About the phenomenon of unreported cases of COVID-19. Op-Ed by Ala Tocarciuc

In addition, we can avoid a possible humanitarian catastrophe in villages, where there is no access to the doctor, and the virus is boiling, it is made a cage, and rather it will set fire to...”

Last week,  the World Health Organization issued a press release stating, among other things,  that there are many unreported cases of COVID-19 worldwide. According to WHO estimates about 10% of the global population has already been infected.

If we start from the world’s population figure around the globe equal to 7.7 billion people, it means that about 770 million people have already been infected, but most of them remain untested and unreported.

The phenomenon of unreported cases is present also in our country and is geographically more present in rural areas, being driven by inequalities of access to health services. If we apply the rate declared by the WHO, we get around 300 000 cases of infection cases already in the Republic of Moldova, and about 80% of them remain unreported.

What would be the main causes of this phenomenon?

There are many causes, but I would mention here only few of them: insufficient and highly polarized communication in some cases, limited capabilities in the primary medicine sector, limited testing, the impact of conspiracy theories and denial of the existence of the pandemic, low living standards, deep poverty.

All this contributes to the neglect of the symptoms of the disease, delayed referral to doctors, the application of non-traditional treatments, the avoidance of the medical system by many people already infected, which ultimately causes the uncontrolled spread of the virus in the community.

What are the real consequences of unreported cases?

The most serious consequence of unreported cases is the spread of this pandemic at high speed through all the localities in the country. While in cities the level of information and the degree of access to the doctor is still maintained within certain limits, then in the villages there is a major risk to trigger a humanitarian catastrophe.

A few days ago, someone was telling me about multiple cases of COVID-19 from a village in central Moldova. Basically, in an entire slum everyone was sick and everyone at home was applying various self-treatments recommended by someone over the phone, including antibiotics injected. There was a lady from the slum, who in the morning would take the cow to the herd, then go from house to house and give injections to the sick, without a mask, without gloves, without knowing that she was transmitting the contagious virus from house to house. I couldn't believe what I heard. But it's a reality, too.

I was trying to make a simple estimate of what's really going on out there. According to the collected data, for a village with 500 people, infected by COVID-19, 20% of the sick people would have serious to severe forms. So, out of a village with 500 people infected, we would have 100 people with mild to severe symptoms and of them, at least 25, would require hospitalization in intensive care unit, and at least 15 would then pass into the death statistics.

If none of these 500 people in that village get to the doctors, do the tests, don't treat themselves properly, then,  as a result, the deaths could pass up to 10% of them or around 50 people. That was the average death rate in Italy in March, when there was no access to health services. In larger villages, those losses will be much higher. These losses will be found in death statistics, even in the situation, when they will not be found in pandemic statistics.

In fact, these reflections are not about unreported statistics

These reflections are about human lives, hidden by these statistics. Maybe it's time to think now about what we do with the villages of Moldova, where there is no family doctor, where there is no pharmacy, where it does not catch the mobile phone, but there are people infected with COVID-19? How do we provide these people with access to health care and how do we keep them in the statistics of the active and working population?

The pandemic is a test for every member of the community, but it is also a double test for those who have chosen to serve community through authorities of various levels. Their degree of responsibility is far superior to the responsibility of an ordinary citizen. From the actual decisions and actions of the authorities, depend on how we live in a month or two from now. Their inactions can have serious consequences and serious human losses.

No country will be able to stop this pandemic, until a vaccine is approved. The most countries apply now the restrictive measures to achieve pandemic slowdown and control over patient flows.

What actions are now required in the short term in Moldova?

The major emergency is the identification of all those infected and their contaminants. This can be done at community level through telephone communication, through the offices of family doctors, through other channels. Each town hall can easily identify the approximate number of infected. We have 900 town halls, so we would receive 900 tables with data, which would create a real picture of the situation in the country, an understanding of the real needs of hospital beds and a possible estimate of the subsequent development.

As an idea for possible use of software, I would propose the use of software from the election. It's just that instead of party names there are other terms. And the data can be consolidated online in no more than 48 hours for the whole country. We're small and compact, and very connected country. It's not complicated to collect these data, if we want to. We also have people trained in using the software already in all villages.

With the data collected we will see the situation and understand what resources we need, where we should apply quarantine, where we only isolate the outbreaks. We will also understand how we conduct elections, how many mobile ballot boxes we need, etc.

The direct communication with all infected people and guiding them to a health communication center is very important. About this online center I've written before. Primary triage of patients can be carried out online, and then with ambulances. The better we're going to be at identifying all those infected, the better we're going to be able to stop the spread of infection.

Even if we don't test them, report them, account for them anywhere, the treatment and preservation of these people's lives is more important than anything now.

We can't stop this pandemic now for good, but we can slowdown it!

At first glance it seems complicated, but it's not. We can slowdown the pandemic now and allow those already infected to be treated and released from the disease by November 1. With this, we could also avoid doubling the number of new cases by 15 November. We could enter the plateau and maintain this plateau without going into total quarantine. In addition, we avoid a possible humanitarian catastrophe in villages, where there is no access to the doctor, and the virus is boiling, it is made a cage, and rather it will set fire to...

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