kad viļņas draugi par savu pilsētas pārvaldību stāsta, man parasti ir skaudīgi klausīties
viņiem ir nakts mērs, nightmare, tas ir, night mayor, kas atbild par naktsdzīvi, pilsētas mērs iet praidā, prakse aizvērt ielu transportam kvīkendā, lai visi restorāni izliekas ārā uz ielas, ir ierasta lieta
labi, augšminētais ir par tām labajām dienām, par kurām tagad varam aizmirst uz kādu laiku, bet arī sūdīgajās ir par ko skaust
tā ļoti vienkāršojot, lietuvā seims ir tie atpakaļrāpuļi, kamēr viļņas dome tie progresīvie (nobirdinu asaru par rīgas domi)
bet šobrīd piemēram viļņas mērs remigijus un viņa soctīklu dienests feisbuka grupā vilnius for foreigners postē regulārus updeitus angliski par situācijas attīstību (knābieni uz stīvo ministriju pusi, es tā saprotu, ir ikdiena)
lūk, piemēram, longrīds no ~21. marta (jā, šobrīd tā liekas sena pagātne, bet paskatieties, cik sakarīgi raksta)
What waits ahead of us and how will we tackle the crisis?
It has been almost a week now that we are in quarantine, living under new, albeit temporary, rules. Uncertainty is what the majority of us worries about the most - how long it will all last, when and how it is going to end. Let’s talk about that.
Residents of Vilnius have united to fight the COVID-19 virus. I have been trying to continuously provide information on their efforts. But this crisis, this virus and the fight against it, is not just about “running and doing”. We must tackle the crisis in our heads first and then use our hands and sweat. So, this fight is planning first of all, which requires analysis and forecasting. Have we seen much of this lately? Yes, I have the same impression as you do.
Therefore, let me tell you in turn where we are now, how we got here, and, most importantly, what lies ahead of us and how we will deal with it. There are still many unknowns, but this is always the case in times of crisis. That is why it is important not only to blow the dust off different crisis plans that were safely lying in the bottom drawer, but to also plan strategically here and now, taking each step knowing exactly what is it that we pursue, how we will measure the results, and what will come next.
Three phases that we have passed
Although this phase is usually left out when calculating, but the zero phase of all crises is “Always be prepared”. I will not discuss it now, let’s leave it for a time when things calm down, so that we can analyse the crisis rather than solving its problems.
So, the first phase of the virus for us was believing that “The virus is somewhere far away and will probably not even reach us”. It was during the New Year period. I am glad that we started putting together the first plans in the City of Vilnius back then, and this gives us a certain advantage now. Another good thing is that Vilnius strategic companies were able to practice to work together during summer hybrid security exercises in Vilnius and later in Ostravets exercises in autumn. This comes in very handy today. But this is already the past, so let’s move on.
The second phase of the virus for us was saying that “The virus is at the doorstep, it will reach us sometime.” This phase began with the first infected people in Europe, in Italy. When I said back then that it was only a matter of time before we have cases in our country, there were people calling this alarming. However, this alarming answered its purpose, because despite it all, we had more hygiene measures, we were better prepared methodically, we could react early to the next phase of the virus, face it being more prepared and having built more barriers to the spread of the virus.
The third phase of the virus, which is already coming to the end for us is “We already have individual foci”. As I have already mentioned, we met it even earlier when those foci appeared with a massive, people-friendly campaign about the three most important things - handwashing, keeping hands away from face and ventilation of premises. It is great to see that this allowed many people to get into the habit of doing these things, which is absolutely necessary now. This is an achievement of enormous importance.
Implementing the following goal of this phase – to have material supplies for future threats – is much more difficult. In many areas, our situation is not the worst, but there were cases when we faced bureaucracy (the case of Vilniaus Degtinė), lack of communication (a failure of the Ministry of Health to answer our letters and questions), shortage of information (uncertainty when it turned out that there are very few reagents in Lithuania for testing and personal protective measures), some sluggishness (when we heard others saying “we are buying”, but the pace of buying was such as if there was no crisis). It also turned out that our expectation of all algorithms (testing, patient grouping, etc.) being at least somewhat clear has proven to be too optimistic, and now we have to create them and revise ourselves.
Here we have missed a basic thing essential at this phase even before quarantine. Obviously, as long as we have separate foci only, we can track and localize them. This requires both testing and information management. I will not talk about testing once more, as I have already talked a lot on the issue, and scientists have said a lot about it as well, and all that is very true. I am glad that testing has finally intensified (although I, together with a group of experts, invited to engage in testing a week and a half ago).
When it comes to information management, the situation is decent - this Wednesday information which I have been asking for almost a week – which public places and when the identified infected people visited – was finally published. This is for us to be able to check if we haven’t had a dangerous contact. Of course, better later than never. It is a shame that the information we receive is incomplete - for example, we still do not know which staircase we should go to disinfect. I hope we will be able to receive this necessary information soon, as it is relevant so far, but will be less relevant in the next phase, as there will be insufficient resources to accurately find and localize everything.
At this phase of single focal points, we have also imposed quarantine measures, and some specialized ones first of all. Do you remember those outraged about restricted visiting of patients at nursing homes and hospitals? Later, we imposed more extensive measures, closing schools, kindergartens, sports clubs and entertainment centres. Good thing we did it, because this allowed us to win a few extra days. Other countries having imposed quarantine at the following phase only experienced significantly greater loads on the medical system and, unfortunately, were far less prepared. There was some misunderstanding with the Government about the quarantine, because we made the decision a little earlier and were accused of that. But luckily, we managed to promptly resolve the misunderstanding by joint effort. I am glad that I no longer hear any accusations for having taken quick action. And if sometimes our rushing has encouraged others to rush as well, that is even better.
Another good thing is independent minds having joined in at this phase. Let’s admit - if it wasn't for Professor Vytautas Kasiulevičius’ calls and reviews, some centralized decisions would have been made much later.
The fourth phase that we are entering now
Unfortunately, now we are entering the fourth phase of virus spread – “Infections are numerous and they are everywhere”.
At this phase, the key task remains the same – to reduce the spread of the virus. However, measures used at this phase may already be different, as we will no longer be able to catch individual focal points (basically this is a sign that we need to completely switch to a slightly different mode). So there is a need to focus more on protecting residents who are most vulnerable (the elderly and people who suffer from chronic illnesses), or whose minds and hands we are in dire need now and will be needing when / if the situation becomes even more complicated (medical specialists and operators of critical infrastructure). There may also be additional general restrictions if this is necessary in light of the speed of spread of the disease and the level of preparedness of the health system for the virus.
Here I want to explain one thing which the Minister of Health should do, but since he does not talk about that yet, I can do that. A lot or a few infected is a very relative number. According to epidemiologists, the virus will go away after about two-thirds of population is affected. So why are we trying so hard to stop the spread of the virus, why haven’t we chosen the path of the United Kingdom and some other countries that have not imposed all these measures (at least at first)?
The answer is simple: so that the health system is sufficiently prepared to save lives. In ideal case scenario (which is unlikely, but worth pursuing), the number of patients should exactly match the capacity of the medical system or be lower.
Why can’t we let the virus get off the chain?
A mistake we often see in theoretical charts of the spread of the virus is that the health system capacity is a horizontal line, like what, say, the UK’s Department of Health said. This is just a basic theoretical option [see legend 1, base morbidity rate and health system capacity scenario]. In the legend vertical axis means morbidity rate, horizontal axis - time, red line - number of cases, dotted line - health system capacity.
If we do nothing, the line illustrating healthcare capacity will go down, because the virus will hit not only citizens, but also medical specialists. The image will look like this [see legend 2, here we have actual morbidity rate and health system capacity scenario].
The part of the curve above the health care capacity is important. This is the part that countries fear the most. If we have, say, 10 000 beds in hospitals, and there are 30 000 patients at a time, everybody will suffer, not only those infected with the coronavirus. Therefore, the aim of almost all countries is to compress this curve, i.e. to reduce a rapid spread of the virus for it to stay below the medical capacity, at the same time increasing medical capacity, as its curve cannot stay horizontal.
Visually it would look like this [see legend 3, pursued morbidity rate and health system capacity scenario].
What are we doing to achieve this? If we systematically prepare, the capacity will increase as we resolve the basic limiters:
- ensure that fewer doctors become infected themselves;
- ensure that doctors are more proficient in diagnostic and prescription algorithms, and that the algorithms themselves are effective;
- ensure that managers of institutions work expeditiously to reach common goals in times of crisis rather than under normal circumstances;
- ensure material supplies from medical ventilators, which we do not have enough, to medication, if it turns out that there is something that actually helps, also hospital beds, and so on.
We have to be very accurate here. According to experience of other countries, out of all the diagnosed cases, 60% have to simply remain in quarantine at home, because they are not at risk themselves, 30% must be under supervision of doctors without any intensive measures, and up to 10% of patients may require intensive measures. It is very important that everyone is where they have to be, so that we do not over-exploit scarce resources and thus save lives. Resources must also be prepared according to those proportions.
Unfortunately, we are in a situation where we still lack a lot, and thus we are doing everything to bring the curve of preparedness of our health system upwards. As I have mentioned a number of times, now we are trying to get more personal protective equipment for doctors and, if situation becomes worse, also more medical ventilators.
Going back to the curves, we must push the disease curve downward and the curve of preparedness of the health system upward to keep them together. Imposition of quarantine allowed us to buy some time, and it is very important now to fully exploit it for getting ready without any delay.
Is the fifth phase “Hell”?
If these steps fail (and so far, unfortunately, no other country, except Singapore, succeeded in this) and the morbidity curve outperforms the preparedness curve, moving on to the next phase, which we called using a different word, but being polite, here we will call it “Hell”, will be necessary. This does not mean a hell to everyone. But this is the phase when the health system is no longer able to serve all the infected people, so we will end up in the situation which is happening in Iran, Italy or Spain (and will soon be happening in the United Kingdom, which unfortunately initially tried to ignore the virus) today, to a greater or lesser extent.
At this phase, protecting doctors (because the situation will get even worse if they fall sick) and working hard would be the main focus, also applying the strictest measures to stop the spread of the virus, as spreading would further increase overloads.
But here I want to remind that the more cases we detect earlier, i.e. if we invest in the identification of all cases, a fewer medical ventilation and other equipment, facilities, and, most importantly, working hours of medical specialists will be needed.
When a brighter day dawns
The sixth phase - “Things are getting better”. How do we know that this is happening? The morbidity curve will start going down, while the health system will be coping with all patients. Patience will be crucial at this phase, because we all will be tired, and many will be angry about quarantine and all sorts of inconvenience and uncertainty about the future.
Therefore, I ask you to get ready for a long fight. For many people, the fight will be special, simply learning how to be at home, without getting angry with each other (but also remembering that anger is a natural emotion, and focusing it in the creative direction is important), and finding meaning in a new routine. Therefore, the things that we do in this direction, namely, finding various means for distance learning, self-development, cultural or other means, are particularly important. And we plan posting information on what to do with children, how to separate work and home spaces and how to find new hobbies online at http://karantinas.lt/
Quality media and psychological advice are also very important, and I want to thank all soldiers of this front-line. But mutual respect, support, understanding (“No to bullying” is relevant more than ever), communication, and other forms of social networking are what matters the most, even at a strict physical distance.
The relaxation of quarantine conditions, which we will come to at some point in time, is a very delicate matter, which must not be done too early or too late. We would like to lift it as early as possible, but it depends on the effectiveness of the current actions. Let’s talk about this in more detail.
How we will restart the economy and a normal life without ruining everything
As I previously mentioned, quarantine allows us winning time for preparation, and therefore saves lives and our conscience. However, it comes at a price, as these are not only economic losses, household, emotional or other inconvenience. This includes human lives. Postponing scheduled surgeries, disrupting supply chains, and, ultimately, no economic value being created means that there will be those who are lacking, which can lead to a sad ending. It is no secret that often protective measures devastate more people than the thing they are used to protect from. The experience of Fukushima in Japan is a very good, precisely calculated and analysed example.
Thus, I have already delegated my team with a task to analyse two things. First is to calculate how many lives quarantine measures could cost (knowing it will allow not to go overboard here), and the second is to find out how some measures can be refined, tightening or facilitating them where necessary. For example, it is very good that the Minister of Justice allowed notaries to work with serious restrictions and exceptions, because for some this may mean being able to avoid bankruptcy and retaining hundreds of jobs having obtained the necessary loans or the like (of course, more extensive use of electronic means and ability to conclude transactions remotely would be an even better way out).
Our life or our economy, to be more precise, is like a large, power-generating nuclear reactor that we constantly have to feed, at the same time keeping it from overheating. Now, this reactor has been stopped, stopping electricity production. It has stopped to avoid the explosion of the reactor with all employees and surrounding residents. However, this will not last long. It will not happen so that one day we will simply press the button and the reactor will restart - we will have to do it slowly, step by step, or otherwise the reactor will overheat. Here the first steps must be taken now.
So, we need to start preparing for the “Things are getting better” phase. Decisions will be needed then, and they will not be easy. However, they will be necessary, if we do not want to face a complete collapse. Let’s remember that no economic aid packages will help, if people cannot work and create. And if they cannot do that for long, we will have nothing to fund not only the economic aid package, but also the health system needs. I have already discussed this with Professor Vytautas Kasiulevičius. I am glad he thinks the same way.
I will not go into more detail about the strategy to exit the crisis, because we will still have time for that. We would all like to see such a time come sooner, but obviously it will not be two weeks of quarantine, as originally announced by the Government, and will take longer. Probably even longer than the closure of schools till St. Easter, which many believed to be announced for supposedly way too long. Finally, we do not know which of the virus scenarios will prove to be true – its full extent during the warm season or its recession and return in the fall, when we unfortunately will still have no vaccine for it (according to forecasts, vaccine for mass use will appear no sooner than in a year).
Either way, the general logic will be the same – to pursue that the health system is able to cope with virus cases, for morbidity and preparedness curves to match (even though this cannot be done without stress). Based thereon, quarantine conditions will be eased (or further tightened, which we definitely do not want).
What will we learn and benefit from this crisis?
I want to talk a little about what we will be like when we come out of the crisis. I very much want us to come out of it as having experienced a temporary disruption, which was pricy and inconvenient, but made us stronger. The above economic package is important for this to prevent businesses from making long-term decisions based on short-term factors.
Learn to work and live in a more innovative and creative way is even more important. For example, achieving that children having spent a couple of months at home, would be more efficient at working independently, performing creative assignments, having discovered the joy of reading, and relationship with the immediate environment, even though not having completed the entire course as per curricula (which they will be able to catch up later) – all this will come in very handy in the upcoming decades.
Moving even more services to the electronic space is very important (we can rejoice over the fact that we now have more such services than other EU countries), also organizing them so that they function well after the crisis. For example, we can already say that public discussion of city projects in interactive video conferencing, connecting from any place, is even more effective than live meetings. I believe that many new things will be discovered and invented, which we will be proud of, benefit from and enjoy after the crisis.
I have preached here so that we can be conscious citizens of a free country, who are well aware of what they have encountered, what the future holds and what will allow making this future less loss-making or even better in some respects rather than simply being blind copiers or executors of someone’s experiences. And I think this is what we will be, especially seeing how enthusiastic, sustainable and persistent my team is in dealing with the crisis. The prevailing age of my team members is such that on March 11 thirty years ago, they were not even running under the table yet, but now they courageously assume responsibilities and make decisions important not only for Vilnius, but for entire Lithuania as well.
At the very end, I want to express my joy over the incredible vitality of our civil society. It’s been a while since I last saw such joint efforts, involvement, volunteering and flow of aid that we have here in Vilnius, and I believe in the rest of Lithuania as well. A big thanks goes to all. We are a very strong society and therefore we will come out the winners despite the mistakes that have and will inevitably be made.
un tad viens pavisam svaigs, no vakardienas
First of all, I want to congratulate the Prime Minister on taking over the control of the crisis management - I have no doubt that this decision will provide more opportunities to deal with consequences of coronavirus more effectively. It has long been a crisis of more than the health sector alone - as we can see, the situation has been affecting all areas of our lives. In addition, the Prime Minister is experienced in dealing with crisis situations.
I also support the tightening of quarantine measures – after all, we cannot close some in hotels, leaving others the right to decide how consciously they are willing to abide by the new rules. These rules must equally apply to everyone, because they have not been adopted for the sake of it, but rather they have been passed to stop the virus from spreading.
I wrote in detail on this subject in the morning, but here is the latest news on mandatory quarantine. Late last night, we applied the exception to families with children, and we have just added a few more groups to this exception, having assessed the problems and dangers they may face when remaining quarantined outside their environment. These include expectant mothers, people with specific health problems (such as schizophrenia, sleepwalking, a recognized serious form of depression, and similar cases) who suffer from chronic and severe illnesses requiring special treatment, ongoing care, and those returning with pets.
Yes, this last group is the strangest one in the whole context, but we also looked at all the groups from a practical point of view - there are people returning with dogs (more than one), there is no place to leave them and they cannot be accommodated in a hotel. To those, who object to the decision - please show me a hotel in business, which would accept 8 dogs. This is a real-life situation and not something I came up with.
By the way, to dispel any speculation - the measures that we have taken are fully in line with the decision of the Minister of Health Veryga. But yesterday everyone, including the Minister, felt at sea with many decisions to be made, and the Minister’s comments made about them contradicted their contents. Even the fact that a county’s epidemiologist has to urgently inspect premises does not mean that premises need to be inspected in advance. While in other decisions, the Minister said that isolated living quarters had to be given a priority, only then turning to hotels. But it’s ok, we will execute any decisions, taking every effort to make them as efficient and logical as possible. If we have any comments, I will voice them, and maybe that will help.
What I have now heard from colleagues at the airport is even more interesting - the National Public Health Center under the Ministry of Health changed its position 180 degrees, and no longer sends travellers having newly returned from abroad from the airport to hotels, sending them to self-quarantine at home. This is unconfirmed information so far, and I will update it as soon as I know more details. And if it is true, it once again shows how important it is to think about implementation when making any decisions. Otherwise, any law becomes unimplementable both by municipalities and the national government.
But for the time being, we are still following the decision of the Minister, and therefore exceptions are needed. They will hopefully make life for many people in quarantine easier, but, most importantly, mandatory quarantine applies to you to the same extent. We will check that you stay at home, and violations will be subject to stricter fines, as the Prime Minister mentioned today. Therefore, for the sake of all, please do not joke - the situation is very serious. If you want to communicate, please do that electronically, make video calls, but getting out of the house will be expensive and painful for those 14 days.
We also started testing electronic means for supervising over quarantine. They are not the same as those used in South Korea or Poland (because there the location of a person in quarantine cannot be determined), but those, that allow actually checking that a person is at the designated quarantine place. So far, this will not be an application, but any communication device, with location tracking installed and certain procedures in place, when we can ask people to send us their photo or other identifying things. We will improve this tool. If it works well, we will apply it more widely. And we will be able to allow anyone to use it.
Today we started holding meetings in Vilnius City Council, and, as should be done in quarantine conditions, we were the first ones in Lithuania to have a remote Council meeting. We faced some challenges in finding not only a legal, but also a technical solution for holding the meeting, as we needed to have a view for fifty Council members and a possibility to vote electronically. We used a programme earlier created for the election of elders for voting - this illustrated how good it is to move as many tools as possible online, as they come in handy when there is no time or human resources to create new tools.
Everything went well - 43 Council members attended the meeting (which is similar to the number of attendees in a usual meeting held in a meeting room); discussions were constructive, and I even noticed that some members of the Council, who tend to be louder and more emotional in meetings, where more quiet and calm at home. Maybe their kids were sleeping behind the wall. We streamed the meeting online. The recording is available online at: https://bit.ly/2UfEGtM
It is exciting to be able to share our experience with other municipalities. We have already passed on our developed technology to those, who were willing to try it. Representatives or mayors from several other district municipalities also attended the meeting as guests to see how this works in practice. If there are more willing municipalities, we will share it with them as well.
Since the Seimas has decided that only decisions related to the management of the emergency situation can be taken at remote meetings, we have done so. But I hope that the Seimas will promptly revise its newly adopted law, allowing to also consider other issues this way.
Today’s most important decisions were related to economic cushions for those affected by the crisis. We adopted what I announced last Sunday: exemption of real estate tax for those affected by quarantine, extension of individual business license periods, and others. I want to remind that the option of deferring the payment of utility bills and some other measures is not within the competence of the Council, so they were not discussed today.
In any case, this crisis has not only adverse consequences, but it also speeds up processes that would normally take longer. I hope the Seimas will follow the example of the Vilnius Council - there is no need to take a risk and gather to vote, if this can safely be done remotely.
The joyful news of the day is the announcement made by Professor @Vytautas Landsbergis that he will contribute a generous amount of EUR 100 000 – a significant share of his life savings – to doctors through the City of Vilnius (Aukok.lt) and the Laisvės TV Foundation. On behalf of all medical specialists, we want to say a big thanks!
As announced by the Prime Minister, starting today, we may only stay in groups of two people or families, and this still must be done keeping a safe distance. I read a study by scientists that quarantine is only effective if at least 80 percent of residents abide by the rules of social distance, which means at least 4 out of 5. If you are a family with two children and a dog, let your dog be the undisciplined one. ;)