While Greece was internationally praised for its initial response to the Covid-19 pandemic back in the spring, its response to the second wave was less effective, says a Greek expert in Public Health at Walden University in the US.
In an interview with Greek Reporter, Dr Vasileios Margaritis, PhD, Senior Faculty member in Public Health Doctoral Programs, lists a number of oversights or mistakes by the Greek health authorities in preparing for the second wave.
He says that Western-type lockdowns, similar to the one applied in Greece, are not very effective in stemming the spread of the virus and warns that lockdown fatigue, economic disaster, and the social-psychological issue of exhaustion and frustration can lead us to declare that the pandemic is over.
Below is the interview with Dr. Maragritis
Do you think that Greece failed to adequately tackle the second wave of covid-19?
This is a tricky question with many political and scientific aspects. But given the current results of increased cases, ICU occupancy rates, and most important deaths, it appears that the management of the so-called second wave was less effective and successful than during the spring crisis.
What went wrong? What were the main factors that distinguish the first from the second wave?
First, we need to highlight that this type of pandemic, which can occur every 100 years, is a multifactorial condition and there is no internationally and well-established management plan. Therefore, each government develops its customized plan which is strongly associated with the human, financial, and health care resources of each country.
The first wave of this novel coronavirus came as a surprise to the whole globe. But the second wave was or should have been expected to come in the fall due to the lower temperatures in the northern hemisphere, the increased indoors gatherings, and traveling between countries especially during the summer holidays.
As far as the nature of the virus is concerned, there is no evidence that the virus has mutated to become more infectious compared to spring.
Regarding the management of the second wave in Greece, significant issues have been detected in insufficient testing when tourists and workers have been entering the country since summer, in systematically collecting multi-site surveillance data, in improving primary care services to avoid overwhelming hospitals, in protecting vulnerable populations such as those residing in elderly care homes and institutionalized patients, and in timely applying simple public health measures like the use of a mask in all outdoor and indoor public places.
Despite the month-long lockdown, there seems to be no reduction in cases/deaths. Why is that?
Unfortunately for many scientists lockdown is considered as a “magic solution” that can address the pandemic. But the lockdowns practiced in Europe and US are completely different than the draconian one applied in Wuhan (China) last spring, thus less effective.
The “Wuhan” lockdown is not feasible in the western world for several reasons such as personal data protection and different political and socioeconomical culture.
In Greece, the lack of adequate, random, representative of the population, and timely surveillance data resulted in a quick surge of cases in many parts of the country so even the implementation of this “western” partial lockdown was delayed in these areas.
Also, this partial lockdown allows many businesses to remain open and agricultural/farming activities to occur, triggering the spread of the virus even under lockdown. Therefore, this type of lockdown is not effective and this disappoints the government and the public.
But most importantly the government failed to convince the public that simple but very effective public health measures (wearing masks, social distancing, regular handwashing, isolation of vulnerable populations) are a realistic way to limit the spread of the virus.
“Wuhan” lockdown should be the very last solution and needs to be applied only in a limited number of communities with extremely high COVID prevalence and hospitalizations, such as villages, towns, or even prefectures but not in the whole country.
Why is northern Greece particularly affected by the second wave?
What is currently happening in northern Greece is a real tragedy. Although this part of the country is in lockdown for several weeks, COVID cases and deaths are stabilized at relatively high levels, and the hospital bed and ICU occupancy has been rapidly increasing.
It is more than obvious that governments and health authorities failed in this case; just a few weeks before the lockdown, northern Greece and its largest city Thessaloniki were praised for effective COVID management. This fact highlights again the lack of expanded random pooled testing and valid surveillance data or any other preventive system that could help us avoid this tragedy.
The reasons for this catastrophe are not well known, since as we said there is lack of data and studies, but three main factors might have mostly contributed: the low temperatures which enhance the spread of many seasonal viruses (SARS-COV2 included) and force people to stay indoors, the incoming tourists and workers by road from countries bordering with Northern Greece (Albania, North Macedonia, Bulgaria) in which the prevalence of COVID is very high, and lastly, the at-home and public gatherings for Thessaloniki’s liberation day and Patron Saint (Agios Dimitrios) during the last days of October.
Do you think that the lockdown should be extended until a substantial percentage of the population is vaccinated?
There are a lot of uncertainties about when a substantial portion of the Greek population will be vaccinated, mostly due to the very demanding supply logistics and the increasing vaccine hesitancy, therefore this process can take until late spring.
But even if we were able to be vaccinated tomorrow, it is not clear how well these vaccines work in people who are at high risk of COVID, how well they protect against severe COVID, and to what extent the vaccines prevent those who have been vaccinated from passing the virus on to others.
Therefore, it is impossible for any economy to survive even in partial lockdown until we can be sure for all these aspects of vaccination.
In terms of public health, lockdowns have significant impact on mental and physical health of all age groups in long-term and significantly increase health and educational inequities.
In addition, lockdown fatigue and feelings of invincibility of the young population can trigger a significant amount of cases.
So, what needs to be done?
We need a “light lockdown” at least until spring to prevent outdoor and indoor superspreader events by closing large cinemas, theaters, stadiums, indoor shopping malls, etc. and by avoiding crowding festivities and rallies.
All the other businesses can be open with strict hygiene protocols. During the winter, a potential late night to early morning curfew can also be applied. Schools and universities should be open with specific hygiene protocols which were applied in Greece this fall (mandatory masks indoors and outdoors, etc.) and with regular testing of students and teachers to assess the spread of the virus in a timely manner.
Also, we need to understand that every person should take simple precautions such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds, regular handwashing, and coughing into a bent elbow or tissue.
At least until summer, wearing a mask should be a normal part of being around other people. Finally, until this nightmare ends, we need to have nationally expanded random pooled testing on a regular basis and ideally 24-hour turnarounds for test results, so if a person tested positive, they could quickly isolate.
When do you think normalcy will return?
Honestly, no one knows and any prediction is very risky. But we can tell two things; first, this virus is not the worse in terms of morbidity and mortality rates in human history, and science is developing vaccines and treatments very fast compared to other infectious diseases, so it seems that we can be adequately comfortable in the second semester of 2021.
But most public health historians and epidemiologists agree that the coronavirus pandemic could end socially before it ends medically, similarly to all previous pandemics.
Lockdowns fatigue, economic disaster, and the social-psychological issue of exhaustion and frustration can lead us to declare that the pandemic is over and that we deserve to return to our “normal” lives soon.
Therefore, the quote by Eliezer Yudkowsky that I recently read can be very helpful: “We are ethically responsible for becoming more ethical than the society we grew up in”.
Finally, a significant take-home message that all scientists should convey to the public is that COVID is not the exclusive health issue we are dealing with, therefore, during the pandemic please do not neglect other diseases or health problems and regularly communicate with your doctors about these issues.