about instead of repeating slogans he was told to memorize during a meeting.
Testing, testing and more testing
Last week, we had to pull teeth to get an answer to the question of why we aren’t seeing widespread testing. Instead of saying right away that there are not enough test kits and protective gear for medical personnel, we were sold a fairy tale were widespread testing was not needed. A single agency or minister cannot convince a million people who believe otherwise whether testing is necessary. Officials seem to be on the defense, with fear of public criticism lingering somewhere in the back of their heads. New information and better ideas altering messages and decisions is to be expected in a situation like this. Communication must be open.
It is clear that tests are needed for doctors to be able to diagnose and treat the disease. But testing has several other benefits.
It is vital to try and keep an eye on the strategy for exiting the crisis. It is likely that societies that can return to at least some kind of normalcy faster will have an advantage. Those who will be able to relaunch economic activity with the risks of the epidemic starting again minimized will likely be the first to make an economic recovery. This way, testing is one tool for gradually releasing people from isolation and allowing them to return to work in the long run.
Involving the best know-how
It is commendable that top specialists in various fields have finally been involved. We have clearly seen that both statisticians and geographers can be useful in understanding the situation and planning activities. It is to be hoped that data can be made available to scientists quickly and in the scope of what’s permitted by law. A health diary people in isolation can add entries to is on the way that scientists hope will provide a more accurate picture of the actual spread of the disease. Using such a diary is still waiting for a green light from the ethics committee.
The government’s decision to convene a panel of scientists is praiseworthy. It is a shame this was not done much sooner – the ministry in charge of medicine should have admitted it lacked know-how.
Postimees turned to the Estonian Academy of Sciences and our advisory committee has met three times. Short summaries of what has been discussed at e-conferences can be found at Postimees Online and have served as inspiration for many stories, also by competing media houses.
The main idea is that we need to harness all the top science we have. Scientists should not be referred to as rubber stamps but instead used for access to our best knowledge and ideas.