New coronavirus, which is on a rampage in China has taken the lives of 170 already. As for January 28, the number of new sickness cases increased to 4515. Many countries are taking measures to prevent the virus from invasion. What about Ukraine?
The outbreak of the new coronavirus (World Health Organization defined this virus as 2019-nCoV) in Chinese Wuhan at the end of last year was one of the most discussed issues. The sickness cases were already found in South Korea, Japan, Singapore, the United States, Thailand, France, Australia, Canada, Nepal and Germany. So, many countries not just express condolences about the situation, but also mobilize in taking measures to prevent the appearance and spread of the virus.
For example, a number of countries are ready to evacuate their citizens from the problem territory: France, Spain, Britain, Germany, Italy, Japan and some others. Some countries have already suspended the sale of tickets or organization of trips to China because of the risks of spread over untimely detection of disease of tourists (tourist offices of Russia and France). What is the situation with preventive measures in Ukraine? У Global Health Security Index 2019 (which assesses the readiness of countries for epidemics and pandemics) Ukraine is on 94th position out of 195 countries near the Dominican Republic, Zimbabwe, Nigeria, and Iran. Maybe our country is facing problems and we need to resolve them quickly.
Theoretical level of readiness for the threat
On January 28, a press-briefing took place concerning “Situation with coronavirus infection 2019-nCoV”, where the officials claimed that Ukraine was ready “to meet” the virus and take it under control.
“The Health Ministry is taking enough coordination measures, so the country and all the system is ready to react timely,” Director General of Department of Public Health Andriy Skipalsky noted.
Health Ministry of Ukraine issued an order on January 24 “On measures to prevent invasion and spread on the territory of Ukraine of sickness cases caused by coronavirus detected in Wuhan (Hubei Province, China).” The order regulates the creation and establishment of emergency response center on prevention of invasion and spread of 2019-nCoV virus on the territory of the country, and define recommendations on what to do in case of turnout of person sick with 2019-nCoV.
According to Andriy Skipalsky, besides this, in order to ensure control over situation and prevent the spread of the virus, the head office made several decisions:
- Introduction of temperature screening on direct flights from China (UIA from February 3 suspends direct communication with China due to the risk of invasion of coronavirus), and spreading information materials + collecting information on travelers for tracking.
It is important to note that temperature screening does not guarantee that the virus will be detected. After all, 2019-nCo can be transmitted during the incubation period, when a person does not even suspect that he/she is ill. The president of the Association of Anesthesiologists of Ukraine, professor-anesthesiologist Serhiy Dubrov confirmed this thesis, noting that the incubation period is up to 12-14 days and there can be no symptoms during monitoring at the airport or plane, but the Ministry of Health recommends it anyway.
In addition, it is strange that, given the long incubation period, it was not about quarantine for the newly arrived people. As, for example, in France: according to the French Minister of Health, Agnès Buzyn, returning people will spend 14 days in the quarantine.
Former MP and doctor Olha Bohomolets supported such measures, noting on her Facebook page: “All tourists who return to Ukraine from areas of epidemic risk must determine the duration of their stay in a house quarantine.”
Moreover, as today the temperature screening applies only to those who arrived on direct flights from China, there is still a risk of bringing 2019-nCoV to Ukraine. For those traveling on indirect flights, the only check may be a screening questionnaire:
“Work is underway to introduce screening questionnaires on board of the planes from China on direct flights, and there is a discussion about indirect flights, where screening questionnaires will also be introduced to inform passengers and collect relevant data on suspected coronavirus,” says the Director General of the Department of Public health of Ukraine Andriy Skipalsky.
- Informing the health departments, laboratory centers and other institutions that are a part of the health care system about how to act, how to detect a case and how to act on a suspected case (providing a list and phone numbers of specialists who are ready to advise on an on-going basis).
There are doubts about the correctness of the criteria for determining the disease case, because, according to Olha Holubovska, chief freelance infectious disease specialist of the Health Ministry, there should be an explanation for each doctor what a suspected probable and confirmed case is: “There should be clear criteria. But the order says that any person with a respiratory syndrome, any pneumonia, regardless of whether he/she was in China or not, is subject to a suspected case. Now we will have more patients than in China, if we will be guided by this definition.”
Public Health Center also held additional measures such as training or coordination meetings with the heads of laboratory centers regarding the actions, response measures and coordination.
“Over the past two days, relevant teleconferences have been held to clarify the situation, and checklists have been prepared for general practice doctors, for patients who need advice on certain risks of infection and ingress of infection on a given territory,” the acting Director General of the Public Health Center of Ukraine Ihor Kuzin says.
The sanitary-quarantine units that operating at the Boryspil International Airport have been reinforced. At the moment, they work in a round-the-clock mode. The emergency ambulance teams and epidemiologists are on duty to help collect certain epidemiological information and assess the risks.
Practical level - medicine availability in hospitals
Theory is good, but what's there in practice? Are hospitals ready for this challenge?
Serhiy Dubrov, professor-anesthetist and the President of the Ukranian Society of Anaesthesiologists, says that the Ministry of Health instructed him to talk with all the heads of the intensive care of the anesthesiology service of our country: “757 departments, which are subordinate to the Department of Health, are 100 percent provided with oxygen (one of the main methods of treatment for the patients with hypoxemia is oxygen therapy)". In addition, the professor-anesthesiologist notes that the level of material and technical support is also satisfactory - the provision of high and middle-class respirators in Ukraine is 0.62 per an intensive care bed, there are 5581 such beds (that means that in case every intensive care bed is occupied, almost every second patient will be able to get these respirators).
“If we talk about Kyiv, I’m positive about the Oleksandrivska hospital and the Hospital No 4. These are the hospitals that have well-equipped intensive care units, and they will be able to save people's lives. But I doubt about the other hospitals in the country,” said Yury Zhygarev, an infectious disease doctor.
Serhiy Kravchenko, the President of the National Medical Chamber of Ukraine, also has doubts: “One of the methods for treating coronavirus is extracorporeal blood saturation with human oxygen, but there is only one device in Ukraine - at the Todurova Heart Institute.” According to the expert, renting this medical apparatus will cost $3,000 - $5,000 dollars per day.
There is also another problem that makes us worry - today in Ukraine, like in other countries of the world (except the USA), there is no test for 2019-nCo detection. But a diagnostic algorithm has already been developed on the national level. It allows to identify a new coronavirus by the method of elimination:
First, the patient will be tested for influenza - for this, express texts will be used to determine type A and type B flu.
If it turns out that the symptoms were not caused by the flu, the patient will be checked for other viruses, including the already known coronaviruses that circulate in Ukraine.
If no matches are found, one can suspect that the person is sick with a new coronavirus (to confirm the opinion, it is worth checking whether the patient has visited a country where the disease is common).
“According to the information of the Deputy Minister of Health Viktor Lyashko, an agreement has been reached on providing our country with kits for polymerase chain reaction at the end of this or the beginning of next week,” the President of the Association of Anesthesiologists of Ukraine Serhiy Dubrov said. Diagnosis will be carried out at the national level in the reference laboratory, which will be determined by WHO.
The directors of health departments were also instructed to develop routes for hospitalization of patients in case of a certain infection, with the specification of treatment measures and hospitals that are better equipped and the staff that is better trained for this therapy.
Former MP and doctor Olha Bohomolets advises the government:
In airport it is better to hold not a questionnaire, but a temperature checks of all the tourists who come to the country;
It it worth creating a quarantine zone for the sick people with suspected coronavirus and define the algorithm of actions in such cases;
To define and publish a list of laboratories which can make appropriate tests;
To recommend Ukrainians to refrain from work and touristic visits to countries with high risk of getting infected.
To update daily the list of countries in which the cases of coronavirus infection were registered.
Bohomolets adds that it is important to create a mobile team in case of finding the first symptoms of virus infection for people who came from high risk areas to gather necessary test materials at patients’ houses. It will decrease the risk of infecting much bigger number of people.
While Ukraine is thinking how to keep away the coronavirus, the Chinese government has allocated about $9 billion to contain the coronavirus. A special hospital was built in a few days in Wuhan for those infected with this type of virus. Neighbors of China close the borders with it and suspend transport communication. Other countries also suspend airlines flights to China. Meanwhile, in Ukraine, according to the head of the National Medical Chamber, Serhiy Kravchenko, officially there are only two anti-plague suits (you can see how on many photos Chinese physicians walk around in them) - and these were purchased during the 1980 Olympics.