The Borisov government reacts mildly as the first cases are being reported in Bulgaria. Strong concerns about the Bulgarian healthcare system's ability to withstand the impact of Covid-19, especially if the situation deteriorates quickly

11/03/2020 -  Francesco Martino Sofia

"In ten days there will be many more cases, in a month many, many more. We are preparing, and the coronavirus will be a real 'stress test' for our healthcare system, showing us how much we are really ready to face challenges of this kind”.

With these words Professor Atanas Mangarov, director of pediatrics at the Sofia infectious diseases hospital, commented on the Bulgarian national radio (BNR) on the first four cases of coronavirus in Bulgaria, detected last Sunday in the cities of Pleven and Gabrovo.

The news certainly did not come as a surprise: while more and more countries in the region announced the presence of "Covid-19", Bulgaria remained one of the few without ascertained cases. However, everyone was aware of the country's close ties with Italy and Greece, with a strong flow of people entering and leaving these countries.

The late detection of the first patients – who have not recently travelled to areas where the virus was already present – indicates in all probability that the number of cases of infection that occurred, but were not ascertained in Bulgaria is probably already significant.

"In all probability in Bulgaria we have people who are infected, but undiagnosed", added Professor Mangarov. "As for our 'zero patient', I don't think they will ever be identified, because in all probability it is not a single person, but several".

Rumors and speculations about the possible "zero patient/s", however, have circulated insistently. Premier Boyko Borisov made explicit reference to a "Greek trail" for the arrival of Covid-19 in Bulgaria, which was later denied. Others have pointed the finger at Italian workers currently engaged in the construction of the "Balkan Stream" gas pipeline in the Pleven area, although no concrete evidence has materialised.

Government measures

Immediately after ascertaining the first cases, Borisov urgently summoned the Council of Ministers on Sunday morning, broadcast live on television. During the meeting, with his traditional assertive attitude, Borisov tried to calm the hearts and appealed to the self-discipline of Bulgarian citizens.

“We will close access to cities [affected by the coronavirus] only as an extreme measure. We don't want to panic, we want to use reason", said Borisov. "True, there are countries that have introduced drastic measures, such as Italy, but others are applying much milder ones, like Germany and Belgium", added Borisov.

To deal with the situation an emergency council was created, headed by General-Major Ventsislav Mutafchiyski, director of the Military Medical Academy. The measures immediately taken included the stop to all indoor cultural events including cinema, the decision to hold all sporting events without an audience, the ban on mass events with the participation of minors and school trips, travels, and excursions.

Borisov has announced the purchase of 50,000 masks and protective suits from neighbouring Turkey, which were delivered this morning. For the prime minister, the country then has medical tissue available which would be enough to produce three million masks. Negotiations with local companies able to produce them started immediately but, according to Health Minister Kiril Ananiev, "it will take a few months" to bring the actual production to life.

Yesterday the emergency council announced that it will present the guidelines of the measures to be taken, which will probably differ between the areas already affected by full-blown Covid-19 cases and those without identified outbreaks.

In general, measures will be soft: in the less affected areas, theatres and cinemas could reopen, although with more distancing between spectators, while public institutions will remain open. The courts, meanwhile, have announced that all trials requiring the presence of litigants, lawyers, and witnesses in the courtroom will be suspended for a month.

Will the system withstand the stress test?

According to a study published in the Bulgarian version of Deutsche Welle, there are currently about 800 beds in the infectious diseases wards throughout Bulgaria. In some key hospitals, like the Military Medical Academy and Sofia's Infectious Diseases Hospital, however, the capacities are said to be already or almost exhausted.

A few days ago Angel Kunchev, national chief health inspector, admitted during a television interview that the most serious problem in the event of an epidemic in Bulgaria will be "the lack of doctors, even more than hospital facilities and beds".

For years, the local media have reported on the loss of medical and paramedical staff, pushed abroad by the lack of decent working conditions and life prospects in Bulgaria. According to data from the Bulgarian Medical Union, 1,692 doctors left the country in 2015-2018. In the last ten years, according to trade unions, almost 30,000 nurses have emigrated.

Minister Ananiev spoke of an emergency plan to channel doctors and specialists from other departments to infectious diseases and resuscitation, to involve doctors from private hospitals and clinics and, in the extreme case, to call retired doctors and nurses back into service.

The doubts about whether the system will actually hold in the case of an epidemic, however, remain. The first moments of tension occurred yesterday in the "Sveta Anna" hospital for respiratory diseases in Sofia, where doctors and nurses threatened to resign en masse due to the lack of masks and adequate protective clothing – a protest that partially subsided after the hospital management provided the required materials, which may not however last long.

Life continues, at least for the moment

Despite far from reassuring news from Italy, Bulgaria still hopes to be spared the heaviest consequences of the Covid-19 epidemic. If cinemas and theatres have closed, shopping centres, casinos, restaurants, and cafes remain open.

At the same time, Prime Minister Borisov has asked for schools to be reopened starting tomorrow (they are currently closed due to a second wave of influence), because "otherwise parents cannot go to work". Mainstream media, such as Nova TV, one of Bulgaria's leading private networks, still publish articles featuring the message "don't panic", as "if you're under 50 and don't live in China, it's more likely for you to win the New Year's lottery than to get sick with coronavirus".

Last night, however, the prime minister himself announced the first two cases in the capital Sofia, which now bring the total number of confirmed patients to six. This morning Yordanka Fandakova, mayor of Sofia, said that she expects schools to remain closed at least until the end of the week. As already seen in Italy, with coronavirus the situation and mood could change drastically in a matter of days or weeks – unfortunately, almost certainly not for the better.

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