Estonia to be locked down in fear of British strain

All tier three ICU beds are full at the West Estonia Central Hospital (LTKH). Photo: Sander Ilvest

The more infectious so-called British strain of COVID-19 is now spreading domestically in Estonia, while the relative importance of people who do not know where they caught the virus is growing. Hospitals in northern Estonia are overburdened as there are not enough doctors to see to coronavirus patients. The government decided in favor of new restrictions on Wednesday, Prime Minister Kaja Kallas told “Aktuaalne kaamera” evening news.

Shopping centers, restaurants and all other non-essential services will be closed from Thursday. Elementary school students will join their older counterparts in having to study remotely. The new measures that will initially remain in force for a period of one month mirror those seen during the spring emergency situation but one will not be officially declared this time.

An explosion of new cases of COVID-19 that started roughly a month ago reached new milestones last week that brought 9,670 diagnoses, over 600 people hospitalized and a 14-day case rate of 1,335 per 100,000 residents that is among the highest in Europe. Only weekly deaths fell to 44 last week from 56 the one before.

Every week since Harju and Ida-Viru County schools were opened in late January has been worse than the last concerning almost all indictors. Positive diagnoses have grown by 15-30 percent every week. This means that registered cases have grown by more than 10,000 or two and a half times in just one month.

While forecasts were usually more pessimistic than reality before, they have been spot on for the last two weeks. The reproduction number (R) still hovers around 1.2, Krista Fischer, University of Tartu professor of mathematical statistics, said. “It seems that growth has slowed down somewhat, while we will know for sure in the second half of next week. It might also be 1.5,” Fischer said.

This still means that new infection figures will match or exceed last week’s as there is a delay between new measures adopted last week and any real effect.

The number of hospitalized COVID-19 patients remained below 500 for a long time before exceeding that number in the second half of February, with a single week filling over 100 beds.

800 in hospitals by late March

Provided last week’s restrictions will not have an effect, the likeliest scenario suggests that hospitals will have over 800 Covid patients in just two weeks’ time, while that figure will roll around by the end of March if the reproduction number can be brought down to 1.

Author of hospitalization forecast models, senior research fellow and deputy director of the National Institute of Chemical Physics and Biophysics (KBFI) Mario Kadastik is also in charge of ICU and mortality forecasts. His model suggests that Estonia could have 100 people in need of intensive care for Covid by the end of the month.

Emergency medical chief of the Estonian Health Board Dr. Urmas Sule said that three negative records were broken over the weekend. “Luckily, we have not yet seen a day bring 100 new patients in need of hospitalization, while we have been close. As of today, 626 people need hospital treatment. Looking at the figures for the last 24 hours, of the 63 people hospitalized, 46 are in northern hospitals, the lion’s share in Harju County,” Sule said. Erecting a field hospital, for example in Narva, has been discussed, while it was decided it would not bring additional capacity. “We have instead dispatched a group of experts from the University of Tartu to help out. We need hospital management to work. Staff is the number one problem in medical institutions,” Sule explained. He emphasized that hospitals have not been designed to concentrate on a single malady and cannot exclusively do that.

Chief doctor for the Estonian Defense Forces Lt. Col. Tarmo Lusti told Postimees that no official request has been made for use of the EDF field hospital. “There is general preparedness and the EDF stands ready to support the country, dispatching the field hospital is a matter of a few days,” Lusti said. He also emphasized that medical staff and to some extent equipment are more urgent needs than infrastructure today.

Deputy Director of the Health Board Mari-Anne Härma said that the agency is making preparations for declaring a tier three emergency. This would give ER the right to dispatch ambulance crews of just two or even a single member and ignore lowest priority calls. Hospitals have been ordered to stand ready for temporary triage in which planned treatment would be ceased completely. She admitted that the board’s northern arm’s resources to find every infected person and tell close contacts to isolate was exhausted two weeks ago. Härma said that the board’s East, South and West regions are still on top of Covid patients and close contacts, while there are signs to suggest South and East will be experiencing difficulties soon. Urmas Sule added that the EDF is sending support and additional equipment. Hospitals in the north will also be relocating patients to southern hospitals. “The longer the distance, the more difficult it is to organize,” the doctor added.

Minister of Health and Labor Tanel Kiik (Center) said that Estonia is short on medical staff. “Estonia has fewer doctors and nurses than the European average whose numbers fall short of EU, OECD and WHO recommended levels. We are short thousands of people,” Kiik explained.

British strain spreading rapidly

Professor of virology Andres Merits said that the British strain is responsible for 10 percent of cases. “The total case rate jumping from 600 to 1,300 is down to old strains. We can speculate that the British strain counts for 150 daily cases. This is not enough to explain the hike,” Merits explained, referring to the UK strain as an additional problem. “In a situation where existing measures are likely not enough to contain the common strain, they are surely not enough to hold back something more serious,” he said.

“The British strain is not a ghost. It is present everywhere in Europe and can be kept in check using tried and tested measures,” Merits said, adding that vaccines are effective against the British strain.

Merits added that the UK has managed well with the strain after three months of tough restrictions that are only now being lifted.

Head of the COVID-19 scientific advisory council Irja Lutsar said that scientists are working on a dataset concerning the prevalence of the British strain in Estonia. “While the British strain seems to be up and coming, a full lockdown is the quickest way to bring down infection, whereas it doesn’t matter which strain we are talking about,” Lutsar explained.

Hanna Sepp, head of the Health Board’s infectious diseases department, said during the COVID-19 press conference on Monday that Estonia has identified 178 cases of the UK strain and nine cases of the South African strain. The British strain has been domestically transmitted in 136 cases.

Minister Tanel Kiik explained that initial signs suggest the mutated British strain is becoming dominant.