Time for civic responsibility amid surge in Covid-19 cases 

Time is high for civic responsibility in the wake of a surge in fresh infection cases:

 

Prime Minister Edi Rama: This is an unusual press conference and the reason has to do with the indispensability to convey a clear message to every citizen in this country as we are witnessing a surge in the number of fresh infections and at a time when we have received reasonable signals suggesting that new variants of the novel coronavirus could have entered the country, and at a time when the number of younger adults becoming infected with the coronavirus is growing and the average age of the people requiring hospitalization after contracting COVID-19 is decreasing.

Of course, we are strongly motivated to do whatever it takes properly so that we are no longer forced to resort to the stringent restrictive measures again. But, in order for this not to happen, motivation of everyone is required. This is a moment for everyone to show utmost responsibility, because what is being increasingly seen as a fresh wave of infections everywhere and what was reflected in a dramatic growth in fresh cases a while ago in Europe is being reflected here now.

The set of existing measures, according to the technical experts, are measures that actually work, but for them to work properly, they should be observed properly. On the other hand, the health authorities’ approach and the relevant authorities tasked with monitoring strict enforcement of these measures has been a more sensitizing rather than repressive approach. However, what health experts are witnessing is that citizens are relaxing their commitment to complying with the restrictions over the past few weeks, starting with the use of the face mask anywhere outside the house, observation of the rules in the commercial units, as well as the intolerable exaggerated conduct of many people, including politicians, in certain indoor premises.

And I would like to make it clear for everyone, that by politicians I don’t mean the politicians belonging to other parties, but also many of those in the party I head, who are violating the rules by gathering in halls and rooms more people than the limits determined by the Technical Committee of Experts. This is irresponsible and unjustifiable, because all together they comprise what is seemingly not a united front of civic, individual and community responsibility in the fight against COVID.

We are not worried about our health stability, but, if we fail to act now, if we fail to react responsibly now, if everyone doesn’t do his part, then the situation could become more complicated, the number of fresh infectious could surge further and the burden on the health system could become heavier, although it is in fact avoidable.

I believe everyone clearly knows that the measures proposed by the Technical Committee of Experts are not proposed by anyone else. But on the other hand, first and foremost, certainly we in the government, but also you in the media, are all obliged to do a lot more than the others to abide by the measures as strictly as possible.

It has been already confirmed that pharmaceutical company Pfizer will soon start delivering the next vaccine doses gradually, starting mid-February. The quantity of available vaccine doses will increase and the vaccination figures will also increase in line with the vaccination plan. However, the time when the vaccine and reduction of the fresh cases would break the infection chain is still far away in all countries, including our country.

I would once again reiterate and emphasize for everyone, starting with shopkeepers, vendors, who should in no way see the flexibility, the understanding and the readiness of the state authorities not to further oppress them psychologically and not to hinder them in their efforts to recover after the blow they dealt last year, as an opportunity to abuse with the rules. Then this goes for everyone else, but shopkeepers, vendors and business owners hold a specific responsibility, as it is their business premises where the interaction among people is greater and where the danger is much higher. The danger is not high on the streets; it is not high in the offices or at homes. The highest danger is right where the interaction among people is more intense. And if we don’t wish to see the stringent restriction measures be reinstated, they should refrain from efforts to earn at maximum, thus putting the folks’ lives at risk and by threatening stability of our health system.

The State Police have adopted a maximum flexible approach. The inspectorates involved in this process have shown maximum flexibility. We don’t want the State Police officers and inspectors to enter cafes, bars, restaurants and clubs, because it wouldn’t be the best thing to do when it comes to the commercial activity performance. But if the tradesmen fail to react promptly, then this would be certainly the case. It will then be the State Police officers and the inspectorates that will impose enforcement of the measures forcibly, including all respective fines and penalties, which we will further stiffen.

In the coming days, we will decide to increase the fines due to be imposed on bars, restaurants, clubs, commercial centres based on the size of business premises and the conditions that would allow them to abuse. Ermal Mamaqi is a very close friend of mine, yet it is intolerable that so many people gather in an indoor space, as it actually happened, and I am mentioning his name being convinced I am not attacking selectively, especially given the fact that he is a renowned and highly respected public figure. It is intolerable! It is the worst example we can set at a time when, in our capacity as public figures, should actually set the best possible examples.

This is also the case with bars and restaurants in the so-called Bllok neighbourhood, other best bars and restaurants in other parts of Tirana and other cities, which are becoming hotspots for the COVID outbreak. This is intolerable!

I reiterate, we are showing understanding with everyone and this is an appeal for solidarity, an appeal for unity and appeal to everyone to help so that no cracks are open wide in a front, where we should all be united, where everyone does his own part, with the government sharing the biggest responsibility  to lead and coordinate all other stakeholders, and where the media has the responsibility to report the problems and violation of rules, while tradesmen, business owners share the serious responsibility to be part of this front by simply abiding by the rules. We won’t part ways with one another; we won’t wage a war on one another. Instead, we should all fight the virus together. The virus doesn’t distinguish amont parties, cousins, patriots, or people from a region or another. It infects and affects everyone.

 -Mrs. Health Minister, given that Albanians are not Swedes and we actually stand out as rule breakers, if not as irresponsible people, would leave everything in the folks’ hands or you have a strategy to contain the disease? If yes, how many daily infections this strategy envisages for the existing measures to be altered? This is because we are seeing Germany, where everyone knows how high is the citizens’ responsibility, and yet the country has imposed a lockdown. The same goes for Greece. Are there a certain number of new confirmed cases that would lead to additional restriction measures?

Health Minister Manastirliu: As for the recent COVID-19 cases or the epidemiological situation, which would later lead to a new decision on additional measures designed to contain further spread of the infection, I would say that there is a set of criteria we consider whenever we decide to impose new measures. It is not the surge in infection cases only, but also the situation in the COVID-designated hospitals, as well as the percentage of patients under intensive care treatment. As of today, the situation in hospitals is fully under control and the hospitals are not overloaded. In addition to 550 beds available at the four COVID-designated hospitals, the regional hospitals have a combined capacity of more than 1600 beds, which are available to treatment of patients who have contracted the novel coronavirus, or show severe symptoms of the disease. As for the capacities of intensive care units, I can confirm that 32% of the capacities are currently in use in the four COVID-designated hospitals. On the other hand, the number of fatalities is another criterion as part of the set of criteria I already explained. So, by dynamically evaluating these epidemiological criteria, we will mull a decision on new measures, which are taken by the Committee of Experts.

As I told you, the Technical Committee of Experts is totally committed to monitoring the situation on daily basis, and therefore a more responsible behaviour is required for the citizens to adopt. We have the best models and there is no need to draw comparisons with Sweden, because, if we are to take a look at the situation just few months ago, and you can testify to it through your reports and news stories, showing how best these measures were observed, with the face mask wearing rule strictly respected by everyone in both outdoor and indoor spaces. So, the strict implementation of the measures yielded a positive impact and if we are to draw a comparison with the wave of infections in the period between October and November and the fall in new cases later, this was all thanks to the measures and their correct observation by the Albanian citizens.

– I don’t know whether you have been informed about at least hundreds of non-hospitalized COVID-19 patients, who are receiving treatment at home with the same medicines being already used at hospitals, even not in the infectious disease ward, but at the intensive care unit? They are using the same medicines and everything else. They have made use of the moderate or early therapies offered by the government for free, yet they think it is better for them to receive treatment at home and they continue to do so. I don’t want to speculate over the reasons why they choose to receive treatment at home. However, I am showing one medicine that is being massively used for home treatment.

PM Edi Rama: I am convinced the Health Minister would provide a more accurate answer to this question. What I would like to say based on the information, consultations and the comparisons to what is happening in the countries in the region, also based on the talks I have had with my counterparts about this situation, as far as I understand, this is the case not only here in our country,  and you can verify it through complete news stories about other countries – I mean at least countries within our constant interest – people tend to take a lot of medication.  Although this trend has been consistently objected by the health authorities and experts, apparently the fear, care, anxiety, the psychological need to be prevent the worst in advance, pushes people to take too much medicine against to what authorities and experts, in other countries too, constantly advise and recommend that this virus should be treated with certain medications approved to treat COVID-19, without hasting to take a lot of medicines if the patient’s conditions is not serious. When a patient shows serious symptoms, he or she should be hospitalized. This is what I can say, without pretending I have provided an exhaustive answer or pretending as if I am talking as an expert.

The other aspect unfortunately involved in this entire story is that this has already become a sort of a lucrative business, not only in Albania, but everywhere else. For example, the fact that pharmacies sell people huge quantities of medicines has become a serious problem in Italy. We have repeatedly stated that the best and wisest thing to do is that the medicines are taken according to the family doctor’s prescription and a basic treatment is prescribed, as long as the condition is not critical. Once a patient shows severe symptoms or his condition worsens, then health authorities should certainly decide to hospitalize him or her.

I am giving the floor to the Health Minister to answer to the rest of your question and provide more details, because I am actually not capable of providing satisfactory answers regarding this problem.

Health Minister Manastirliru: I can’t deny the fact that the issue you actually raised is not worrisome for us too. The element having to do with any deviation from the standard protocol and guidelines currently in place is also a matter of concern also for our health structures and the experts in particular, who evaluate entire progress of healthcare for the citizens. We have currently a standardized guideline for treating COVID-19 symptoms at home. This guideline is performed by the family physicians for two forms of the diseases, mild and moderate symptoms. The guideline is changeable and is performed according to scientific evidences produced by the international institutions that deal with such evidences and we then adapt treatment guidelines for patients in our country. These are guidelines to be implemented and performed by qualified doctors and it is the family physician and nobody else the one who can fill the prescription and determine treatment of the mild and moderate symptoms of the disease.

As to the hospital guidelines, and I would like to reiterate my appeal, as it is really worrisome for hospital doctors, who are finding out that a number of patients showing severe symptoms have neglected themselves and the symptoms by choosing to stay at home and receive treatment that is provided at hospital. These individuals have also avoided the required laboratory tests and screening and therefore their condition has often deteriorated. “First, do no harm” is the principle in medicine and our appeal to the citizens is: if the condition of a patient worsens, he or she should immediately be hospitalized or ask for the doctor’s expertise as they are specialized and qualified to provide care and the therapy.

As far as the home treatment is concerned, there are exactly two specific guidelines for the two symptoms of the disease. What we are actually doing, precisely because we place utmost attention to the citizens plight conveyed through your voice, but trust me, we have received information about the home treatment through hospital protocols  and about which we are introducing measures vis-à-vis with the standardized pharmaceutical prescription issued by doctors and such a standard prescription would allow us for real-time checks to find out who is the doctor who prescribes such medication, not for COVID treatment only, but for other therapies too. Based on which protocol he or she prescribes the medication? This certainly would be worth for the transparency, but also for the citizens’ care.

PM Rama: Your question contained a nuance that deserves an elaboration, as you said people choose to receive treatment at home for reasons you wouldn’t want to speculate about. If I got it right, the implication of what Erjon said was that people choose to be treated with hospital protocols at home as they don’t trust healthcare provides at hospitals and this is definitely a problem, if this is really the case. It is a problem we need to address and I think we should address it together, of course, with everyone doing his part, because I am not the one who should do the media’s job, and it is not the media the one that should do my job, but each of us should do their part.

Of course, there have been reasons to feel not quite well, or even feel bad when the media has reported cases that do no honour to our health system. The most flagrant case was that concerning the cleaning woman, who had behaved like a true monster, by deceiving a whole family to reap benefits and money, but by revealing such cases and, by doing so, providing a valuable contribution to the efforts to address them, either when a certain case is of a criminal nature, just like it was the case in question, or of a problematic nature concerning hospitals’ management, rules enforcement or anything else part of the health system complex. We must keep in mind and you must also provide a contribution to this aspect that as thousands upon thousands of people receive proper care, that while the system works best for the vast majority of cases and people, as long as the figures and facts show it, as long as the number of the hospitalized patients receive care and recover is very considerable. This means you share an important responsibility that we have yet to build a justice system that properly does what is meant to do in all aspects, then you should reveal all these cases and help that perpetrators are properly punished. The cleaning woman ended up in prison thanks to the contribution of an investigative TV show and this is actually a tremendously valuable contribution. The same goes for the investigative TV show “Fiks Fare” whose contribution along its entire history is probably much greater than that of all prosecutors offices combined over the years.

On the other hand, it is essentially important to realize that given the current conditions, given that the social psychology is really fragile, as we are not talking about a common seasonal flu and we are not talking about less important and uninteresting phenomena, but we are talking about issues concerning the interest of everyone, which affect every mind, because everyone is exposed, everyone is at risk and it is directly related to health and therefore it is very important  that in one way or another the other side of the coin also come to the fore. And it is not very important for the media – and this is understandable – to show and report about the construction sites and ongoing projects all over the country that people see only when I visit them and, after all, it doesn’t matter at all whether people are informed or see the construction sites, because the sites will remain there, although it may influence the people’s perception over our work and performance, but this doesn’t threaten neither lives nor the people’s safety. We are talking about the citizens’ lives and safety and this is what matters most, because I think that doctors and nurses in this country really deserve to be put on a pedestal, and not be felt trampled or crushed underfoot because of the attacks against them and the way they are exposed to them, as this is just one side of the coin, which is definitely a pretty dark one and which we need to tackle together, but which is not the only one side and it is and is much less than the other side.

The concrete case in question, again the thing is that this is our shared concern, as far as I can understand, yet it is crucially significant for everyone to realize that improving care quality, strengthening professional integrity and professional dignity, and the professional seriousness in entire health system is unequivocally linked to the revelation of every potential similar case. This is always good news for us, as it is translated into one less cancer cell in the whole system. But it has also to do with the need to calm people and provide them security and spare people of a panorama and perception that anyone hospitalized in Albania’s hospitals is doomed, whoever ends up in a hospital is robbed, stolen, because if it was to be the case then we would have had hundreds and thousands of deaths; hundreds and thousands of people robbed. But this is absolutely not the case. There are a total of 65,000 surgical interventions performed each year in Albania, plus the mini-invasive interventions and the total is over 90.000. It happens that many surgical procedures go wrong. It was just yesterday or two days ago, where an unprecedented tragedy took place at a hospital in Span. Not long time ago, fire broke out in a hospital in Romania, the second deadly hospital fire in that country, killing at least 20, in the first fire accident and 10 in the second one. Fires broke out at hospitals and people were killed because of the faults in oxygen supply installations and their overuse 24 hours seven days a week. In other words, these are grave and tragic incidents that take place, yet there is an equilibre.

This is the reason of my intervention and thank you for your question, Erion.

-There is a plan to shut bars and restaurants down or extend the nightly curfew until this phase of the pandemic is over?

PM Edi Rama: Thank you for the question, as it helps me to recapitulate this conference and reiterate my message. We have chosen a flexible approach to this phase of the war against the virus, obviously enjoying the support of the Technical Committee of Experts, who think, so far at least, these measures are sufficient at this stage and believe that people will continue to abide by the restriction measures as they have already done until a few weeks ago.

However, what we are witnessing now is that people are no longer behaving the way they used to until few weeks ago. People have seemingly relaxed their behaviour after the year-end holidays and many are failing to respect the rules, starting with the violation of the face mask rule. This is a fact. It is obvious that people have relaxed their behaviour and are ignoring the rules. But it is clear that the virus advances further at every inch of the ground we lose. This is very clear. In every centimetre we gain, the virus recedes, because I know very well that there are many experts in Albania, not like me and you, but experts without due qualification and training – they are usually omniscient, who seek to make fun and mock us by saying “the virus sleeps at night and it shows up itself during daytime only.”

The curfew would lead to the potential limitation of the contacts. If you can’t afford resorting to a total lockdown for one, two or three years until the virus is gone – as it was the case with the England’s King Henry VII who isolated himself totally in the wake of an epidemic outbreak and he maintained a safe distance from any potential contact, then you have to limit the contacts as much as possible. It is not a matter whether it emerges during the night-time or during the daytime, but it means fewer contacts in two, three or more hours.

So, in this aspect, this is an additional option. Unfortunately, we are exploring ways to curb the spread of the virus since last weekend and we will wait for a decision from the Technical Committee of Experts.

First of all, we should all strictly abide by the existing rules and measures and the State Police and inspectors would need to alter their approach. I am very sorry that this would be the case if the owners and managers of the commercial units would fail to change their approach and conduct. I am really sorry as the last thing I would wish to see happening in this country is the image of inspectors, tax collectors, and representatives of state authorities enter cafes, bars, restaurants and businesses. Seeing no inspectors knocking on their doors is for business operators a sort of third liberation after Albania’s liberation in’44, second liberation in ’90-s. And we have accomplished this and we are implementing it now step by step until no inspector will ever exist again once the fiscalization process completes. Because I know it best that once this begins, the abuses begin too. But what are we supposed to do when people stand close to each other in indoor bars and clubs, easily spreading the virus among themselves and others?

We will observe the citizens’ reaction following this message over these days, while we are making preparations to ensure rigorous enforcement of the measures and explore more potential restriction measures, without wanting to reinstate the stringent restrictions that were imposed last year. However, we are mulling a set of other restrictions with a minimal economic impact, yet with a maximum impact on efforts to reduce the interactions and the infections cases. You know, it is the Committee that evaluates and takes stock of new cases, trends, etc., but we are very convinced that now we have to react strongly, if there will be no reaction from the commercial units and of course we will react, not by resorting to force, but stronger on the citizens who do not wear the mask everywhere when they are outside the home.

Thank you very much!