"We are already at half capacity at the hospital, and the wave peak is still ahead, with 10,000 to 15,000 new daily infections. What concerns me is whether the hospitals at Karaburma and Batajnica will be sufficient for taking care of patients from Belgrade during the summer. I'm sure that in the fall we won't be able to, and that larger medical centres will need to enter the Covid system. Our hospital only has the vulnerable groups of people – the elderly and those with underlying conditions who haven't taken the fourth dose of the vaccine even though it had been clearly recommended. The immunity lasts about three months, so if they have taken three doses, now it's like they haven't been vaccinated at all," Colonel Ivo Udovičić, PhD, Assistant Professor and Commander of the Karaburma Military Covid Hospital, says in his interview with Kurir.
How many patients do you have at the moment?
"Prior to the wave, we only had seven patients, and now it's already 47. Although we're nearly at half capacity of the hospital, this is the maximum admission capacity with respect to the number of available staff. We didn't expect this summer wave and so many admissions. Our staff are on vacation, with many using up vacation days that they hadn't been able to before. I do insist that their vacations not be interrupted – this is the third year running of healthcare workers shouldering an enormous burden, on top of which we're in for a fall with the hospital at full capacity."
What is the profile of a current Covid patient ?
"Before the wave and while the epidemic was low-intensity, patients' age ranged between 80 and 90. Now the bar is getting lower – we are getting people younger than 70, with the youngest aged 57 but also with a malignant disease that had been operated on. At the moment, patients are elderly and have underlying medical conditions. They're mostly not very mobile and have severe lung, heart, and kidney conditions, or cancer. All of them present severe clinical symptoms of Covid. Most are on oxygen, whose consumption is admittedly lesser, but all of them have double pneumonia, and still die. The ICU has 10 percent of the patients at any given time (during the Delta strain, it was up to 20 percent), so now we have four, three of whom are in ventilator beds. There are many patients from other hospitals."
Is the key problem now getting infected at hospitals?
"Yes, that is the key problem indeed. You fill up the hospitals, so when you cram patients into a closed group of people, it's enough for one person to bring in the coronavirus, as they are the most susceptible to getting infected."
'THE MOST VULNERABLE SHOULD BE VACCINATED THREE TIMES PER YEAR'
Is there an end to this, next year at least?
"When this whole coronavirus thing was kicking off, we knew that it would last four years. I'm sure that the epidemic will last next year as well, but I don't know how intense it will be. We will again have cyclical waves, no fewer than two. The big problem is that the virus mutates truly incredibly. Whenever we think we have created immunity, it changes. We already have more types of Omicron than I can count, and each new variant evades our immune system. The most vulnerable population should be vaccinated three times per year if necessary because the immunity lasts about three months. The vaccine isn't as efficient as it was, but all the studies show that it still protects against the severe form of the disease, death, and long Covid."
Patients must be negative to be admitted into a hospital. While it is possible that someone who tests positive can nonetheless slip through, it appears that here the main culprits are primarily the medical workers, who don't wear face masks and don't get tested.
"There's no doubt there are cases like that, no one could claim otherwise. If all healthcare workers respected the measures, wore masks and gloves, and wiped their hands with ethanol, things would look different. A large majority of them are young and can introduce the virus without having any symptoms. We have admitted a 96-year-old old-timer, who asked me, 'How could I have gotten the corona when I don't go anywhere?' But his grandchildren visit him. That's the problem. If we didn't have the elderly population, perhaps we could declare the end of the epidemic. The clinical presentation in young people is mild or non-existent – a two-day fever, a sore throat – much milder than the flu."
Well, it is possible to make sure the measures are strictly adhered to at hospitals.
"That should be done. Each hospital has epidemiological measures, and they are overseen. I do think that those whose job this is are doing great work, but the staff or the administration don't exactly listen to them. I can understand the need to do as much as possible, but when someone is admitted, and then you go and operate on him, and then he contracts Covid, the question is – what have we done to this patient? Was it a god idea to operate during the peak of the wave if we could have waited? During the peak of the epidemic, any epidemiologist will tell you that hospitals should be emptied out or be at maximum half capacity, with both the staff and the patients following all the measures. These patients are the most vulnerable, and now there's a great risk of staff bringing the coronavirus into the hospital."
Epidemiologists expect the peak in two weeks, but we already have over 4,000 new daily infections.
"We thought that this wave would start in the second half of August, but it started a month early all across the world and in this country too. The peak will be felt when we have between 10,000 and 15,000 daily infections. The fall will come, with conditions favourable for the virus, so perhaps there will be no flattening and drop in the number of infections. Perhaps this wave will simply link up to the fall one and go on until the New Year's, when the numbers will fall, and then rise again in January."
Do we always multiply the official numbers by five to get the actual number of new infections?
"We always multiply the numbers by five. However, for us what's important is the number of Covid hospital admissions and the number of those infected at hospitals. That is what we must focus on to stop the spread of infections at hospitals. Also, we should avoid visiting the elderly during the peak of the wave – we must keep them in good care."
At least this BA.5 Omicron strain, now dominant here, presents the mildest symptoms so far.
"It's a stroke of luck that the clinical presentation for a huge majority of people is fairly mild. Having said that, our Covid hospitals are getting filled up again. The good thing is that treatment is shorter on average. For the Delta strain, it was 11-12 days, and now it's 8-10 days. This means that we practically get two days for every 12 days, which means a lot in terms of hospital admissions."
Are you concerned about the so-called Centaurus, i.e. the BA.2.75 subvariant of Omicron?
"No, I'm not concerned about any of the Omicron subvariants. What worries me is whether Batajnica and our hospital will be sufficient to take care of the patients from Belgrade, as well as whether Kruševac will be big enough for the portion of Serbia it covers, or Mišeluk for Vojvodina. We'll be teetering on the edge in this summer wave. We have 140 beds, if we start using the other, smaller building. Batajnica has 907, but more can be added, so we can take care of about 1,100 patients. At the moment, two percent of those infected end up at a hospital (with Delta it went as high as 10 percent), so Batajnica has between 20 and 35 admissions per day for app. 4,000 new infections. As long as the daily caseload is up to 10,000, I think we can go it alone. Afterwards, however, especially in September, we're bound to need the help of some of the bigger hospitals."
'LONG COVID MILDER IN THOSE VACCINATED'
Long Covid isn't even brought up anymore.
"Regardless of all the criticism, I still think that as a country, we have fought the coronavirus successfully. The only inadequate response was the vaccination. Hundreds, if not thousands, of those younger than 40 years of age have died of the Delta strain, and it would have been different had they been vaccinated. Of course, the majority have survived, but they will suffer severe consequences. Studies have already been published on long Covid, showing that it is much milder in those vaccinated. The biggest problem in long Covid is the heart – myocarditis (the inflammation of the heart muscle), arrhythmias, effusions, and heart failure."
Does it make sense at all to take the jab now?
"For the vulnerable groups of people, for whom we recommended the fourth dose as early as last year – absolutely. At the moment, we only have one patient at our hospital now who has taken the fourth dose. As for the third dose, it was administered to everyone until the end of November 2021, which was eight months ago. Since the start of the epidemic, waves have come every three months, which is the length of the natural or vaccine-based immunity. And now, eight months in, those with three doses practically have nothing, it's as if they hadn't been vaccinated at all. And that's where the problem lies. They should have taken the fourth dose in March or April. But, as soon as the wave is behind us, everyone forgets it's not the end. So, they say, OK, we'll take the jab this week, and then in 15 days, and then 15 more days later… And thus we have missed the fourth dose. The worst option is when people take the vaccine during a peak of the epidemic, where the numbers of infections are huge. They will get Covid, and then they'll say it's because of the vaccine, which has happened before. Nevertheless, it needs to be stressed once more that they should get the fourth dose."
Is it realistic to bring back some counter-epidemic measures?
"No, I wouldn't agree with that either, although I'm a doctor and someone who should naturally recommend them, because this strain is so infectious that not even face masks help."
Not even N95?
"N95 is, but they are expensive masks and only efficient for four hours. On top of that, people keep taking masks off and then putting them back on. Moreover, it's summer, everyone is spending time together in large numbers and travelling, so introducing bans is impossible."
Will we all now get herd immunity?
"For herd immunity to develop, we would need to allow between 20,000 and 30,000 daily infections. Those who take care of themselves should wear them, there is no need for the government to introduce measures. Three years in, there's not a single grown person, or a child, for that matter, who doesn't know the protection measures. This is now truly an act of personal responsibility. There are already more people wearing masks in the street now than before. As for the young people, they're not to be more responsible towards themselves, but towards others. They are the virus carriers without even knowing it, and yet they visit their grandmothers and grandfathers, the elderly."
'I'M NOT AFRAID OF PANDEMICS CROSSING'
The WHO has declared the highest level of health emergency and an epidemic of monkeypox. Are you concerned about the two pandemics crossing?
"I'm not afraid of the pandemics crossing. At any rate, the details on the new model of transmission should be provided by infectious disease specialists and epidemiologists."
Kurir.rs/Jelena S. Spasić
