Talving: Single family Christmas this year

Peep Talving. Photo: Madis Veltman

Chief of medicine for the North Estonia Medical Center (PERH), member of the government’s COVID-19 scientific council Peep Talving would put basic schools in Ida-Viru, Harju and Tartu counties on remote learning from next Monday at the latest and close choirs and practices. Talving urges people to spend Christmas and New Year with their immediate family and contact grandparents and other relatives virtually.

Are you on the same page as scientists and doctors who say that without tougher restrictions, the situation will deteriorate beyond recent forecasts?

I think that we can take an objective look at the reproduction number R for the past month and in the context of recent measures. The government introduced new rules on November 24 and they have not had any effect on R. The model by Mario Kadastik and Krista Fischer suggests we will have 700 people hospitalized by New Year’s Eve with 100 new patients coming every week. This will put pressure on the entire healthcare system.

What will it mean for hospitals and patients?

It means we are creating resources for COVID-19 patients, while it has to come at the expense of something as we have a limited number of staff and beds. We will be gradually pulling resources away from planned treatment. PERH will be switching to the A4 phase [this Thursday] that means dialing back planned treatment in favor of COVID-19.

Should tougher measures be ordered immediately?

I would say proportionate measures. We need to consider whether Saaremaa and Hiiumaa need to be locked down completely. I think not. However, certain proportional measures should be taken in some areas.

What would help?

Keeping distance. The situation is worst in Ida-Viru County today. The case rate per 100,000 people is nearing 1,000 in some places in the county. All other countries have introduced very tough measures upon reaching that point. Ida-Viru County needs the toughest measures. The case rate is 450 for Harju County, with Tartu County catching up, currently on 350. I believe that Harju County, Ida-Viru County and Tartu County need new restrictions. The decisions will be made by the government.

Is a complete lockdown in order?

I believe it should be discussed for Ida-Viru County, while I do not believe Harju and Tartu counties need to be cut off.

Spas remain open. Does that worry you, seeing as we’re heading for school holidays?

Of course, it entails risks. Spas might not have the best ventilation. Sharing a sauna or spa premises with an asymptomatic carrier poses a risk. Dressing rooms are also potential hazards. Should we close all spas? I think that many have found sensible ways of ensuring dispersion. On the other hand, Ida-Viru County spas and party venues are fully booked for New Year’s celebrations. I do not consider that a proportional measure during a pandemic.

What would you say to people who have booked venues in Ida-Viru County?

I would say that people who really want to make sure they catch COVID-19 should attend. If we want to be sensible and avoid contact with people not to get sick or infect our families, that is not the way to go.

Nature on November 16 published the results of a study on the most effective measures to stop the spread of COVID-19. Coming in at number one is banning small gatherings or family parties, followed by closing of educational institutions in second and national border closures in third. Our government has not deemed any of these necessary. Is that a mistake?

The cabinet has been discussing these restrictions all along. The Nature article listed over 6,000 measures. Indeed, in first place we have small gatherings. Looking to Christmas, it has been suggested that two families at most could come together. But I would refrain from recommending that. I would like people to limit contacts to their immediate family this winter. Every family by themselves and in touch with other relatives using telecommunications channels. I wouldn’t even include grandparents this time. Single family Christmas this winter.

Should we close educational institutions, send kids on Christmas break early?

High schools are on remote learning in Harju and Ida-Viru counties today. My proposal would be to do the same for basic schools. Grades 1-4 [elementary school] pose less of a risk, but we only have two weeks until Christmas. I really believe we could make exceptions and switch to remote study in the coming days, next Monday at the latest.

Are we emulating what Sweden did in spring, even though they have changed tactics in favor of tougher restrictions now?

Indeed. The first and second waves are very different. It was the same with the Spanish Flu a century ago. The second wave claimed many times as many lives because we lose the component of fear. We try to lead ordinary lives and pandemic lives simultaneously. We do not take measures seriously or listen to the authorities. Looking at the previous weekend in Tallinn – it was nothing but people moving in and out of and mingling in bars and entertainment establishments. Like there was no disease. How to hammer this message home? Sensibly and wisely, I believe, while we cannot make do without [new] restrictions.

What to think of the decision to keep hobby schools open?

Hobby schools are a problem. Especially those where masks cannot be worn, such as choirs or sports practices where people are out of breath or singing. I believe such hobby activities should be suspended now and opened in three- or four-weeks’ time.

However, the decision is nowhere to be seen.

The decision is not up to me or the scientific council. The decisions will have to come from the government.

Have hospitals discussed the ethics committee document from spring with guidelines should triage become necessary?

The debate was held in spring. It could become relevant again as the problem is becoming more serious. We have not currently discussed when to implement triage. But it’s there should things progress to that point. A decision will be made for each individual patient. But we are still far from that situation today.

There have been stories lately of young people who usually go through a milder version of the disease failing to fully recover. People are complaining of losing their sense of smell and taste and of chronic fatigue. It is possible these effects are permanent?

There have been quite a few articles now and it is what’s known as long Covid. The articles started in Italy where people still had three or four symptoms left three months after being discharged from hospital. We know the people who have been hospitalized and quite a few have long Covid. The main symptom is fatigue, with 98 percent reporting disproportionate tiredness two to four months after leaving the hospital. Headaches, muscle pains, shortness of breath, trouble concentrating – these are the symptoms. It is reality for me. It is not a bubble or conspiracy theory of some sort. It exists and people are complaining.

Could Covid stay in us?

These are microinjuries, while people who are brought to the hospital have macroinjuries. The latter are suffering from changes in the lungs, while we cannot see what is happening on the level of small receptors, small blood vessels. The virus’ spike proteins can latch onto different places. If they attach themselves to the heart, they create heart disease. We feel tired if the pump is not working correctly.

Is it possible we will never be rid of the disease?

Time will tell. I cannot promise you anything one way or the other.