COVID-19: “The State-pacient” and our homework. Op-Ed of Ala Tocarciuc

„If we carefully read our pandemic playbook once more time, we review more some chapters, we do diligently our homework again, we could help to diminish the number of new cases of COVID-19. This in turn, would also help with the complex treatment of this "state-patient"..."
Lately more and more voices are wondering, why Moldova has a large number of patients with COVID-19 compared to other countries in the region. I'm going to try to do a little analysis and propose some homework.

The COVID-19 pandemic entered Moldova unexpectedly at the beginning of March and generated a large wave of panic among the population and authorities at all levels. All of us together have gone through the vicious circle of panic, grinding fear and collective uncertainty. As a result, some have become attentive and vigilant, others still remain anxious, but there are also those who have managed to reach total negligence.

We are witnessing an intensive care process of a “state-patient"

The first actions to stop this intruder virus in Moldova were similar to those approved in other countries. Borders were closed, epidemiological sheets were completed, and the first tests were performed, several beds were prepared at the infectious disease’s hospital and other hospitals, doctors were trained and that's all about it. Morally we were prepared, and we remain prepared in the visions of many.

The exceptional state of situation was later established with all its components and consequences. Other actions followed as well, but they essentially failed to break the curve and turn it down. Moldova remains stable in ascending to all the main indicators related to COVID-19.

In fact, the pandemic found Moldova as a patient with several comorbidities, some of them chronic and totally decompensated, as well as with limited treatment options on all dimensions. And now all of us together are witnessing a process of intensive care of "a state - patient", in a situation of diagnosed acute viral infection, aggravated by polyorganic insufficiency.

The question is, how do we save this “State – patient”?

An epidemiological process has three mandatory elements:

  • Source of infection;
  • Transmission mechanism;
  • The receiving body.

And when we want to stop a pandemic, we work on each of these elements.

In the case of COVID-19 the main source of infection is man. This smart virus from the very beginning uses only humans to spread around the world. And the fact that it's spreading so fast, it tells us, that we humans are losing in this competition with a virus. This virus is now smarter than all of us, Humans. This virus uses every possible tool to conquer countries around the globe one by one. Among the most used tools would be conspiracy theories, neglect of science, social discrimination, political and demographic processes and, last but not least, human dependence on modern technologies.

To stop the pandemic it is necessary to stop the contamination chains. To stop the contamination chains, we need daily, permanent and long lasting human cooperation.

Man is the main source of infection and also man is the one, who can stop its spread.

The population of each country is now divided into three broad categories of people:

group, which is still the largest, are those who have not yet contacted the virus. They are potential future sources of infection. These people do not have traffic restrictions, as a rule, and they can activate, respecting the protection measures. Open communication and motivating these people to collaborate at the community level are extremely valuable in this pandemic.

Another group are suspects or those who have contacted infected people and possibly are also infected. These people should be quarantined as soon as they know about their status. And it would be good to test them for COVID-19.

And the last group is represented by those people who are already infected and sick, with various forms of the manifestations of the disease and are treated, respectively.

In general, there has not been and is still no universal playbook to stop a pandemic. Basically, each country in the world has tried to establish its own playbook to stop this pandemic.

The Republic of Moldova also tried to write its own playbook, sometimes with significant delays for some chapters, and multiple deficiencies in implementation on the practical side. This, in fact, has also determined our current situation and the large number of patients compared to other states.

Trying to complete the playbook with a few homework assignments

The epidemiological
supervision at the border and on the inside territory was applied at the beginning of March, when already many countries in Europe were officially entered into the pandemic. The first epidemiological investigation sheets contained major failures and in many cases did not allow surveillance of those entering the country. Family doctors were getting with significant delays the investigation sheets and often could not find people at the addresses indicated in the records. Compliance with the 14-day quarantine was not being monitored, practically. This has helped to maintain the continuity of contamination chains and increasing the number of new cases. At present, apparently, all those who enter the country fill out the epidemiological sheets, are subject to thermometry, are forced to quarantine and some are even fined for non-compliance. Moldova does not use artificial intelligence to facilitate epidemiological control at the border and on the inside territory, and this would be a homework in this chapter.

Testing of those infected and suspects is an important component in the fight against this new virus. The importance of testing is also determined by the diversity of clinical forms, from asymptomatic to very serious. If we return to the source of infection as a main element in this pandemic, then it is clear that we can identify the source of infection exclusively through testing. Without testing, each of us is a potential suspect. From the very beginning it was clear that we have limited testing capabilities in the country. There have been multiple attempts to assess the testing capabilities for COVID-19 in Moldova, resulting in various recommendations and solutions for expansion. Regrettably, we continue to see a limited testing capacity, given the increase in testing requests, driven by an increase in the number of patients, an increase in the number of suspects and, more recently, an increase in the number of those who go to other countries and demand the result of the test at the border crossing. The fact that we can now detect by testing a maximum of 500 new patients daily does not allow us to say that we have control over the spread of the pandemic. The homework is a simple and obvious one: we need new testing capabilities in every district center and in big cities.

The contact tracing and the application of mandatory quarantine to these individuals is part of the equation for breaking chains of transmission of infection. Several experts say that this task is the most complicated in the current pandemic, as there are many asymptomatic patients. Complicated, however, does not mean impossible. Many countries have demonstrated that effective contact tracing or, at the very least, reducing their impact can be ensured by applying individual protection measures, including social distancing and wearing masks. The method of transmission of the virus is already proven by research. COVID-19 is spread through aerosol or vapour exhaled by the infected person, through direct contact of at least 15 minutes. Wearing masks, respecting the social distance and mandatory quarantine would be key to efficient contact tracing and breaking contamination chains. The homework would be to develop a COVID-19 patient roadmap and ensure the efficient contact tracing throughout.

It was mentioned above that the receiving body is an important element in the process of fighting the pandemic. If we fail to protect this organism from infection through epidemiological measures, we will have to treat it. Treatment of those with COVID-19 is done in two ways: hospital treatment and home treatment. The quality of treatment in the hospital is significantly superior, and includes the testing component. Whereas treatment at home is not in all cases completed with testing, is not supervised by a medical professional and often leads to complications or chronic sequelae. Moldova is no exception to this compartment and another homework would be to prepare hospital capacities for a possible increase in the number of patients. And when we say "prepare," we mean the infectious disease and intensive care departments. And this doesn't just depend on doctors, it depends on local communities to a large extent.

The pandemic comes from "pan" - all, and "demos" - the people

Pandemic is a disease, which attacks in a short time almost the entire population of a country and comes from "pan" - all, and "demos" - the people. We, now, here in Moldova still do not have a pandemic in the full sense of this word yet, but we have a piece of the global pandemic, which grows unhindered daily.

If we carefully read our pandemic playbook once more time, we review more some chapters, we do diligently our homework again, we could help to diminish the number of new cases of COVID-19. This in turn, would also help with the complex treatment of this "state-patient".

If we remain repeaterrs and negligent, it will infect "all the people", truly.

Our actions or inactions in relation to this virus may affect our lives in the long term.

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