Cyprus Mail

Coronavirus: Covid measures in a holding pattern for now

Health Minister Michalis Hadjipantelas

The routine extension of Covid restrictions until November 9 by the cabinet this week suggests the government is currently in somewhat of a holding pattern when it comes to where and how to take measures next, rolling them back a bit or tightening them up, according to comments made to the Sunday Mail by Health Minister Michalis Hadjipentalas.

Either way, the situation is uncertain and the information fuzzy. As other countries prepare for a possible winter surge, Cyprus’ current weather is keeping winter at bay, which could delay whatever the next stage of the pandemic will look like. Right now, cases are leaning in an upward trend but hospitalisation numbers and deaths have fallen in recent days.

Regardless how this autumn and winter season pan out covid-wise, does the ministry in general have a roadmap for tapering off or ending the unofficial state of alert? The answer: it’s hard to tell.

“When it comes to easing/tightening restrictions, we don’t exactly have fixed benchmarks in mind – as in, we’ll do this when we hit this number, we’ll do that when we get that number,” Hadjipantelas told the Sunday Mail.

What health authorities do, he added, is monitor the situation as a whole, since several factors are at interplay with one another.

“We look at trends. There’s no standard number per se. For instance, if we get a signal that hospital admissions are going up, then obviously we can’t loosen up.”

There’s also the Delta+ variant to think about. “And we have to keep an eye on schools…because it’s all interconnected.”

But testing at schools has consistently generated extremely low numbers of positives – and this amid a largely unvaccinated section of the population. The positivity rate among pupils typically clocks in at an order of magnitude lower than the national rate.

When we pointed this out to the minister, he replied: “Yes but still…we operate on the precautionary principle. Not taking any chances.”

Fair enough – though some might argue that one can take the precautionary principle too far, as the restrictions don’t exist in a vacuum.

But pressed on the point that the government must use some gauge to determine covid policy, Hadjipantelas said they do have some rough guidelines.

And they break down like this:  Hospitalisations are the key index. The government will consider the situation ‘safe’ once the number of patients drops under 20, and when those in ICU are less than five.

But that yardstick should not be seen in isolation, or taken to mean that when those figures are reached, relaxations will immediately follow.

What of the cases/positives? “When we get to under 50 a day, and it stays that way for at least a week, that’s a good signal,” he said.

Asked how realistic that is, considering that roughly speaking some 50,000 tests are done every day, Hadjipantelas offered:

“Well yes, that works out to a positivity rate of 0.1 per cent. A good place to be.”

He then on his own solicited: “Let’s say we were now in April instead of October. With the numbers we have now, if this were April, then we might have given some relaxations. But as it stands, going into autumn and winter, when typically you get a resurgence in respiratory infections, we can’t risk it.”

Asked if the current measures will by and large remain for the foreseeable future, the minister said yes. “We don’t want to have a dangerous situation on our hands come Christmas. We absolutely want to avoid having to impose extra restrictions at that time.”

On whether such restrictions – should the government deem them necessary – might include a lockdown, the minister all but ruled it out. “I don’t think a lockdown, but a tightening up, like venues having to close at 11pm. Or the banning of music at entertainment establishments.”

However, should the current state of affairs persist, the ministry may over the coming weeks consider slackening a little – but just a smidgen. For example, the requirement for two (negative) PCR results per week for entry to closed structures (such as care homes) could drop to one PCR a week.

And the SafePass? Not going away until at least January, and provided that the epidemiological indicators allow it, said Hadjipantelas.

“But at some point we are going to abolish it [the SafePass].” He did not elaborate.

The Sunday Mail next reached out to Constantinos Tsioutis, head of the coronavirus advisory committee – but a conversation was not possible by the time this report went to print. Another scientist on the team we contacted, declined comment regarding the management of the pandemic here, saying it would be best to speak to Tsioutis.

The individual said only that the team “merely advise” the government, which has the final say on policy. But the source did drop a hint that certain members have more access to the health minister than do others.

The game of tag over who it is really that shapes Covid policy – the government or the advisory team – has been a long-running theme here. Certainly, different people will have different views that need to get synthesised – but 18 months on, the dynamic of how these decisions are made remains fuzzy.

This point was highlighted by Elpidoforos Soteriades, Associate Professor of Epidemiology and Public Health at the Open University of Cyprus:

“You may recall that we have repeatedly heard politicians claiming they base their decisions on the suggestions of the scientific committee, while at the same time members of the committee were in the media expressing their disagreement to specific measures.”

Getting back to the question as to whether authorities rely on specific scientific criteria in terms of the measures, before they are enforced, Soteriades took it a step further, saying it’s likewise unclear how those in charge assess the effectiveness of the measures after they are implemented.

“Over the past year we have seen many strange, illogical and irrelevant measures imposed under different phases of the epidemic that raise serious concerns about the approach of the government,” he said.

“Measures not in place during some outbreaks of the epidemic were imposed during periods of decline in cases or when we had a much lower positivity rate of viral transmission in the community. Frankly I’m puzzled by their decisions.”

The scientist zoomed in on the SafePass, introduced by the European Union to facilitate travel between countries. Instead, remarks Soteriades, the Cyprus government “abused” this international travel tool and set up “extreme internal barriers within the country” in imposing the SafePass – even for buying food and attending school or work.

Although the SafePass was introduced last June, he adds, “we’ve witnessed another extensive wave of community transmission of the virus during the summer in Cyprus with no discernible benefit of such a measure or other measures in controlling the epidemic.”

Regarding the mass vaccination drive, tied to the SafePass, Soteriades went on to cite a paper recently published in the European Journal of Epidemiology by scientists from the Harvard School of Public Health.

It just so happens that the Cypriot epidemiologist knows personally the study’s lead author, professor S.V. Subramianian, an instructor at the time Soteriades studied at Harvard.

Subramanian and co-author Akhil Kumar found that within a specific timeframe examined, increases in Covid-19 cases were unrelated to the levels of vaccination across 68 countries around the world and some 3,000 counties in the USA.

“The authors,” Soteriades goes on, “argue that we need to re-examine the sole reliance on vaccination as the primary measure to control the Sars-CoV-2 epidemic. I hope the members of the [Cyprus] scientific committee will take note of this important scientific finding and the government will revise their public health policies accordingly, as well as stop stigmatising unvaccinated people.”

Asked what might justify lifting the informal state of emergency vis a vis covid, Soteriades had this to say:

“It’s absurd that the government is using this type of language for the past one-and-a-half years. We have to ask ourselves what kind of ’emergency’ is this that lasts for so long. Almost two years after the first Covid-19 cases, the government claims even now that they need to impose such extreme measures to protect public hospitals from overcrowding.

“I wonder whether this amounts to a major sign of failure of their own approach. How many more years will the Cyprus government need in order to identify democratic and proportional solutions to this problem? In my opinion, the answer relies heavily on a few concepts: public dialogue, collaboration, solidarity, social cohesion, respect, democracy, and freedom of choice.”

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