Dr. Miljana Grbic is World Health Organization Representative and Head of Country Office in Romania at WHO.
Spațiul Medical: What steps have been taken to continue the usual (routine) immunization during the pandemic?
Miljana Grbic: WHO has published guidelines to help national authorities prioritize essential health services, including maintaining of routine immunization during the pandemic. Romania aligned to WHO recommendations and health authority issued instructions for continuation of the national programme of vaccination, with special considerations given to measures to prevent and control COVID-19 spread.
Any disruption of immunization services, even for short periods, will result in an accumulation of susceptible individuals, and a higher likelihood of vaccine-preventable disease outbreaks. This may result in deaths and an increased burden on health systems already strained by the response to the COVID-19 outbreak. Immunization services are essential. If they have been interrupted, catch up measures must be taken as quickly as possible. We cannot allow the impact of COVID-19 to be amplified by neglecting other vital health protection measures.
Health professionals delivering immunization programmes across the Region are working hard to ensure that as many children as possible have access to vaccine services while preventing COVID-19 infection. Some health services have introduced parallel tracks, with regular check-ups and vaccinations for babies alternated to ensure limited indoor waiting times, and kept fully separate from curative care for others.
A message to parents is to make no mistake, the safest choice also during this pandemic is to vaccinate your children. Use this opportunity to protect them and others from diseases that we can prevent.
Spațiul Medical: When do you think that we will be able to talk about administering an effective treatment against COVID-19 for patients in Romania?
Miljana Grbic: No pharmaceutical products have yet been shown to be safe and effective for the treatment of COVID-19. However, a number of medicines have been suggested as potential investigational therapies, many of which are now being or will soon be studied in clinical trials, including the Solidarity trial co-sponsored by WHO and participating countries.
Romania is joining the Solidarity trial, an international clinical trial to help find an effective treatment for COVID-19. More than 100 countries have joined the Solidarity Trial, and more than 1 200 patients have been randomized from the first five countries, to evaluate the safety and efficacy of four drugs and drug combinations. Based on data from laboratory and clinical studies, Remdesivir, Lopinavir/Ritonavir, Lopinavir/Ritonavir with Interferon beta-1a, and Chloroquine or Hydroxychloroquine have been selected as treatment options for the ongoing Solidarity Trial, to find treatment for COVID-19.
Remdesivir, previously tested as an Ebola treatment, has generated promising results for the Middle East Respiratory Syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS), which are also caused by coronaviruses, suggesting it may have some effect in patients with COVID-19. A number of studies are ongoing globally and WHO is constantly reviewing the findings, through its technical expert networks. One of the Solidarity trials carried out by WHO will look specifically at the role of therapeutics in COVID-19 prophylaxis and post-exposure prophylaxis in health care workers, including with the use of chloroquine, to reduce their risk to become infected in a health care environment.
WHO also published a medical product alert to warn consumers, healthcare professionals, and health authorities against a growing number of falsified medical products that claim to prevent, detect, treat or cure COVID-19.
A Solidarity trial for vaccine development has been launched, in addition to the one for therapeutics. This large, international, multi-site, individually randomized controlled clinical trial will enable the concurrent evaluation of the benefits and risks of each promising candidate vaccine within 3-6 months of it being made available for the trial.
Spațiul Medical: What are the WHO recommendations for the relaxation period that will follow most probably after 15 May in our country?
Miljana Grbic: The transition out of lockdown is set to be a complex and uncertain phase. Challenges and circumstances vary from country to country and there is no one-size-fits-all approach. It is vital that countries clearly communicate this to the public to build trust and ensure that people observe restrictions specific to their situation. WHO guidance includes 6 criteria for moving to ease lockdown restrictions. Countries must ensure:
- that evidence shows COVID-19 transmission is controlled;
- that public health and health system capacities are in place to identify, isolate, test, trace contacts and quarantine them;
- that outbreak risks are minimized in high-vulnerability settings, particularly in homes for older people, mental health facilities and crowded places of residence;
- that workplace preventive measures are established, including physical distancing, handwashing facilities and respiratory etiquette;
- that importation risks can be managed; and
- that communities have a voice and are aware, engaged and participating in the transition.
Due to the nature of COVID-19, it is difficult to understand the impact of any easing of restrictions until 10–14 days have passed. As a result, the easing of restrictions will be gradual and many will return to a new normal of hand hygiene, coughing etiquette and distancing routines. A trend showing increases in the number of new cases would require a quick reintroduction of physical distancing measures to contain the outbreak.
Last week, we issued essential guidance for countries considering and planning COVID-19 transition. In that guidance, we emphasized that health systems must have the capacity to operate along a dual-track – continuing to deliver regular health services, whilst responding aggressively to COVID-19.
The interview is part of the communication campaign of the Romanian Hospital Convention – ROHO 2020. This year’s edition will take place at the Novotel City Center Hotel in Bucharest.
Master Partner ROHO 2020 – Philips. Main Partner: Medicare. Professional Partners: Kapamed, Bristol Myers Squibb.
More details here.
Photo © Miljana Grbic
