Gen. Mutafchiyski: The war on coronavirus is on several fronts

The entire world has been ravaged, I am in a constant state of anxiety that the same fate awaits us

Most probably, until the world develops a vaccine or a reliable cure which will help to overcome this epidemic, we will have to learn to live with it, says Maj. Gen. Ventsislav Mutafchiyski, head of the National Operative Staff, in an interview to Telegraph

Gen. Mutafchiyski, do you remember how you felt when the first coronavirus cases in Bulgaria were confirmed?

Awful. From the time the National Operative Staff was set up, right up until the first case was confirmed on 8 March - a moment I will never forget, we were very active in looking for people who would test positive. Our anxiety grew with each passing day. We sent out memos to hospital directors to be vigilant when it came to patients with double pneumonia and to administer Covid-19 tests. We expected the virus and knew it was just a matter of time, but we were in search mode for a long time. By the end of the wait, our molecular virologist Assoc. Prof. Metodi Kunchev would even say, “Unfortunately, there are no cases to report today either, General.” And I was wondering why he was talking like that, why that news should be unfortunate. I thought we should be grateful for not having cases. But infected people kept popping up in our neighbouring countries and it was becoming increasingly clear that we would not remain an island of calm in this coronavirus sea.

Do strangers stop you in your day? What do they say to you?

Yes, that happens very often, and people mostly express support. I prefer to go about my business unnoticed, but at the same time this response is reassuring to me because, like anyone else, there are times I question whether I fully grasp what I am dealing with. It is nice that people who stop me realise the gravity of the situation and the need for strict measures, whether those measures inconvenience us or not. This feedback is a barometer of sorts.

You have the highest approval rating in every opinion poll out there. What does that acknowledgment mean to you?

Actually, those approval ratings are like comparing apples and oranges because everyone else on such lists is a politician, and I am not. My name should really not be included in these opinion polls. Sociologists normally make the distinction when presenting such results. It is just a case of people approving a particular job that someone is doing, but that does not mean that things will be the same if an opinion poll is conducted for strictly political purposes. I find real comfort in that. I believe that the two things should not be conflated. I have been a doctor for 30 years and I know from experience that patients are willing to give me the highest approval when I am treating them and they feel vulnerable. Their only hope is tied to what I'm doing. Just a month later the same patients might not have such confidence in me even though their treatment was successful.

Bulgaria is highlighted as a good example for Europe due to the timely measures taken by the National Operative Staff. Was it hard for you to convince the premier and the cabinet to stand by you and go ahead with the mitigation measures despite the initial public outcry?

The prime minister was absolutely convinced that some decisive and unfortunately unpopular measures had to be taken. If I am to be completely honest, the ministers were quite sceptical. They expressed their concerns, each of them noting how devastating of an impact the physical and social distancing could have on their sectors - closing restaurants and bars, hotels. In fact those are the businesses we have closed in Bulgaria in addition to schools and kindergartens. And that's it, nobody else. As far as the economic pain is concerned - we have not closed a single factory, but the world economy is in a recession and that is affecting us. However, these consequences do not stem from our decisions. Even if we had not closed all restaurants and hotels, do you really believe that any reasonable person would have felt comfortable eating or staying in those establishments in a time like this? I do not think so. And so, after a spirited Council of Ministers meeting, the decision was taken.

You made one of your most emotional statements on 14 March following an emergency Council of Ministers briefing. You said at the time that an epidemic of unprecedented ferocity was headed towards us and it was no time for revelry. What would be your message now?

The virus has been less ferocious in Bulgaria so far, while laying waste to the rest of the world. Humankind has not seen such a disaster since World War II. You see the growing number of victims, destroyed lives, the devastating economic effects. The entire world has been ravaged. I am in a constant state of anxiety that the same fate awaits us. I became really concerned when I saw that the public was failing to see the threat. The speech you are referring to was completely spontaneous. When I talk publicly, I never read from a card. I do not prepare speeches, but I know what I want to say. To me, words are most powerful when they come from the heart. I hope my sincerity came through at that moment. I think that many people became motivated to follow the guidelines, however unpleasant they may be to all of us. That is what we all should be doing.

Still, there are people who do not seem to get it.

This is typical of Bulgarians - it does not take long for us to start complaining and picking things apart. I am hearing all sorts of questions, like are we allowed to cross parks or should we get around them? We are the kings of exceptions, and before you know it the rule has become the exception. We should not let this happen. Yes, Bulgaria was among the first countries to shut down, but we followed the recommendations of the World Health Organization and the Centers for Disease Control and Prevention in Atlanta, US. We also monitored the trends in Asia as well as the situation in Italy, when things started to get out of control there. The only working mechanism of containing the spread of the virus was, and unfortunately remains, physical distancing. Europe has much stricter measures in place than Bulgaria, but they were introduced much later, which is why they have not been so effective in staving off the ferocity of the coronavirus. We took action earlier and currently we have one of the most liberal regimes in Europe. Some countries are starting to ease certain measures, but those mostly concern steps we never took in the first place. Plus, plans to relax measures have been declared but are yet to be implemented, which is significant. This kind of talk is typical for politicians, and I am not one. I say what I think we should be doing at the moment. I avoid making comments about the future.

Why?

Because I have learnt that the Bulgarian public is starved for news. And when we say that something will happen in 20 days, many act as if it has already happened and start ignoring the rules. Unfortunately, I gained some insight into how the Bulgarian people think, thanks to this situation, and now I am really careful in my statements. I want to say so many things to Bulgarians - about the plans for the future, because, you see, everything that is happening now is the result of a plan of action we devised between the moment the National Operative Staff was set up and the confirmation of the first coronavirus case. We had a clear idea of what would have to be done in terms of reorganising the work of medical facilities, the stages in which they will join the coronavirus battle, the gradual supply of protective gear, treatment strategies, educating medical workers about this novel coronavirus. We tried to prepare the healthcare system as much as we could so we can handle the increased load despite the system's limited capacity.

The fact that our capacity is limited is a potentially serious problem, is it not?

Yes, because in such a situation it is very hard to work with a limited capacity. You see what is happening even in the US, France, Italy and Spain. Keep in mind that those are healthcare systems we have aspired to emulate. There is this rating of countries that measures how prepared their healthcare systems are for such emergency situations. The US is ranked first with their preparedness measured at over 80%. The top is made up of the same countries where we now see devastating death tolls and overburdened healthcare systems. We knew that our system could be easily overwhelmed and that we had to bring the rate of transmission to a level that can be handled with our limited capacity. A lot of pundits came out and said how it would cost BGN 500 million to test everyone and how we could build herd immunity - all sorts of expensive ideas to cope with the situation. That is all well and good, but we have to be realistic about where we stand.   

And where do we stand?

The fact is that we made a start with just one reference laboratory, to this date we have 19. It is also a fact that in the Balkan region our country stands very well with regard to the number of infections and the number of deaths. Looking at the statistics for Romania, Turkey, Serbia, Macedonia, Greece, I think things are clear. Set against the other European countries, we also maintain a very good level. Our opponents are trying to imply that our results are so good because we test too few people. Yes, but if he haven't found 10,000 infected, at least 2,000 of them would develop an acute form of the disease and will hardly stay isolated at home, while 200 of them would die. And this is not something we could hide. That is precisely the reason why I am currently studying the overall mortality rate for Bulgaria in the past year, in order to compare it with the same period during this year.

However, to this moment the figures are quite revealing. Are you proud of the results attained?

It's too early to say. I am proud of the fact that we have not overloaded our healthcare system and my colleagues can work normally. Because they are the great heroes. While we are talking, some people play hide-and-seek in the city gardens, try to cheat policemen, and spread tall stories on Facebook, but there are also people who don't come home, they are wearing protective garments, working 12-hour shifts, and they do it every day.    

It is obvious that sometimes you get annoyed at the inappropriate questions. What makes you angrier - that you often have to repeat the same thing, or that there are people who do not yet understand the gravity of the situation?

During one of the briefings, I said that I will never get tired of repeating the most important things. I will not be tired of repeating over and over again how we have to wash our hands, keep safe our family members, and keep distance. These are the things I will never tire repeating. Yes, the inadequate questions do annoy me, but I'm trying to show understanding because people have different interests. The truth is that most of the questions are well-meaning and I am extremely grateful because if the mass media did not deliver all of our messages just as they were worded and did not cover the course of events in the West, our work would have been doomed to a complete failure. That is why I would be inclined to pardon everything that you would do, even the most stupid of questions.  

Currently you are in the hottest of all seats. What does that cost you personally? Do you have enough time to rest?

I don't know why everyone thinks that once I come home, around 7pm, it is a proper time to call me up and ask me questions, because at that time I am less busy. As soon as I sit down to have diner, the telephone starts ringing. This certainly bothers my family, but they diligently observe the quarantine. I almost don't see my sons. One of them came back from Germany, he was not infected but was put under the mandatory quarantine, and I made him stay in quarantine for 16 days. We saw each other after it was over. Otherwise we speak on the phone every day. With my other son we also speak on the phone frequently. He works from home. I took out some chairs on the terrace to be able to watch the trees and the surrounding nature. At home we all observe the quarantine very rigidly.    

You were on missions in Iraq and Afghanistan and took part in real military actions. Many people have defined the fight against the coronavirus as war. Do you agree?

The answer is both yes and no. During a war it is clear who the enemy is, and you concentrate all efforts on preserving the lives of your soldiers because this is the key principle of military surgery. During war you kick into high gear and cannot work in routine mode. The tension is omnipresent. The current war is being waged on several fronts. The first is the coronavirus. Next come some unscrupulous media outlets which launch a downright nefarious campaign against the National Operative Staff. They even make some absurd statements, claiming that there's no epidemic, that all this is a make-belief story aimed at establishing control over society.

You said that at the beginning you knew all of the infected patients by their names. How does it feel when you are responsible for so many human lives?

The feeling may be described as constant headache. Physical headache. To be mobilised to full capacity, to be fully aware of everything, because this is what is expected of you. You must help. On the other hand your colleagues, the journalists, they don't ever let me at ease in this complicated situation. This way it becomes ever more difficult to follow individual cases, moreover while new hotbeds of infection emerge where we must show heightened attention. It would be highly damaging to stigmatise whole social groups, certain communities and people. We clearly understand at which locations the quarantine measures may fail, leading to a growing number of infections, and we are monitoring such places day and night. Now people are very nervous and I understand them. However, it may easily spill over into very ugly situations.

According to world experts' prognoses, Bulgaria will reach the disease peak already this month. However, the prognoses of the Bulgarian Academy of Sciences show that the realistic scenario for Bulgaria is for the end of June. Do you think that we will be able to keep the situation under control if it lasts until the summer?

Actually, no one knows how long this situation will last. And this is the worst about it. With this in view, the EC has issued a roadmap for working under the Covid-19 epidemic. It is aimed at restoring production, reviving economies, lifting the limitations. But even this roadmap gives only broad-brush instructions, there are too many obscure items in it. Most probably, until the world develops a vaccine or a reliable cure which will help to overcome this epidemic, we will have to learn to live with it. The other worrisome thing is that it is not clear what immunity is acquired by those who have suffered through the illness. Because the standard measures cannot be applied to this epidemic. And this is the counterpoint to the so-called “herd immunity”. Maybe to me it is an advantage in this situation, because I am not an epidemiologist nor infectologist. Because otherwise I would support the concept of herd immunity or other similar practices. And they could well lead us to the situation which we now witness in Spain and Italy. This is a nonstandard situation and it cannot be resolved with standard methods. I am sure of this.     

Are there any examples we could follow?

Together with my colleagues from the National Operative Staff, I have been following very closely the developments in Singapore because we badly need good examples as well as practices and directions. We have to look at the other states which had such experience and know how to cope with the situation. At a certain moment we had the impression that in Singapore they have solved the problems, but only several days ago it came to me like a bolt from nowhere when I learnt about a new boom in infections registered there. Within one day alone, they registered 384 cases, having in mind that the total number of infected was a little over 2,000. And it happened after we had considered them as a benchmark of quality in coping with the infection. During the last month, in Singapore they didn't even speak about anything being worrisome. And all of a sudden - boom! In my opinion this is horrifying.

And what do the developments in Singapore show us?

They show us that apparently every approach has its own drawbacks and that maybe it is too early to ease some measures. Obviously the world is hesitating and cannot find the right way out, yet. That is why I am surprised to see some of my colleagues - and not only colleagues - talking as if everything is clear to them. However, I know that nothing depends on them. This is the greatest difference. This is the hot seat you asked me about. If I and my colleagues from the National Operative Staff issue wrong recommendations, we would bear our responsibility for it. And this is a very heavy responsibility. Because later someone may come out and say, “So many people died because of you, since you didn't do your job.” This is where the differences in the manner of speaking come from.

 

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Ventsislav Mutafchiyski was born on 20 August 1964. He graduated in medicine from the Sofia Medical Academy and in 1996 earned a degree in General Surgery. In 2015 he became a professor of surgery. He was surgeon of the Republic of Bulgaria as well as a national consultant in surgery. On 7 February 2018, Mutafchiyski was appointed as head of the Military Medical Academy. In 2019 he was promoted to the rank of Major General. He is a member of the American College of Surgeons, FACS. Mutafchiyski took part in military missions in Iraq and Afghanistan.

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