Better safe than sorry: Ukraine moves to outrun coronavirus

On March 12, the same day as Ukraine shut schools and canceled mass events to prevent the spread of COVID‑19, the country reported two new cases of the disease identified as a global pandemic by the World Health Organization.

Now, medical experts say that the restrictions were justified.

“It’s the first time that the country is working preventively (against the virus), not just trying to catch up with the situation,” Viktor Lyashko, Ukraine’s chief sanitary doctor, said on March 12 when the nationwide quarantine measures came into effect.

But there is a lot of uncertainty about the real scope of the disease in the country. The most common concern is that only around 51 people have been tested nationwide — exclusively those who came from hotspots for the virus abroad, such as Italy — and had flu-like symptoms.

“There are obviously more cases,” said Fedir Lapiy, a pediatrician specializing in infectious diseases. “But Ukraine can’t test all the sick or all who want to test. The (healthcare) system can’t stand it.”

Meanwhile, the government doesn’t communicate to the public how to test for coronavirus: no TV ads, nothing on state websites and social networks, which only provide information on disease statistics and personal safety. Lyashko speaks about the testing algorithm and how the public can undergo tests only when pressed by journalists at daily briefings.

Designating Lyashko as a government speaker on coronavirus, creating a special hotline and Telegram channel are positive steps, said infectious disease doctor Volodymyr Kurpita, but the government’s communication strategy is still “unclear and confusing.”

“And when the government imposes some rigid measures (against coronavirus) without enough information, it gives the impression the authorities are hiding something,” said Kurpita, who’s also the former head of Ukraine’s Public Health Center. “So people stop trusting these measures.”

The response

Ukraine started to get ready for COVID‑19 in January, when the disease became an epidemic in China: The government evaluated medical capacities and resources across the country, sent out instructions to the regions, started to train doctors, including via webinars and simulations.

In February, the government procured its first Chinese virus-related test systems for laboratories in Kyiv. And on Feb. 29, a Ukrainian returned from Italy and was immediately hospitalized with fever and coughing in Chernivtsi, a city of 500 kilometers southwest of Kyiv. His samples were sent to this Kyiv lab for testing, and two days later, the tests confirmed he was infected with COVID‑19. On March 2, Chernivtsi Oblast closed all schools.

Since then, the spread of the coronavirus has surged in Europe, especially in Italy where it has infected 12,462 and killed 827 people so far. While subsiding in its origin country China with 80,981 infected and 3,173 killed, the virus became a global pandemic — it has infected 135,000 and killed 5,000 people around the globe.

The European Union countries responded with airport and border screenings of passengers for flu symptoms. They have closed most of their flights to China and Iran, another hard-hit country, and Ukraine did the same. Italy banned mass gathering and later placed severe travel restrictions inside the country. Other EU countries are gradually following suit.

But Ukraine, having one of the smallest numbers of confirmed cases of the infection in Europe, decided not to wait. The government announced that it would impose a quarantine starting on March 12, and it would last for three weeks until April 3.

“We don’t want to wait until (the virus epidemic) grows parabolically here,” Prime Minister Denys Shmygal said at a press briefing following the government’s decision. “We want to protect Ukrainians and Ukraine to the maximum, and pass this phase as easily as possible.”

So Ukraine has closed its nurseries, schools, and universities; it banned mass gatherings of more than 200 people, except events of “state necessity” such as parliamentary meetings, and sporting events given there are no spectators.

Ukraine also imposed limits on flights to and from Italy and closed 170 out of 219 border checkpoints, including to Russian-occupied parts of the Donbas. The remaining 49 checkpoints will have thorough medical screenings and add mobile quarantine centers.

The government also allocated Hr 100 million ($4 million) to buy personal protective equipment from Ukrainian private companies — gloves, masks, and protective suits — to supply medics and other state employees. The state has prohibited the export of such equipment until June 1; it will purchase infrared screening equipment to take the temperature of passengers at Kyiv Boryspil International Airport.

With these measures, the government says it’s ready to face the coronavirus outbreak. The state has around 12,000 beds in infectious disease wards with 605 medical ventilators for patients with lung damage. There are 2,000 infectious disease doctors and 5,000 medical workers in Ukraine.

The government also keeps procuring hundreds of coronavirus stationary test systems and thousands of rapid test kits, which take 10 minutes to give a result. On March 12, test systems were sent to seven cities: Dnipro, Lviv, Rivne, Ternopil, Vinnytsia, Zaporizhia and Zhytomyr. Kyiv also bought additional 5,000 kits.

Late on March 12, the government reported two new cases of COVID‑19 in Ukraine: an elderly woman in Zhytomyr, a city just 140 kilometers west of Kyiv; and another man in Chernivtsi Oblast, the region where the first case had been reported.

There are now three confirmed cases in Ukraine.

Workers disinfect a trolleybus after it arrived at a bus depot in Kyiv on March 12, 2020. The Cabinet of Ministers has approved on 11 March 2020 the restrictive measures amid the Covid-19 coronavirus threat to prevent the disease from spreading in Ukraine. Measures include a three-week lockdown of all educational institutions, introducing restrictions on holding mass events with over 200 participants, which does not apply to events of state importance. (Oleg Petrasiuk)

Is it enough?

Medical experts welcome the measures Ukraine has taken to prevent the spread of COVID‑19 and agree that more measures should follow. However, some say that Ukraine should have reacted even more proactively.

Ivan Kondratenko, a private doctor in Dnipro who worked in state hospitals for over 18 years, says that Ukraine should have done a month ago what Israel did on March 9, when it started to require a 14-day quarantine for all people entering the state and banned entry for people coming from some affected countries altogether.

Kurpita, the former head of Ukraine’s Public Health Center, says that Ukraine’s underfunded infectious disease wards may not be ready to receive scores of COVID‑19 infected patients and provide adequate care. The 12,000 beds would only be enough if there were no patients with other infectious diseases.

“That’s why it’s urgent that the government comes up with a clear algorithm for how to repurpose general wards to treat patients with COVID‑19,” Kurpita says.

For most COVID‑19 patients who suffer only mild symptoms, the doctors should recommend that they self-quarantine and stay home, pediatrician Lapiy said. At the same time, doctors should keep in touch with these patients.

The government should also buy more medical ventilators in addition to the current 605, Lapiy said. Currently, it’s unclear how many of them are in different oblasts, and there should be some available in all wards, the pediatrician said.

Kurpita and Lapiy agree that the available medical personnel — 2,000 infectious disease doctors and 5,000 staffers — is not enough, especially since many of them can get sick as well. Ukraine may have to mobilize interns and retired medics as Italy and the U.K. are doing.

“A volunteer movement should be mobilized just as it was during the EuroMaidan Revolution and has been since the war,” Lapiy said. “Ukrainians are pure of heart and will be ready to help others.”

Despite the fact that the Ministry of Health organized centralized trainings and webinars, the readiness of doctors in facing COVID‑19 may strongly vary across the country, private doctor Kondratenko said.

“The degree of preparedness of health workers depends solely on the competencies of the heads of hospitals, because neither the minister nor the deputy minister trains health workers,” Kondratenko said.

Lapiy claimed that many Ukrainian doctors treated patients during the 2009 flu pandemic. They know the practice and tactics of treating patients with lung damage and will pass the knowledge to younger doctors.

In the face of danger, doctors require a lot of motivation, Kurpita said, adding that besides the moral kind, the government should also provide them with financial motivation and social benefits.

“As a citizen of my country and a doctor, I know what I can do and must do,” Kondratenko said. “The rest should be on the people who get their salaries from the taxes I pay.”