Rate of infection among young people cooling optimism

PHOTO: Madis Veltman

The government agreed on a set of metrics last week based on which potential relaxing of emergency situation rules will be considered. While a total of seven metrics will be used, there has been no explanation in terms of levels from which restrictions would be alleviated. Postimees has put together an overview of the situation.

A group of University of Tartu mathematicians that advises the emergency situation’s Scientific Council, headed by professor of mathematical statistics Krista Fischer and senior research fellow of the Institute of Chemical and Physical Biology Mario Kadastik, has been trying to model the epidemic since it began. Their model is based on the number of people hospitalized, those on assisted breathing and deaths. The former two are also among the government’s metrics.

The council’s latest forecast will likely be published on Tuesday, while last week’s scenarios also suggest the epidemic is rather following the optimistic forecast. Only the number of deaths rather follows the middle forecast.

This means that if the reproduction number R was 2.5 when the epidemic began, meaning that a single carrier infected 2.5 people on average, it had come down to 1 by April 6 and has remained stable at 0.8 since last week.

“There is a correlation between the number of new cases and patients over 50 who need to be treated in hospital, while this segment is also shrinking today. That said, the reproduction number hovers around 1 among younger people in Harju County, meaning that the epidemic is not yet dying out in the county. The number is below 1 elsewhere in Estonia and the virus is on its way out,” Kadastik said. The situation is made more difficult by the fact patients’ place of residence is determined based on the population register that might not correspond to where people really live, for examples, in the case of students.

The age dynamics of new diagnoses suggests that the case rate is clearly falling in the 50+ age group, while the fact the rate has remained stable among younger people is worrying researchers. “If we were to alleviate restrictions, young people would be the first to move around and communicate more that could drive the coefficient up again,” Kadastik said. This is not reflected in hospital statistics as fewer younger patients need hospitalization.

Treatment needs to be restored gradually

Once figures pertaining directly to the epidemic are out of the way, planned treatment is the next order of business.

The government ordered hospitals to cease planned treatment in mid-March. Private clinics were ordered to put down their tools a week later. Hospitals approached the ban differently. The number of people hospitalized fell by 20 percent year-over-year in April at the North Estonia Medical Center (PERH).

The number of hospitalized patients fell by 40 percent between March 14 and April 12 year-over-year at the Tartu University Hospital. The number of ambulatory appointments was cut in half of which 60 percent were conducted remotely. Treatment volumes fell to a similar degree at the West Tallinn Central Hospital.

“Naturally, hospitals acted differently and proceeded based on readiness level two where they have to determine whether treatment can be postponed and whether they have enough personal protective gear, with some hospitals better equipped than others,” head of the Estonian Health Insurance Fund Rain Laane said.

Head of emergency medicine at the North Estonia Medical Center Vassili Novak said that ambulances are bringing the same number of people to the hospital as they did last year. “Luckily, we cannot yet say that patients are in poorer condition or that their condition has deteriorated. More accurate conclusions would require a retrospective study, of course.”

Orthopedist Madis Rahu, who works at both PERH and a private clinic, said that settling treatment arrears needs to begin slowly and gradually. While day surgery could be restored, returning to full-time outpatient care at major hospitals is dangerous as people will gather and the virus will be given the chance to spread if patients or employees are not diligent or are unaware of having COVID-19.

Laane also supports gradual relaxing of restrictions. “We could start by allowing women to give birth with partners present because they are together before the delivery and could be allowed to stay together at the maternity ward. Kuressaare Hospital is another matter entirely and restoring planned work will take longer there.”

With planned treatment taken care of, the government will look to trust measures capacity that translates as sufficient protective equipment stockpiles and the ability to sustainably acquire more. Hospitals are also procuring protective gear, while the state organizes central procurements in charge of which is Minister of State Administration Jaak Aab. “Since the start of the crisis, Estonia has taken delivery of seven aircraft loads of protective equipment, including 4.84 million surgical masks, 1.65 million FFP2 respirators, 25,000 FFP3 respirators, six million pairs of gloves, 110,000 protective gowns, 89,000 pairs of goggles, 50,000 protective suits. In addition to smaller things like footwear covers etc.,” Aab said.

Equipment procured using central tenders will reach everywhere front line staff has need for it, such as hospitals, nursing homes, police, prisons, state agencies, local government social workers – people who need and use protective gear in the public sector and hospitals.

“I can say that the public sector, hospitals and other medical service providers – dentists, family doctors etc. – should have roughly a month’s supply by the time equipment flown in on the last plane is distributed,” Aab said.

Mental fortitude for putting up with restrictions holding

One of the government’s metrics treats with people’s preparedness to suffer restrictions in the form of studies on whether people are willing to suffer emergency situation measures and their opinion of them. Pollster Turu-uuringute AS has carried out five corresponding studies. One of the more important questions reads: What do you think of measures taken so far – do you believe they should be altered?

If toward the start of the emergency situation, over half of people questioned found that measures should be toughened, the latest study from last week found that only 27 percent still believe tougher measures are in order. No fewer than 60 percent of people now find that current measures are sufficient and a little over 10 percent would like to see restrictions relaxed.

It is important to note that while desire for relaxed measures is not very popular yet, that is where the trend is pointing.

Economic situation poor but could be worse

The economic situation is another important metric when deciding whether to alleviate crisis measures, while measuring it is difficult. Statistics is a largely retrospective phenomenon. That is why faster methods used in nowcasting need to be employed. One such is the labor market situation where different agencies are publishing changes on a weekly basis now. The Unemployment Insurance Fund reports registered unemployment and unemployment benefit figures, while Statistics Estonia calculates changes in employment relationships with a weekly lag. The situation is bad, while it could also be worse.

Surveys also allow a quick glimpse into how the economy is doing, with the entrepreneurs’ confidence index one of the more popular examples. The index is calculated by the Estonian Institute of Economic Research and took a nosedive in the second half of March.