By Paul Niland.
Published March 20, 2021
As Ukraine (at least, regions of Ukraine) heads into a third lockdown period due to record numbers of new coronavirus cases, an analysis of how we got here, and the lessons the government can learn from highlighting their failures, is necessary.
This is not criticism for the sake of grumbling.
Lives are being cut short.
People are dying, and there is no acceptable level of premature death.
Hopefully, someone in the Ministry of Health and in government and on Bankova Street will pay attention to this constructive criticism, and do more to be pro-active about fighting this virus when citizens and residents of Ukraine emerge from the three weeks of isolation that we are about to undergo to play our part.
Because the government has to do better at playing their part.
Let’s put things into stark perspective. In the 72 hours prior to writing this, Ukraine recorded over 45,000 new infections. Based on the global average, approximately 3% of those people are going to die. That’s 900 lives lost.
Things haven’t always been this bad. Some early moves by the government, with citizens playing an important part, have been positive.
The first national lockdown, from March 17 to May 24, may have been difficult for all of us, but it was a key factor that stopped the virus, at that time, from seeding widely across the country as it has done in other places that have been hardest hit, predominantly through the incompetence or science denialism of their leaders. But the dynamics of this virus, and the fact that the spread is exponential, means that this mass seeding and a case doubling every 10 days can occur at any time. This is precisely what is occurring in Ukraine now.
Another thing that Ukraine did well was controlling people entering the country so that new arrivals could not import more of the virus. On arrival at Ukraine’s borders, it was mandatory for people to download an app to their phones that would monitor them for adherence to mandatory self-isolation until they had received a negative PCR test result.
As a result of these policy choices Ukraine has recorded 678 deaths per million inhabitants.
For a relatively poor country with a decrepit health infrastructure, that is a success compared to the horrors of the UK death toll of 1,848 deaths per million souls.
But with a 10-day cycle of cases doubling had we not applied the brakes now with the new lockdown, today’s 15,000 cases would be 30,000 cases per day by the end of this month and exponential growth would translate to 60,000 daily cases by the middle of April. So, this lockdown is necessary, not only to curb the spread and stop this trajectory but also to alleviate pressure on the healthcare system.
The list of things that authorities in Ukraine have got wrong, and MUST fix in this window that the government is being granted by citizens again agreeing to curtail their lives for the next few weeks, is not particularly long, and nor is any of this rocket science. There are known solutions that we can observe from the best international practices and adopt here.
The first failure that must be addressed is an age-old problem in Ukraine. Communications. It has always bewildered me that Ukraine (especially as the country is at war, but that’s another topic) has consistently failed to be proactive with communicating internally and externally. The only information posters I have seen urging people to stay home if they’re sick or to maintain physical/social distancing carry on them logos from organizations like the World Health Organization and the U.S. Agency for International Development. In other words, international governmental organizations based in Ukraine have made that happen, rather than Ukraine’s government.
There needs to be more information, through all channels, that are a constant drumbeat of the basic rules that will keep us safe.
Reducing our contacts (yes, that even includes hand-shaking) to the bare minimum.
Communicating during a pandemic is not as simple as “well, we set up a Telegram channel, what more do you want?” At a time like this, it is necessary for the message to be carried to the country, not rely on people to opt in to something. In addition to the basic health information campaign, a focused vaccine safety awareness campaign is urgently needed.
Vaccine safety awareness
Vaccines are the way out of this awful period. We will not be safe from this virus until at least 70% of the population (especially the most vulnerable) are vaccinated. With well in excess of 50% of the country being reportedly unwilling to get the jab, we will never get to the vaccine take-up needed for the country to be able to emerge from the shadow of coronavirus. No, a one-off photoshoot of the president getting his shot or a few local politicians getting theirs is not an information campaign. “More than 410 million doses of these highly effective vaccines have been administered around the world, with no problems reported as a result” is an example of a potential campaign message that resonates and will build much-needed trust.
In the recent massive coronavirus relief bill passed by the Democrats in the United States, there’s a $250 milion allocation for vaccine safety awareness. Here in Ukraine, we took part of the money allocated to fight the healthcare crisis and spent it on roads.
On the subject of vaccines…
Yes, there has been a problem securing supplies of the miracle drug, the speedy development of which is a testament to the greatness of the scientific community and not remotely due to cutting any corners in the process. Rich countries bought up the first batches as they rushed to protect their citizens.
We all saw the “me-first” attitude. It was actually pretty understandable. However, the delay in getting any vaccines to Ukraine at all should have equated to time spent in preparing the necessary infrastructure for distribution, storage, and administration. The fact that Ukraine is injecting at a snail’s pace points to not only the vaccine hesitancy but also to the failure to have ramped up ways of getting the shots out and into arms once they were in the country.
More than 500,000 doses arrived in the country just short of one month ago.
As of today, slightly more than 100,000 vaccines have been administered since Feb. 24.
That is pathetic, by any standards. It is completely unacceptable. Something like 300,000 people have signed up for the waiting list, while other countries are getting millions of people vaccinated on a daily basis. It is possible. This logistical failure will condemn more people to death, and the blame lies squarely with the government and responsible (irresponsible) authorities.
Another hard truth.
According to French research, if you vaccinate 100,000 people over the age of 50 tomorrow instead of today, 15 more people will die. Deaths attributable to delays like this are the direct outcome of the dismal vaccination program in Ukraine. This needs to be fixed. Again, it is possible to look at international examples, a change of attitudes (from election fixing to problem fixing) in the top leadership in the United States means that they’ve ramped up vaccine administrations from less than 1 million per day two months ago to an average of 2.5 million per day now.
TESTING, and contact tracing
Since the outset of the pandemic it has been well-known that tracing people who have been in contact with infected individuals and instructing them to isolate has been one of key tools to fighting the spread of the virus. The World Health Organisation told us this, and some countries (particularly those who had previously been exposed to outbreaks of things like SARS and Ebola) have done well at this. During our March-April-May lockdown, my assumption was that the Ministry of Health was building a program like this. Maybe after almost 20 years in Ukraine I am still naïve. This has not happened. No contact tracing is being done.
Of course, contact tracing when you have 15,000 cases per day is nigh on impossible (even if you have spent or allocated 37 billion pounds on it) but when we emerge from this lockdown there will be a more manageable caseload. Again, examples abound internationally on how to do this properly, relevant expertise can be contracted, and existing contact tracing models can be borrowed and adapted. This is, after all, a time of unprecedented global cooperation, as vaccine development has proven.
The fact is, with the slow pace of vaccinations, as a country we will be living with this for some time, many months into the future at least, that we have failed to implement a contact tracing program so far is a historical failure, it cannot be allowed to be a future failure too. That would be willful negligence for ignoring a known tool to fight this fight, such government negligence as this will cause more families to lose loved ones.
Of course, we cannot have contact tracing without testing to find cases. Again, international experience can inform us of how best to do this. Testing is absolutely essential and a national strategy for testing needs to be both put in place and carried out properly.
At present, there are (in theory) two ways of getting a test for coronavirus in Ukraine, private or through the health system. The problem with private testing is that the cost is prohibitive for many people. The problem with the health care system offering free tests to those who need them (via a referral from a family doctor) is that it simply doesn’t work as it should. A quick question among my friends found out the theory and also the reality of trying to obtain a free government test in Ukraine, the system is broken and needs fixing. Patients are refused the test, told that as the results take two weeks there’s no difference and so just isolate for that period anyway.
One thing that may surprise many is that the country where this strain coronavirus entered the human population which was ground zero for the global pandemic is, as we all know, China.
And (this is the surprising part) today China is actually one of the countries with the lowest death rates in the world, at 347 per million people, it is almost exactly half of the death rate as Ukraine’s. Without a doubt, the early methods that China took to control their outbreaks were barbaric and typically authoritarian. But their most recent successes of fighting the spread of the virus have come, in large part, due to massive testing programs. When even small clusters of new cases have been found, China has mobilized to test cities of millions of people in the space of a few days. If the technology exists to find every single case in a city of nine million in five days in China, then the technology exists to find every single case in a country of 40 million within a month.
The cost of a national mass testing program, delivered free to every person in the country, is likely to be quite high, when looked at as a line item on a budget. However, when looked at in comparison to the costs to the economy of being continually subjected to the restrictions caused by the pandemic, that cost will look relatively low. Put the cost of a national testing program against the cost of fighting the disease in on hospital wards. Put the cost of a national testing program against the costs measured in human lives lost. Spending government resources is a matter of choices, of priorities.
Find every case.
Trace their contacts.
Communicate to the country, particularly about vaccine safety. There are vaccines on their way, in large numbers.
Ramp up the vaccine infrastructure to get those shots in arms as fast as humanly possible.
Those are the challenges that President Volodymyr Zelensky, Prime Minister Denys Shmyhal, and Health Minister Maksym Stepanov must address.
We will play our part for the next three weeks, do not, again, waste the time that this will buy for you. Otherwise, blood will be on your hands.