Assoc. Prof. Mihail Okoliyski: Measures to fight Covid-19 are not violating human rights, but protecting people

If we come together and maintain solidarity, we will overcome this challenge

We must take a look at ourselves, recognise our mistakes and start following the recommendations, showing extreme care for our own health and that of others, Assoc. Prof. Mihail Okoliyski says in an interview to Monitor.

Assoc. Prof. Okoliyski, as of noon of 22 March, global data showed 311,894 coronavirus cases and 13,071 deaths. In Bulgaria, the number of people who tested positive for the new virus has reached 171. Considering the figures available for our country and Europe, is it fair to say that the virus is spreading at a lower rate in Bulgaria compared to the rest of the continent?

The Ministry of Health and the National Operative Staff are following all the instructions provided by the World Health Organization (WHO) when it comes to tackling Covid-19. The cases in Bulgaria could be fewer or many more. No one knows the real number of the infected because not every single one of them has been tested. In other words, the numbers showing the real contagion remain hidden and we can only hope that they do not exceed official statistics by several times. Bulgaria is still holding up well compared to countries with better healthcare systems such as Italy, Spain and France. And this is a direct result of the timely measures being taken by the crisis team.

However, there are those who complain that the measures are too strict, arguing that the virus does not even require rest at home. How would you comment those opinions?

We are seeing the result of milder measures in Italy, especially in the northern part of the country. In a very short period of time large swathes of people got infected. The most severely affected are people over the age of 65 and with more than one underlying condition. The death rate is highest for that group. Most of the Covid-19 casualties in Italy come from that age segment of the population. I do not know if people calling for a less strict approach realise that we would be risking the lives of our mothers, fathers, grandmothers and grandfathers. That should not be allowed to happen.

What kind of chronic conditions make people most vulnerable to Covid-19?

Those would be cardiovascular diseases and diabetes. People in that category are very vulnerable. Cardiovascular diseases are exponentially aggravated by such infections - of the upper respiratory tracts, and pneumonias have devastating consequences for them. All three deaths in Bulgaria are of people who had suffered heart attacks, strokes or experienced similar symptoms. It is important to know that if people with cardiovascular diseases succumb to stress, panic and rush to stock up on food, for example, they risk suffering a stroke or a heart attack brought on by the panic. This is why the WHO developed and shared with the Ministry of Health guidelines on maintaining good mental health, especially when it comes to the elderly.

Do people with high blood pressure, who regularly take medication for their condition and keep their levels within relatively good limits, fall into the category of at-risk people with chronical conditions?

They should not be at such a great risk, since, as you said, they keep their blood pressure in check. But people over the age of 65 should be extremely careful. In recent days, we heard calls for the National Operative Staff to ease off the measures so that people could go for strolls in the mountain and spend time outdoors. But every single Bulgarian citizen should be aware of the price they may pay for such a stroll. Now is the time for us to be disciplined and patient. Everyone should heed the measures introduced by the crisis team because they are meant to protect us, our health and our life. All restaurants and bars have been closed. Only grocery stores, gas stations and pharmacies remain open. If there are still cafes working somewhere and people congregating there, that is extremely irresponsible.    

WHO Director General Dr. Tedros Ghebreyesus says that on the one hand, we have to maintain the balance between healthcare and keeping our individual health, to avoid economic and social shocks, and on the other - to observe human rights. The measures being undertaken in Bulgaria do not violate human rights. Their aim is not marginalisation or stigmatisation of certain groups of people, such as the elderly or the Roma, but to provide aid and prevent the infection spreading among them. With this in view, WHO believes that if social and economic life comes to a standstill, it will be much more difficult for us to recover afterwards.  

That is why every one, be it a factory director, or employer, or hospital manager, has to think how to protect their people. Some of them may be allowed to work remotely, others to be at home on sick leave, and still others may go on working but under stricter protective measures. Wearing a medical mask is a measure targeting exactly these people. Apart from those who are ill and may spread the infection when sneezing and coughing, only medical professionals should wear masks. Meanwhile, we see healthy people out in the streets wearing masks, which doesn't make sense. 

Bulgaria is not the only country where people wear masks during this pandemic. Why shouldn't they wear them?

Wearing a mask may expose healthy people to risk, because the masks give them a false sense of security. They become contaminated when people touch or adjust them. When we wear a mask, we tend to underestimate the requirement for keeping 1.5-metre distance from each other as well as for washing our hands regularly and disinfecting the spaces around us. Breaching these rules increases the risk.

As regards the lockdown of certain places, for instance the ski resort of Bansko which became a hotbed of infection, the measures are correct. The lockdown of Wuhan and other Chinese towns proved to be a very good and effective idea because these measures really worked. China has already reported that there are no local cases of infection, apart from those imported by people who stayed in Italy or other countries affected by Covid-19. Bulgaria is a democratic country and it would be difficult to impose such strict measures, it will be a great challenge. 

Opinions have been voiced that the spread of infection in Italy may reach its peak by 29 March. Can we forecast when exactly it will happen?

It is certain that WHO has never committed to making such prognoses because they strongly depend on the local development of the epidemic. We cannot forecast nor give any social engineering foresights. Such prognoses may only confuse people and make them think that the situation will last for about two months, maybe for longer or shorter time. No one knows it. Every person must be very careful when voicing such forecasts. China is most probably past the peak. It is not clear when Italy will reach its peak. We saw that there has been a certain slowdown but now more and more reports are coming again about new cases of infection as well as about a growing lethality rate. That is why we shouldn't commit to making prognoses. This is the reason why WHO doesn't make such forecasts. 

Does it mean that the mathematical model of the coronavirus spread proposed by the Bulgarian Academy of Sciences will not work?

I cannot comment on this model. What WHO is trying to do is to help the government to postpone the epidemic in time, which would allow for the healthcare system to cope better. If no measures are taken and people en masse catch the infection from each other, we will have to pay too dear a price. It means that many elderly people will die or suffer.

At the same time, the healthcare system will collapse because it will not be able to meet the needs of patients who have to be intubated or will require intensive care. For the moment, it manages to cope and doesn't feel short of resources. Our medical professionals are highly motivated and are real experts. They are working day and night and this is evident in the people's response. But apart from being thankful to them, we must take a look at ourselves, take account of our mistakes and follow the instructions to be as much as possible responsible for our own and for the health of others.

I think that we have been showing solidarity and this is good news - we don't stigmatise nor discriminate each other. People help each other, young volunteers do shopping for the elderly. If we as a society stand united we will overcome this challenge too.



Assoc. Prof. Mihail Okoliyski was born on 21 June 1972 in Sofia. He earned a degree in sexology from the Humboldt University of Berlin in 1995. He has been serving at the Bulgarian office of the World Health Organisation since October 2014.

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