Adaptive quarantine: is only half the country really ready for mitigation?
The Ministry of Health is now opposed to quarantine concessions in 11 regions and in Kiev. How do regions determine their readiness and why are there doubts?
An adaptive quarantine model has been introduced in Ukraine – the second of five steps to ease government-approved restrictions will begin. But in the near future, they will not be able to rejoice in relief far from everywhere. According to the epidemiological and risk assessment method approved by the Ministry of Health, only half of the regions are ready for the start of a new phase of quarantine exit.
In this case, experts pay attention to the “flaws” of the proposed model which, in their opinion. In particular, the outcome of the assessment does not depend on the number of new patients detected in a particular region or locality, but on the number of tests performed. According to the treatment protocol for Sovid-19 (if you let doctors and law enforcement “test” outside the brackets), the tests are only performed for contact persons of people who are already sick. In other words, in regions where there are fewer patients, there are no mass tests. Consequently, these regions and cities do not meet the “standard” reduction in quarantine. As an example, they cite the Poltava region, where, according to the Ministry of Health, it is too early to weaken quarantine. Although there have been virtually no new cases of infection in the region in recent times.
But “reinsurance”, when quarantine restrictions are extended to “epidemiologically clean” areas, is not all that bad. The problem will be if you hurry up and quarantine establishments and regions prematurely with a large number of patients – only on the basis that active tests take place there. Ukrinform decided to study the epidemiological assessment methodology in more detail, to learn about the guidelines of central and local authorities and to give the green light to quarantine concessions. And also to summarize the information on the regions whose inhabitants will not be able to benefit in the near future from the advantages of the second stage of the quarantine mitigation measures.
How is the will of the regions to weaken quarantine determined and what is wrong?
In areas that will be allowed to relax quarantine restrictions, public transportation (including suburbs and intraregions) will resume, religious events will be allowed (1 person per 10 m2), hotels (without restaurants). From June 1, gymnasiums, fitness centers, swimming pools will open, interregional transportation will be restored. From June 10, it will be possible to be in the premises of cafes and restaurants. This was said during a briefing by the head of the Ministry of Health Maxim Stepanov.
There are three preparation criteria to weaken quarantine in the regions of Ukraine. The first is incidence, which is the average number of coronavirus cases in the past 7 days per 100,000 people. This indicator must be less than 12 people. Why so much? Maxim Stepanov explained that when the figure was determined, they took the data as of May 11, when the first step in reducing quarantine was introduced. Then we determined the coefficient of resistance – the ability of our health care system to provide appropriate assistance, the congestion of the beds. “Thus, we have reached indicator 12 – it is completely adequate, understandable and responds to the deterrence strategy that Ukraine has chosen,” said the minister.
The second is the congestion of beds in health facilities for the hospitalization of patients with coronavirus, which should be less than 50%. This figure has so far been exceeded only in the Chernivtsi region (55%). In fact, it should be correlated with the number of infected people detected. The more people infected per 100,000 people, the larger the size of the beds. However, in some regions the situation is the opposite, for example in Zhytomyr, Nikolaev, Rivne, Kharkov – the incidence is lower than the congestion of beds in hospitals. How is it possible? Question to which I would like to hear the answer. Most likely, the fact is that the doctor makes the decision to hospitalize the patient, so this indicator may be somewhat subjective.
The third – the number of PCR tests and immunoassay tests – should be more than 12 per 100,000 inhabitants within 7 days. This criterion has been the most criticized. As noted by former Deputy Minister of Health Pavel Kovtonyuk, he enters into a mutually exclusive relationship with the Сovid-19 treatment protocol, according to which testing should only be done for contacts of people who are already sick. “There are fewer patients – fewer tests. Becomes less testing – you can’t weaken quarantine. Like the Poltava region, where there are almost no patients (the incidence in the region is only 0.65 per 100,000 inhabitants and the bed occupancy is 1.49%. – NDE ). Error 404, “wrote Kovtonyuk. Therefore, a logical question arises – why the Poltava region, like Chernihiv, should continue to maintain strict quarantine?
Although, for the sake of equity, it should be noted that in Italy, during the transition from the first to the second weakening phase, the quarantine was guided by similar criteria. Namely: the stability of the virus transmission, the lack of overload of hospitals, active preparation (for the civil protection prevention system), the possibility of operational tests of all suspected cases, the ability to provide resources adequate for contact tracing, isolation and quarantine, writes Glavcom.
Quarantine exemptions. To whom to rejoice, to whom – to wait …
The national health ministry says: in Ukraine, almost half of the regions are not ready to take the second step to lift the quarantine restrictions imposed in relation to the coronavirus. In particular, relief is not yet possible in the regions of Volyn, Dnepropetrovsk, Donetsk, Transcarpathian, Kiev, Lugansk, Nikolaev, Poltava, Rivne, Khmelnitsky, Chernivtsi and in Kiev.
This is explained by the high incidence, the high congestion of beds in medical establishments and the low coverage of tests. For example, although the capital is actively preparing to ease restrictions – in particular, to restore full functioning of transportation – the second stage of adaptive quarantine in the city will have to be postponed. The fact is that the incidence in the capital is now 15.6, while the norm is less than 12 people. Although, according to other indicators, Kiev is ready for the next step in lifting restrictions: bed congestion – 36% (standard – less than 50%); Coverage with PLR tests is 44 per 100,000 people (the standard is more than 12 tests). The metropolitan area will not weaken anti-epidemic measures. After all, the incidence here also exceeds the established indicator. Certainly not much – 13.9 per 100,000 people. Consequently, it is possible that the situation will improve in the coming days and that the decision to postpone the second phase of quarantine in the metropolitan area will be reconsidered.
Meanwhile, the mayor of Kiev, Vitali Klitschko, calls on the government and the Ministry of Health to allow the quarantine to be relaxed. After all, the city’s epidemiological situation, he says, is under total control. The number of tests is quite high. There are enough free beds in specialized medical facilities. The excess incidence rate is due to the influence of a single incident – an epidemic that occurred a week ago at the Darnitsky orphanage for girls (more than 80 confirmed cases of coronavirus). In the future, this indicator will decrease. Klitschko therefore calls on the government to support a “compromise” version of the quarantine mitigation. “Allow Kiev to enter the second phase of the concessions, but not all. And those who are essential to the city and to business. In particular: restore the functioning of land public transport (there should be no more passengers than seats in lounges) and commercial establishments up to 1000 square meters – from May 23. And do not open before the children’s and sports fields. To open the metro, as planned, on May 25 because the city is suffering from the collapse of transport, “said the mayor during a daily briefing.
But in the Lviv region, where, according to the Ministry of Health, the quarantine may be weakened, on the contrary, they decided to play it safe. And they moved the start of the second stage of adaptive quarantine to May 29. As explained in the regional state administration, the restrictions remain at the same level due to the increase in the number of patients with coronavirus. “The day before, COVID-19 was confirmed in 65 people, 53 others were hospitalized for a suspected coronavirus infection. It is early to speak of a significant weakening of quarantine in the region, because our priority is to to preserve the health and life of the inhabitants of the region, “said the president of the regional state administration Maxim Kozitsky. He is particularly concerned, he said, that there are more patients with a severe course of the disease in the region. In particular, 30 people are now in intensive care.
It should be recalled that the responsibility for making and implementing decisions to mitigate or strengthen local quarantine will henceforth be assumed by the regional commissions for technological and environmental security and for emergency situations. Subject to compliance with three objectives. And, of course, with the preservation of compulsory regular disinfection, the maintenance of social distance, the wearing of masks and the presence of identity documents in the streets.
Julia Gorban, Vladislav Obukh, Kiev
According to the materials: ukrinform.ru