It has been almost a week now that we are in quarantine, living under new, albeit temporary, rules. Uncertainty is what the majority of us worries about the most – how long it will all last, when and how it is going to end. Let’s talk about that, writes Vilnius Mayor Remigijus Šimašius.
Residents of Vilnius have united to fight the Covid-19 virus. I have been trying to continuously provide information on their efforts. But this crisis, this virus and the fight against it, is not just about 'running and doing'.
We must tackle the crisis in our heads first and then use our hands and sweat. So, this fight [needs] planning, which requires analysis and forecasting. Have we seen much of this lately? Yes, I have the same impression as you do.
Therefore, let me tell you in turn where we are now, how we got here, and, most importantly, what lies ahead of us and how we will deal with it.
There are still many unknowns, but this is always the case in times of crisis. That's why it's important not only to blow the dust off different crisis plans that were safely lying in the bottom drawer, but to also plan strategically here and now, taking each step knowing exactly what we pursue, how we will measure the results, and what will come next.
The three phases that we have already passed
Although this phase is usually left out when calculating, but the zero phase of all crises is 'always be prepared'. I will not discuss [the government's response] now, let’s leave it for a time when things calm down.
So, the first phase of the virus was believing that 'the virus is somewhere far away and will probably not even reach us'. It was during the New Year's period.
I am glad that we started putting together the first plans for Vilnius back then, and this gives us a certain advantage now. Another good thing is that the strategic companies [operated] by the Vilnius’ municipality were able to practice to work together during the hybrid security exercises in Vilnius in the summer, and later during the Astravyets drill in the autumn. This comes in very handy today. But this is already the past, so let’s move on.
The second phase of the virus was saying that 'the virus is at the doorstep, it will reach us sometime.' This phase began with the first infected people in Europe, in Italy. When I said back then that it was only a matter of time before we have cases in our country, there were people calling this alarming.
However, the alarmist [measures] answered their purpose, because despite it all, we [in Vilnius] had more hygiene measures, we were better prepared methodically, we could react early to the next phase of the virus, face it being more prepared and having built more barriers to the spread of the virus.
The third phase of the virus, which is already coming to the end for us is 'we already have individual centres of infection'.
As I have already mentioned, we approached the phase with a massive, people-friendly campaign even before the centres of infection appeared. We spoke about the three most important things – handwashing, keeping hands away from your face, as well as properly ventilating premises. It is great to see that this allowed many people to get into the habit of doing these things, which is absolutely necessary now. This is an achievement of enormous importance.
Implementing the following goal of this phase – to have material supplies for future threats – is much more difficult. In many areas, our situation is not the worst, but there were cases when we faced bureaucracy (the case of Vilniaus Degtinė), lack of communication (a failure by the Ministry of Health to answer our letters and questions), shortage of information (uncertainty when it turned out that there are very few reagents in Lithuania for testing and personal protective measures), some sluggishness (when we heard others saying "we are buying,” but the pace of buying was such as if there was no crisis).
It also turned out that our expectation of all algorithms (testing, patient grouping, etc.) being at least somewhat clear has proven to be too optimistic, and now we have to create them and revise ourselves.
Here, we have missed a basic thing essential at this phase even before quarantine. Obviously, as long as we have separate centres of infection only, we can track and localise them. This requires both testing and information management. I will not talk about testing once more, as I have already talked a lot on the issue, and scientists have said a lot about it as well, and all that is very true. I am glad that testing has finally intensified (although I, together with a group of experts, asked to [increase] testing a week and a half ago).
When it comes to information management, the situation is decent. The information, which I have been asking for almost a week, on which public places and when the identified infected people visited was finally published on Wednesday.
This is for us to be able to check if we haven’t had a dangerous contact. Of course, better late than never. It is a shame that the information we receive is incomplete – for example, we still do not know which staircase [in the apartment buildings] we should go to disinfect.
I hope we will be able to receive this necessary information soon, as it is relevant so far, but will be less relevant in the next phase, as there will be insufficient resources to accurately find and localise everything.
At this phase of single focal points, we have also imposed quarantine measures, and some specialised ones first of all. Do you remember those outraged about restricted visiting of patients at nursing homes and hospitals? Later, we imposed more extensive measures, closing schools, kindergartens, sports clubs and entertainment centres. Good thing we did it, because this allowed us to win a few extra days.
Other countries having imposed quarantine at the following phase only experienced significantly greater loads on the medical system and, unfortunately, were far less prepared.
There was some misunderstanding with the government about the quarantine, because we made the decision a little earlier and were accused of [taking unilateral action]. But luckily, we managed to promptly resolve the misunderstanding by joint effort. I am glad that I no longer hear any accusations for having taken quick action. And if sometimes our rushing has encouraged others to rush as well, that is even better.
Another good thing is independent minds having joined in at this phase. I it wasn't for Professor Vytautas Kasiulevičius’ calls [to increase testing and said medical workers lack resources], some centralised decisions would have been made much later.
The fourth phase that we are entering now
Unfortunately, now we are entering the fourth phase of virus spread – ‘Infections are numerous and they are everywhere’.
At this phase, the key task remains the same – to reduce the spread of the virus. However, measures used at this phase may already be different, as we will no longer be able to catch individual focal points (basically this is a sign that we need to completely switch to a slightly different mode).
So there is a need for increased focus on protecting residents who are most vulnerable (the elderly and people who suffer from chronic illnesses), or who we are in dire need now and will be needing when / if the situation becomes even more complicated (medical specialists and operators of critical infrastructure). There may also be additional general restrictions if this is necessary, in light of the speed in which the disease spreads and the level of preparedness of the health system for the virus.
Here I want to explain one thing which the Minister of Health should do, but since he does not talk about it yet, I can. A lot or a few infected is a very relative number. According to epidemiologists, the virus will go away after about two-thirds of the population is affected. So why are we trying so hard to stop the spread of the virus, why haven’t we chosen the path of the United Kingdom and some other countries that have not imposed all these measures (at least at first)?
The answer is simple: so that the health system is sufficiently prepared to save lives. In an ideal case scenario (which is unlikely, but worth pursuing), the number of patients should exactly match the capacity of the medical system or be lower.
Why can’t we let the virus go wild?
A mistake we often see in theoretical charts of the spread of the virus is that the health system capacity is a horizontal line, like, for example, the Department of Health in the UK said. This is just a basic theoretical option [see legend 1, base morbidity rate and health system capacity scenario]. In the legend vertical axis means morbidity rate, horizontal axis – time, red line – number of cases, dotted line – health system capacity.
If we do nothing, the line illustrating healthcare capacity will go down, because the virus will not only affect the citizens, but also medical specialists. The image will look like this [see legend 2, here we have actual morbidity rate and health system capacity scenario].
The part of the curve above the health care capacity is important. This is the part that countries fear the most. If we have, say, 10,000 beds in hospitals, and there are 30,000 patients at a time, everybody will suffer, not only those infected with the coronavirus.
Therefore, the aim of almost all countries is to compress this curve, ie to reduce a rapid spread of the virus for it to stay below the medical capacity, at the same time increasing medical capacity, as its curve cannot stay horizontal.
Visually it would look like this [see legend 3, pursued morbidity rate and health system capacity scenario].
What are we doing to achieve this? If we systematically prepare, the capacity will increase as we resolve the basic limiters:
– ensure that fewer doctors become infected themselves;
– ensure that doctors are more proficient in diagnostic and prescription algorithms, and that the algorithms themselves are effective;
– ensure that managers of institutions work expeditiously to reach common goals in times of crisis rather than under normal circumstances;
– ensure material supplies. From the medical ventilators, which we do not have enough, to medication, if it turns out that there is something that actually helps, also hospital beds, and so on.
We have to be very accurate here. According to experience of other countries, out of all the diagnosed cases, 60 percent simply have to remain in quarantine at home, because they are not at risk themselves, 30 percent must be under supervision of doctors without any intensive measures, and up to 10 percent of patients may require intensive measures.
It is very important that everyone is where they have to be, so that we do not over-exploit scarce resources and thus save lives. Resources must also be prepared according to those proportions.
Unfortunately, we are in a situation where we still lack a lot, and thus we are doing everything to bring the curve of preparedness of our health system upwards.
As I have mentioned a number of times, now we are trying to get more personal protective equipment for doctors and, if the situation becomes worse, also more medical ventilators.
Going back to the curves, we must push the disease curve downward and the curve of preparedness of the health system upward to keep them together. Imposition of quarantine allowed us to buy some time, and it is very important now to fully exploit it for getting ready without any delay.
Is the fifth phase ‘hell’?
If these steps fail (and so far, unfortunately, no other country, except Singapore, succeeded in this) and the morbidity curve outperforms the preparedness curve, we will move onto the next phase. Being polite, here we will call it ‘hell’.
This does not mean a hell to everyone. But this is the phase when the health system is no longer able to serve all the infected people, so we will end up in the situation which is happening in Iran, Italy or Spain (and will soon be happening in the United Kingdom, which unfortunately initially tried to ignore the virus) today, to a greater or lesser extent.
At this phase, protecting doctors (because the situation will get even worse if they fall sick) and working hard would be the main focus, also applying the strictest measures to stop the spread of the virus, as spreading would further increase overloads.
But here I want to remind that the more cases we detect earlier, ie if we invest in the identification of all cases, a fewer medical ventilation and other equipment, facilities, and, most importantly, working hours of medical specialists will be needed.
When a brighter day comes
The sixth phase – ‘things are getting better’. How do we know that this is happening? The morbidity curve will start going down, while the health system will be able to cope. Patience will be crucial at this phase, because we all will be tired, and many will be angry about quarantine and all sorts of inconvenience and uncertainty about the future.
Therefore, I ask you to get ready for a long fight.
For many people, the fight will be special, simply learning how to be at home, without getting angry with each other (but also remembering that anger is a natural emotion, and focusing it in the creative direction is important), and finding meaning in the new routine.
Therefore, the things that we do in this direction, namely, finding various means for distance learning, self-development, cultural or other means, are particularly important. And we plan posting information on what to do with children, how to separate work and home spaces and how to find new hobbies online at http://karantinas.lt/.
Quality media and psychological advice are also very important, and I want to thank all soldiers of this frontline. But mutual respect, support, understanding (No to Bullying campaign is relevant more than ever), communication, and other forms of social networking are what matters the most, even at a strict physical distance.
The relaxation of quarantine conditions, which we will come to at some point in time, is a very delicate matter, which must not be done too early or too late. We would like to lift it as early as possible, but it depends on the effectiveness of the current actions. Let’s talk about this in more detail.
Restarting the economy and normal life without ruining everything
As I previously mentioned, quarantine allows us to win time for preparation, and therefore, saves lives and our conscience. However, it comes at a price, as these are not only economic losses, household, emotional or other inconvenience.
This includes human lives. Postponing scheduled surgeries, disrupting supply chains, and, ultimately, no economic value being created means that there will be those who are lacking, which can lead to a sad ending.
It is no secret that often protective measures devastate more people than the thing they are used to protect from. The experience of Fukushima in Japan is a very good, precisely calculated and analysed example.
Thus, I have already delegated my team with a task to analyse two things. First is to calculate how many lives the quarantine measures could cost (knowing it will allow not to go overboard here), and the second is to find out how some measures can be refined, tightening or facilitating them where necessary.
For example, it is very good that the justice minister allowed notaries to work with serious restrictions and exceptions, because for some this may mean being able to avoid bankruptcy and retaining hundreds of jobs by having obtained the necessary loans or the like (of course, more extensive use of electronic means and ability to conclude transactions remotely would be an even better way out).
Our life or our economy, to be more precise, is like a large, power-generating nuclear reactor that we constantly have to feed, at the same time keeping it from overheating. Now, this reactor has been stopped.
It has stopped to avoid an explosion with all the employees and surrounding residents. However, this will not last long. It will not happen so that one day we will simply press the button and the reactor will restart – we will have to do it slowly, step by step, or otherwise the reactor will overheat. Here the first steps must be taken now.
So, we need to start preparing for the ‘things are getting better’ phase. Decisions will be needed then, and they will not be easy. However, they will be necessary, if we do not want to face a complete collapse.
Let’s remember that no economic aid packages will help, if people cannot work and create. And if they cannot work for a long time, we will have no funds for the health system, as well. I have already discussed this with Professor Vytautas Kasiulevičius. I am glad he thinks the same way.
I will not go into more detail about the strategy to exit the crisis, because we will still have time for that. We would all like to see such a time come sooner, but obviously it will not be two weeks of quarantine, as originally announced by the government, and will take longer.
The schools will probably be closed for longer than until Easter, which many believed to be announced for supposedly way too long.
Finally, we do not know which of the virus scenarios will prove to be true – its full extent during the warm season or its recession and return in the fall, when we unfortunately will still have no vaccine for (according to forecasts, a vaccine for mass use will appear no sooner than in a year).
Either way, the general logic will be the same – to pursue that the health system is able to cope with virus cases, for morbidity and preparedness curves to match (even though this cannot be done without stress). Based thereon, quarantine conditions will be eased (or further tightened, which we definitely do not want).
What will we learn and benefit from this crisis?
I want to talk a little about what we will be like when we come out of the crisis. I very much want us to come out of it as having experienced a temporary disruption, which was pricey and inconvenient, but made us stronger. The above economic package is important for this to prevent businesses from making long-term decisions based on short-term factors.
Learning to work and live in a more innovative and creative way is even more important. For example, achieving that children having spent a couple of months at home, would be more efficient at working independently, performing creative assignments, having discovered the joy of reading, and relationship with the immediate environment, even though not having completed the entire course as per curricula (which they will be able to catch up later) – all this will come in very handy in the upcoming decades.
Moving even more services to the electronic space is very important (we can rejoice over the fact that we now have more such services than other EU countries), also organising them so that they function well after the crisis.
For example, we can already say that the public discussions of city projects in interactive video conferencing, connecting from any place, is even more effective than live meetings. I believe that many new things will be discovered and invented, which we will be proud of, benefit from and enjoy after the crisis.
I have preached here so that we can be conscious citizens of a free country, who are well aware of what they have encountered, what the future holds and what will allow making this future less loss-making or even better in some respects rather than simply being blind copiers or executors of someone else’s experiences.
And I think this is what we will be, especially seeing how enthusiastic, sustainable and persistent my team is in dealing with the crisis. Thirty years ago on March 11 [Lithuania’s independence day], my team members were [very young], but now they courageously assume responsibilities and make decisions important not only for Vilnius, but for the entire Lithuania as well.
At the very end, I want to express my joy over the incredible vitality of our civil society. It’s been a while since I last saw such joint efforts, involvement, volunteering and flow of aid that we have here in Vilnius, and I believe in the rest of Lithuania as well.
A big thanks goes to all. We are a very strong society and therefore we will come out the winners despite the mistakes that have and will inevitably be made.
Remigijus Šimašius is the mayor of Vilnius and member of Lithuania's Freedom Party.
The views expressed in this article are the author's own and do not necessarily reflect those of LRT.