People don’t feel safe until loved ones do not fall in the intensive care unit: an interview with Victor Lyashko about the epidemic of coronavirus

Ukraine can go a Chinese company for clinical trials of a vaccine against COVID-19

After the weakening of quarantine in Ukraine every week record “records” the number of patients with coronavirus. The critical situation in the Carpathians – in the region begin to open additional medical facilities.

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What measures will the Ministry of health in case of further growth in the number of patients, how to work with schools on 1 September and will the country receive a vaccine against coronavirus – in an interview with “Today,” said the chief sanitary doctor of Ukraine Victor Liashko.

– Recently, the employment of beds in hospitals in Transcarpathia reached 70%. This is a very high figure. In a matter of days hospitals can be overcrowded. What to do?

– Indeed, we see increased morbidity in Transcarpathian region. The same situation in the Lviv and Volyn regions. Transcarpathia is already attracting hospitals in the second wave. This process provides and we to prepare for it. There are hospitals of the first wave, which concluded contracts with the National health service and assist patients with coronavirus disease. In these hospitals there are places for adults, for children and resuscitation. There is also the resuscitation team, for which the calculated rate, and NCSU pays for their work. If the occupancy of beds in the hospital reaches 50%, the region should prepare the next hospital with the second wave, which will hospitalized patients. The inclusion of the hospitals of the second wave in the list of clinics that can help patients with coronavirus, occurs after occupancy of beds reaches 75%. These 75% are not from all sites, and separately for child, adult and resuscitation. For this just follow the health departments of the regions. We saw that in the Transcarpathian region, the Department is allowed to hospitalize in the hospital of the second wave, not counting the filling of beds. So we quickly organized a teleconference, again explained everything and the process went. Three hospitals definitely included in the list of hospitals that provide assistance to patients with COVID-19, and then the head of the regional state administration together with the Department of health fulfills a mechanism to expand the number of beds to assist. In parallel, preventive activities, which should prevent patients.

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– You now see the risks for the individual cities, regions, where beds lacking?

Yes, we see such risks and work with these regions. The day before yesterday (1 Jul. – Ed.) We held a conference call with Zakarpattya, Rivne, Volyn, Lviv, Ivano-Frankivsk regions. These are the regions in which most hospitalized patients. Chernivtsi region has long been at the peak, now the number of active patients on 100 thousand inhabitants is constantly decreasing. Now the region goes to indicators that mitigate quarantine measures. For these areas it was necessary to tell you how it’s done, not to hurt the physicians that they were protected and provided with personal protective equipment.

– Will there be enough of Ukraine of the hospitals in the second wave? In the first wave were the most prepared, and the second wave included the rest of the hospital, less prepared?

– It is not. For the first wave was defined by the hospital to spray patients in all hospitals and there was no nosocomial infection below the virus is not picked up by other patients. In the first wave of 25 thousand beds. Out of these 25 thousand 16 per cent. We see the power margin among hospitals of the first wave. But such interest cannot be regarded Ukraine as a whole, so each area is considered separately. And the occupancy of the beds we took as an indicator that tracked the mitigation of quarantine and the introduction of austerity measures, and the daily occupancy of beds is published on the website of the Ministry of health. This allows us to track the dynamics. The next stage is 10 thousand beds at hospitals of the second wave. And now they have to modernize. Since the beginning of the epidemic increased the number of beds, which is oxygen, and the doctors are now trying to bring to the ventilators. The quality of medical care allows the patient on oxygen to pass critical stage and bring people to outpatient treatment. The number of people on artificial ventilation of lungs is constantly decreasing, despite the fact that the last time there was a jump in the number of patients.

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Since the beginning of the epidemic increased the number of the ventilator 1,100, 1,700 – monitors patients, about 900 oxygenators. That is, the material-technical condition of the hospitals is improving, plus go the additional purchase for the funds of the state budget loan from the world Bank, EBRD. Modernization of healthcare institutions allows to expand opportunities and to provide medical assistance.

– Control over the implementation of quarantine requirements imposed on local authorities. But if in Kiev still wears a mask, the Kiev does not. For example, on the weekend I was in Kherson, in transport and at the entrance to companies are warning that no masks are prohibited. But when you come to the mask, it turns out that all the staff including, without masks. Obviously, the control isn’t working. What’s with this plan to do?

– People do not feel the danger until, until someone from the family or relatives does not fall in the intensive care unit with coronavirus disease. Only then is there sense of danger and have no warning, comply with all requirements and restrictions. I have a lot of messages and calls with questions: “What to do? Our close relative or friend was hospitalized with COVID-19”. Such things are better not to joke and follow recommendations and influence to curb the spread of the disease.

– Do you plan to strengthen control by means other than the use of control by local authorities?

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– He was working. Local authorities by law are responsible for the observance of quarantine in a particular area. Also, increased supervision by the State service for food safety, which monitors compliance with the requirements in catering establishments, institutions of mass stay of people, and also by the police. It is the authorities that control the quarantine at the national level. Also the State service for labour monitors the observance of sanitary norms in large enterprises. In particular, in one of decisions of the Commission on questions tekhnogenno-ecological safety and emergency situations in question, it is necessary to strengthen control at the enterprises employing more than 250 employees, to prevent the mass distribution COVID-19.

– In Kiev, have imposed restrictions, according to which institutions are unable to work after 23:00. Such decisions – it is not an imitation enhance quarantine activities from local authorities? Hardly coronavirus infection active is transmitted after 23:00. If it really does not affect the spread of the virus, then other cities may start to imitate the strengthening of quarantine measures.

– Limit the operation of establishments to 23:00 set by the decree of the Cabinet of Ministers of Ukraine in order to eliminate the operation of night clubs and discos for the period of quarantine. Since the last massively violated anti-epidemic norms when in a confined space indoors there is a large number of people. This all leads to high potential risks of infection with coronavirus.

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Understand why some local governments are afraid to make unpopular decisions, like imposing restrictions on restaurants. On the nose the local elections. They all want to earn political points. But, in my opinion, no political dividends should not prevail over the preservation of life and human health. Therefore, the proverb “One man is no man” could not be better illustrates the need for enterprises to combat coronavirus and overcome the effects of the epidemic. Only by combining (national government, local government, business and people) we can overcome coronavirus disease and save the lives and health of Ukrainians.

– Until recently, the morbidity rate in Ukraine was in Poland – with a delay of two weeks. It seems that the country has deviated from this path and ahead of Poland. Why did this happen and what are your predictions, how will be distributed the incidence?

– To predict the spread of coronavirus disease is difficult because of several mathematical models analytical institutions showed 100% disease development. When we said go after Poland, we went with her to the quarantine restrictions, and dynamics was one to one with a delay of 14 days. When did the easing of quarantine measures – they were not mirrored, but very similar, it’s probably influenced people’s perception of easing of the quarantine as his undoing. It gave the effect that we have today in many cases.

– Europe opened us border, but Ukraine is open to all. We have the criterion “red list” of countries weaker. Why action in Ukraine differ from those in European countries, although we have seen shows the deterioration?

– The night before we prepared the resolution, the EU countries have discussed how they will open the border. They spoke about restrictions for countries where more than 40 active patients per 100 thousand inhabitants. This is the norm and we have used and divided up the country into “red” and “green” zones. But the EU has not agreed on this position. Then on 1 July they agreed on a standard 16 patients per 100 thousand of population, and us – 26 because of the surge, when our day was 900-1000 new patients. Today the EU countries are closed for travel, and working the diplomatic channels are working.

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– How many in Ukraine now patients per 100 thousand inhabitants?

– If we are talking about active cases, we have 58 active patients on 100 thousand population. If we are talking about the last two weeks, on July 2, we have 26 per 100 thousand

Prime Minister Denis Shmyhal stated that when the indicator 60 infected per 100 thousand inhabitants the restrictions will be introduced at the country level, areas. What limits it?

– This question was 10 days before the start of EIT (external independent testing. – Ed.). We have seen dynamic growth in the number of patients and approved the figures at which we had to make a decision: will we hold UPE or move it to the improvement of the epidemiological situation. Among these indicators was to achieve 60 active patients on 100 thousand population. The second indicator is if 50% of the regions is higher than the national indicators. On June 22 we gathered and saw that these indicators had not been achieved and decided that the testing conducted in already established time. When we are talking about more stringent quarantine, on the quarantine adaptive (which is valid until 31 July) in excess of one of the four indicators for three consecutive days the chief state sanitary doctor of the region refers to the Commission on questions tekhnogenno-ecological safety and emergency situations. He points out specific reasons why this is so and offers suggestions that you need to consider at the regional level and adopt strict limits.

And if there was 60 patients per 100 thousand inhabitants in the country, will be taken some of the all-Ukrainian action?

– This figure was laid under contrib.

– Apart regions on adaptive quarantine can be closed in a certain city. Now you see what the city can be closed in the near future?

Now adaptive quarantine allows you to close not only the area. Can be closed by the area or district in the city, a certain town, a certain area, e.g. forbidden wedding, the functioning of the restaurants to 11-12 hours.

We national level no monitoring the situation on human settlements, we track indicators at the regional level. Heads of headquarters for elimination of consequences of emergency situations with the main sanitary doctors a more detailed look at areas and settlements.

– Kyiv school of Economics predicts that the outbreak will be in the Odessa region, which borders with Moldova and are experiencing growth. There is really a growth of 37%. Planned closure of Odessa and resorts in the region?

– Everything will depend on the achievement of the criteria we talked about. They can introduce restrictive measures that could lead to a particular effect and the recreation season. There is another parallel there is a risk of other infectious diseases. Recently, July 1, in Kyrylivka at the recreation center, which opened without permits, there was an outbreak of acute intestinal infection. 12 children under the age of 7 years with diarrhoea admitted to the infectious diseases hospital where they can help and coronavirus diseases. This all leads to additional stress on the health care system.

– That is, hard constraints are considered only at the level of regions?

– Until then, until we see that the situation ceases to be controlled at the level of the region and the need to gather and take action at the national level.

– Transcarpathian region even comes close to such an uncontrollable level?

– No, in Transcarpathia increased the number of patients and number of admissions, therefore, added the hospital of the second wave. Now the situation has stabilized, the number of patients increases with progression – fixed a number of cases, but it was more than the average for Ukraine, and we are watching this situation.

– And what criteria uncontrolled nature of illness and what measures can be used? This may be a full closure?

– Close we went when we didn’t know how to behave in coronavirus illness and the spread of the virus coincided with the growing season the incidence of influenza and SARS, therefore, decided on the complete closure of social distance. Now need to plan approaches to implementation of quarantine. We estimate that yields the greatest effect, and that the smallest and how it all start.

– What scenarios of the spread of coronavirus infection in the fall? There is reason to believe that the virus will become weaker, or, on the contrary, it will be sustainable and with the cold will be more patients COVID-19, because it will overlap another flu and SARS?

Is a new infection, and to make predictions quite difficult. Many experts have suggested that COVID-19 will have a seasonality, but that is not clearly expressed, especially in Eastern Europe.

Now we encourage to get vaccinated against influenza and are working on ways to provide free vaccination of people at risk (doctors, police), in order to prevent the combination of the two dangerous diseases.

– You already have rules which will operate schools and universities on September 1?

– We are considering different options, but now on the agenda for the safe conduct of external independent evaluationto draw conclusions and lessons. The other day we talked with the new acting Minister of education and considered several options that can be in the case of complication of epidemic situation to do it remotely, and that – online. What lessons can be moved, what should be the content of the classes, as it can affect the economy given the fact that the school performs the function of childcare, while parents are at work. We are looking for colleagues from other countries, who resumed his studies in the schools in may. We have a few developments. It’s all spoken, but now we are not ready to make the final result.

Distance learning is envisaged as a possible option for our schools?

– As an option – considered. Perhaps some lessons can be remote, but now I’m not going to comment because it’s premature.

Health Minister Maksym Stepanov said that Ukraine has begun negotiations with several countries for pre-order vaccines against coronavirus infection. What the results of these negotiations?

– Negotiations are under way, but the question is, what vaccines yet. There is only development, and just recently the Chairman of the world health organization Tedros said that is 141 the development of a vaccine. I know that we had negotiations with a producer from the European Union. Plus there are talks on the arrival in Ukraine of one of the Chinese manufacturers to conduct clinical studies. American manufacturers say that, in case of successful registration of the vaccine, they will not have priority countries, and they will proportionately distribute the vaccine to all, regardless of economic opportunities.

– I understand that the purchase of vaccines to be included in the budget for next year.

– Yes, but we don’t know neither the cost nor age, nor the multiplicity of the introduction of the vaccine, and therefore still not identified the risk groups that need to be covered. It’s all you can plan, if there are any developments. Now there are prototypes of the vaccine two to threefold, which form the immune system. The cost is now generally no one reads, so it is quite difficult to plan budgets. This issue will be raised during the planning of the budget, which will be built in a certain amount which will be calculated at least on the example of influenza, to purchase a vaccine if it is successfully tested.

– Now Ukraine has no possibilities to develop its own vaccine. In our last interview you said that you will have a new laboratory at the Institute of epidemiology and infectious diseases, which is available for development of a vaccine. Unable to give a timeframe for when such a laboratory would appear?

– The date is difficult to call. This work is carried out by the Academy of medical Sciences together with US in cooperation to reduce the spread of biological pathogens. This issue is studied, there are options. But we understand that since the agreements, the allocation of funds to construction takes time. At least two years this process will continue.

In Ukraine returned to the position of chief sanitary physician of the epidemic COVID-19 and the need to provide medical care to patients. As the chief sanitary doctor you are now engaged in other matters?

– In addition to the post of the chief state sanitary doctor of Ukraine, I am still a Deputy Minister of health. And in my area of responsibility is the whole field of public health, in particular strategic directions: prevention of non-communicable diseases, HIV, tuberculosis, hepatitis, infectious diseases, vaccination and blood donation.

– In previous interviews you said that there are several options for the development of sanitary-epidemiological service in Ukraine. You are now able to talk about them?

One of the options that we are now considering, is the establishment of a centralized vertical with the epidemiological surveillance of communicable and non-communicable diseases by the reorganization of the laboratory of the centers in the centers for control and prevention of diseases.

The centers for control and prevention of diseases of Ministry of health of Ukraine will be entrusted with the function of epidemiological surveillance (monitoring), monitoring, preparedness and response to hazards and emergencies in the field of public health.

We have also prepared a draft law on the system of public health, which will be allocated the responsibility of implementing the functions of public health at the national, regional and local levels, the establishment of a network of centers for control and prevention of diseases, identifying sources of funding after experiencing a pandemic coronavirus disease COVID-19 in Ukraine.

– How to change the algorithm of funding infectious disease hospitals, offices and when?

For infectious disease hospitals until the end of the year will be developed and approved a package of services that will ensure their constant readiness to respond. Infectious diseases hospital could not be financed on the occasion. There must be a system that runs permanently in the country and which in the event of an outbreak will be ready to provide medical assistance.

– Some media reported that you will stand in mayors of Kiev.

– I don’t know, there is still the 208th district in Chernihiv region – there will be elections of people’s deputies. Perhaps it will be interesting to realize their political ambitions.

And you are going to file his candidacy?

– I think there Lyashko will be in the lists (Central election Commission has scheduled elections in single-mandate constituency № 208 due to the death of people’s Deputy Valeriy Davydenko. In may Davydenko found in his own office with a gunshot wound to the head, the gun was next to him. Later, the leader of Radical party Oleg Lyashko said that he will run in the parliamentary elections in constituency No. 208. – Ed.).