Eighteen months after the Covid-19 pandemic struck, the caretaker government of Stefan Yanev finally addressed two pivotal issues. First, two weeks ago, it answered why Bulgaria was hit so badly, losing 35,000 more people than in a normal year. And second, a week later, the Health Ministry issued an epidemic response plan stipulating clearly the manner and timing of new restrictions if another Covid-19 wave hits in coming months.
Until recently, the authorities announced measures not on the basis of epidemiological data and the situation in hospitals, but on political motives. Or, as caretaker Healthcare Minister Stoycho Katsarov said, "at the last minute, with an immediate effect, on the basis of personally-influenced decisions about who is close to the Prime Minister or who called on the phone, asking [the Crisis Response Committee] to open this or that business".
This chaotic approach led to thousands of avoidable deaths from Covid-19, but also overcrowding of hospitals and additional fatalities of those suffering from other illnesses. Additionally, the haphazard measures undermined public trust in the state's capacity to manage the crisis and probably deterred them from being vaccinated.
Four zones to rule the pandemicBefore we conduct a post mortem into the government's mismanagement, let's review the proposed response to a future Covid-19 wave. The plan divides the levels of infection into four tiers based on occupancy rates in hospitals and new recorded infections per 100,000 people in a two-week period within a certain region.
This is what is allowed and not allowed in the four scenarios:
Green zone(Fewer than 100 new cases per 100,000 population, less than 2,500 hospitalized at a national level)
This is the current level of infections in most regions. In this situation, gatherings of up to 20 people from 3-4 households are allowed, as well as private events that include up to 100 people indoors or 200 - outdoors. Public events at stadiums, entertainment venues and conference halls can proceed at 50% occupancy rate, with 1,5 m. physical distancing and mask rules. The same applies to restaurants and shops, where the authorities will allow small teams of up to 10 people who are vaccinated, or had the virus recently, to dispense with masks. Office employees are allowed to return to their desks at 50% occupancy. No travel restrictions within the country are applied in this zone. Schools and other educational facilities operate normally and hotels remain open.
Yellow zone(100-200 new cases per 100,000 population, 2,500 - 6,000 hospitalized nationally)
If infection rates increase, then only 10-15 people from up to 3 households are allowed at domestic gatherings, depending on regional authorities' instructions. Larger private events such as weddings are restricted to 50 attendants indoors and 100 - outdoors. Sports and congressional events are now restricted to 30% occupancy, with masks and distancing compulsory. The same applies to fitness and sports halls, museums and other cultural venues. As for restaurants and cafeterias, they are allowed to work at 30% capacity, between 6am and 11pm, with groups of up to 6 people from up to three families allowed at a table. Again, if the entire staff is vaccinated or has had Covid, 50% of the capacity can be used instead of 30%. Hotels and schools remain open, shops can operate under limited capacity, office workers remain free to go to their work stations under the same rules as in the "green zone".
Orange zone(200-500 new cases per 100,000 population, 6,000 - 9,000 hospitalized nationally)
Restrictions for domestic gatherings tighten; now only up to 7 people from two households are allowed at the same place. Other private gatherings are limited to 15 people indoors and 25 - outdoors, congresses and events indoors are not allowed, sports events are also forbidden, unless they are professional. In such a case, no audience is allowed. Fitness facilities remain open "for private use," museums and galleries are shut down - unless they can provide a good reason for staying open. Restaurants can operate between 7am and 10pm, but only those with outdoor seating and tables ought to be placed at 2 m. distance. Clubs and casinos are closed. Hotels can only provide services to guests and have to abide by restrictions of regional authorities. Most shops in shopping centers and malls are closed, unless they provide essential services such as banks, communal services, phone and internet services, and food and medicine stores. Non-essential travel between regions, especially for over 65s without vaccination, is limited. Kindergartens remain open, but schools shift to distance learning.
Red zone(More than 500 new cases per 100,000 population, more than 9,000 hospitalized nationally)
In the worst case scenario, only family gatherings are allowed in private homes, while all other private events are suspended. The same goes for conferences, sports events, fitness facilities and cultural activities and halls. Restaurants are only allowed to deliver food, hotels can work - but only serve food in rooms, only key businesses, such as banks, pharmacies and food stores are allowed to operate. Only essential workers are allowed in offices. Kindergartens are shut down, unless 100% of their personnel is vaccinated or have gone through Covid. Even then, only children of fully vaccinated parents are allowed.
In addition to all these measures, the Health Ministry announced it is planning to use 63 million euro from the Regional Development EU program to get 132 dedicated hospitals ready to admit Covid patients and medics treating the infection would continue getting monthly bonuses for their service. When presenting the plan, Dr Katsarov underlined the pressing need for public vaccination, warning that the cost of another Covid wave and lockdown might be up to 300 mln euro.
What went wrong?Two weeks ago, the National Centre for Public Health and Analyses (NCPHA), at the request of the caretaker government, issued a report on reasons for the high mortality rates during the period March 2020 - May 2021.
The main takeaways from the report included that the country's healthcare system was unprepared for the strong second and third wave of the pandemic in the autumn of 2020 and the spring of 2021 and that the authorities made wrong decisions regarding the management of hospital care. Anti-epidemic measures were often based on political rather than epidemiological considerations and restrictions should have been preventative rather than after a surge of infections.
Those problems, which coincided with the overall poor state of the nation's health, led to 18,000 Covid deaths and an overall excess mortality rate of 35,000 people over the period. Other significant mistakes were that, last summer, the health authorities failed to separate hospitals into Covid-19 treatment centres and ones for general illnesses. This led to higher infection rates among patients with additional conditions, and, sadly, "people with chronic conditions becoming the biggest victim of this pandemic," according to the head of NCPHA Hristo Hinkov.