We have reached a health emergency

While Estonia has already been in some risk of being part of a health emergency, the Health Board has now declared a state of emergency due to the increasing risk of infection. Hospitals and the ambulance service are preparing for an increase in the number of COVID-19 patients and, during this state of emergency, patients will only be hospitalised when they require urgent medical care. For now, scheduled treatment is not yet being disturbed, but we must also be prepared for this development.

Üllar Lanno, director-general of the Health Board, has decided that the increased spread of COVID-19 has to result in the declaration of a state of emergency. The level of preparedness for healthcare providers will be raised as of 20 August. Declaring a level two emergency above all means a new level of preparedness for the ambulance service, providers of in-patient specialised medical care, and providers of general medical care, They must be prepared for a situation in which the number of people needing help exceeds the normal capacity for service providers to be able to provide that help. ‘At this point, scheduled medical treatment is not yet being disturbed but, regrettably, we are back in a situation in which hospitals must allocate additional beds for COVID-19 patients. We can see a trend which shows people ending up requiring hospital treatment, primarily unvaccinated people. This allows us room to hope that the need for hospital treatment will be more modest when compared to the peaks of the previous wave of the virus,’ Üllar Lanno explained.

The Health Board lowered the threat level on 1 July. Since then, healthcare institutions have been focussing on supplementing their supplies and restoring scheduled treatment. ‘The new wave of infections has hit us two months earlier than last year’s spike in numbers. We have been focussing on increasing the number of vaccinations, as immunisation allows us to keep society open to the greatest extent possible. Restrictions must be implemented, however, keeping in mind the fact that over half of the adult population has already been vaccinated. The Health Board would like to thank everyone who has already done their duty to this country by getting themselves vaccinated,’ said Lanno.

Last year, a health emergency was declared in Estonia when sixty-three COVID-19 patients were already in various hospitals. Today (as of 11 August 2021) there were also sixty-three COVID-19 receiving hospital treatment, with four of those individuals in intensive care and three having been placed on a ventilator. In total, 1,265 COVID-19 patients have died in hospitals, and hospitals have closed 8,263 COVID-19 cases involving a total of 7,893 people. Based on an epidemiological assessment, the R₀ (or ‘R’ factor) is currently at a too-high a figure of 1.2, and the number of cases out of every thousand people in Estonia over the past fourteen days is at 223.60. Based on the ECDC risk matrix, the intensity of the epidemic can be classed as being high all across Estonia. The percentage of fully vaccinated people in Estonia is 44.1%. The share of those adults who have received at least one vaccine shot amounts to 60.2%.

‘The situation regarding the infection has changed rapidly in Estonia and in neighbouring countries. As we have warned since the beginning of July, the coronavirus delta variant spreads at least a third quicker than the older alpha variant, and this fact has turned out to be the greatest issue in the current fight against the virus. We have been able to restrict outbreaks quickly, but the infection potential for the virus is extremely high. We have seen outbreaks at outdoor events, which proves the high level of risk of infection,’ said the Health Board’s director-general.

The organisation of healthcare services during a crisis is based on the principle that resources are limited and must be allocated so that the capability to be able to provide urgent care is ensured above every other consideration.

Health emergencies are divided into three categories in Estonia:

• Level 1: declared in the case of the risk of a crisis
• Level 2: implemented in a crisis situation, after the risk has materialised and when it is causing a disturbance to the continuity of a vital service
• Level 3: implemented in the event of an extensive crisis.

This spring we were very close to declaring a level three emergency. If a level three had been declared, Estonia would have reached the point at which the healthcare system would only have been able to provide urgent care, as the volume of COVID-19 patients would have exceeded the system’s capacity to properly treat them. In the case of a level three emergency being declared, scheduled, out-patient, and even emergency medical care would have been limited. This would have meant the need to make difficult choices in hospital waiting rooms in order to ensure that urgent care could be supplied to individuals who may otherwise have died or who could have ended up with permanent damage to their health if they had been denied care or if such care had been postponed.

‘Let’s hope that we will never have to declare that highest threat level in Estonia,’ said Üllar Lanno at the time at which last year’s raised threat level was able to be lowered. Now, with the same Health Board director-general declaring a raised threat level once again, the healthcare system is moving back towards a process in which it must limit scheduled treatment from the end of August. ‘The disturbance in continuity for the hospitals and their normal schedules is certainly of concern. All of those people who have been postponing the decision to get themselves vaccinated should now realise that the time has most certainly arrived! We must learn to cope with the virus. We must also keep in mind the fact that it will not be disappearing anywhere in the near future,’ he said.