By Vasileios Margaritis, PhD, MSc, DDS
Two months ago Greece seemed to successfully bend the coronavirus curve and was able to open some activities for a few weeks (retail stores, schools).
However, during the last weeks we are unfortunately seeing again a significant surge in COVID-19 cases and hospitalizations, especially in Attica where almost the half of the population lives.
Being under one of the strictest lockdowns in the world for four months now, it is obvious that most of the strategies implemented by the government have failed to control the pandemic.
Countries like Australia and New Zealand followed the “Zero COVID” approach by implementing strict lockdowns and border controls when lockdowns lifted to successfully achieve a significant degree of freedom within the country.
But the majority of European countries have followed the “suppression approach” by applying strict and ongoing lockdowns, with few reopening breaks. However, they did not aim to reduce infections to zero in defined geographical areas or have hospital bed and ICU occupancy as a main criterion.
Greece did not learn coronavirus lesson
In Greece, unfortunately, we did not learn our lesson from the second wave — which was not adequately tackled, especially in Northern Greece — and we are continuing to believe that lockdowns are the “magic solutions” that can fix everything.
But simply put, they cannot, without a predetermined and well-defined endpoint.
We did not significantly improve our surveillance system or any other preventive system.
We did not implement and monitor well-customized preventive policies in workplaces, public transportation, and mass gatherings (e.g. demonstrations), especially in Athens.
We did not apply adequate strategies for strengthening health system resilience, as the WHO and other health organizations suggested.
It was only earlier in the week when the government announced a plan for a public/private health services partnership for receiving and treating COVID-19 patients, due to the enormous strain on the public health system during the last several weeks.
Border controls and testing
Further, even before Christmas, many public health experts had warned the government to implement strict border controls at least until the summer, to limit the importation of variants which are proved to be more transmissible and unfortunately carry an increased risk of mortality.
We did not do regular testing of students and teachers to assess the spread of the virus in schools in a timely manner.
And most importantly, we did not take into consideration the lockdowns fatigue, economic disaster, and the social-psychological issue of exhaustion and frustration of the great majority of the population, who see no light at the end of this tunnel.
Many of the applied public health strategies in Greece have been ineffective.
For example, instead encouraging people to be outdoors and socializing outside as weather improves, knowing that outdoor transmission is minimal and the significant benefits of getting fresh air and exercise, there are strict stay-at-home orders, especially during weekends and holidays, thus contributing significantly to household transmission.
What needs to be done
First, we need to learn the lesson from Israel, that vaccines are the most effective way to suppress the virus — but only when they are also available to younger age groups (80-85% of collective immunity) and this will take significant time for most countries.
If Greece wants to break the cycle of continuous lockdowns, we need to have zero tolerance for COVID-19, using vaccines and more effective public health strategies to stop the transmission of the virus.
7 strategies to stem coronavirus in Greece
1) Even now, a very aggressive trace and isolation policy of new COVID-19 cases to significantly decrease workplace and household transmission, by also providing alternatives to people who cannot isolate at home (e.g., use of hotels which are mostly empty at present);
2) Strict border controls at least until June with testing at arrival in Greek airports and potentially 2 to 6 days isolation in hotels, regardless vaccination or negative PCR test from the country of origin.
For a while, we need to close borders to non-essential international travel; this is the tradeoff that we need to accept if we want to have a good chance to end the pandemic by Fall.
But at the same time, we can support local tourism industry and hotels, by providing incentives to Greeks to travel and enjoy their country after months of strict lockdowns, as other countries do.
When borders will be more open, Greek expats can be given a priority, especially those from the US and Australia, who were not able to visit Greece last year;
3) Relaxing restrictions on outdoor socializing first, including the outdoor facilities of cafes and small restaurants;
4) Opening schools in a phased process, allowing younger primary students to go back first, followed by other students over the coming weeks, with systematic monitoring of the impact of transmission in school settings;
5) Preventing outdoor and indoor superspreader events by keeping closed large cinemas, theaters, stadiums, indoor shopping malls, etc. and by avoiding crowding festivities and demonstrations, but all the other businesses can be open with strict hygiene protocols; and
6) Maximizing our efforts in making public and private health systems more resilient to COVID-19 crisis. We need to prioritize and avoid back-and-forth measures that confuse and distract the public from the threat of this virus.
Finally, we need to be sincere with the public — this is a 100-year natural disaster and unfortunately, we did not act proactively to save as many lives as we could.
But we can and should save our country from collapsing.
Vasileios Margaritis is a Senior Faculty in Public Health Doctoral Programs at Walden University