Author: Denis Tahiri
June once again brought Covid-19 to the attention of all Albanians. For the first time after several months of absence, in Albanian hospitals, the loss of life from the virus returned. Seeing the increase in the viral load of the virus in Albania, the Technical Committee of Experts, which had not held a meeting for some time, returned once again, recommending the third dose of the vaccine and wearing a mask.
Since the start of the COVID-19 pandemic, the official number of lives lost in Albania is 3,520, but according to international institutions, this figure is not even close to the real one. The World Health Organization estimates that around 12,689 people have lost their lives in our country during 2020-2021 as a direct or indirect result of Covid 19.
The increase in mortality by 12 individuals for 2020 and 2021 is what makes a big difference compared to the number of deaths recorded in years when the country has not faced a pandemic. On the other hand, the World Health Organization bases its findings on a statistical model and results that the real loss of life from Covid-19 should be between 11,575 and 13,710 people.
But how did the reporting of the loss of life from Covid-19 work in Albania? What determined that a hospitalized citizen lost his life from the virus?
Ervis Saliasi, former nurse at the Infectious Disease Hospital, who was also in the first group of nurses that went to Brescia, Italy to help Italian hospitals in the battle against Covid-19, says that not always the main cause of the change in life has been COVID-19, however, has undoubtedly been a very powerful trigger, exacerbating the health problems that patients have had.
"It happened that some patients with Covid died of cardiac arrest and there were many cases, about 40%, where the cause of death on the death certificate was written as cardiac arrest even though the patient may have been hospitalized in the COVID ward," he said, adding that various pulmonary problems were also written on the death certificates because Covid mostly affects the lungs. " In other cases, other problems were also written that the patient had even though he had been hospitalized in the Covid ward," he concluded.
In response to how the loss of life from Covid-19 was certified in Covid wards, Saliasi states that that certification was done by specialists. " Based on all the parameters that came out either from the scanner or from the various analyzes. In cases where the patient had 90% of his lungs affected by Covid, it is normal that he did not die from anything else, but from Covid. The specialists would gather, look at the file, discuss and in the end make a decision," he says.
The Ministry of Health was asked by ACQJ journalists through a request for feedback regarding the figure of loss of life given by the WHO as well as the protocol for determining the cause of loss of life from COVID-19, but until now there is no reaction.
Victims, experts: The numbers are not real, manipulated
Around 13 thousand deaths, is the WHO's estimate regarding the loss of lives from Covid-19 in our country. This number provided by the World Health Organization also includes citizens who have died from causes indirectly related to COVID-19. But this is not the only document from an institution that highlights a large imbalance between officially reported figures and deaths in the country during the pandemic. "Monitor" magazine was going to publish a European Commission report for 2020 stating that Albania had the highest additional death rate in Europe in 2020 as a result of the spread of the Covid-19 pandemic, by 27%. According to the European Commission's calculations, the additional deaths for 2020 in the EU were 12.8% higher than the annual average for the years 2016-2019. On the other hand, in the Balkans, after Albania were Bosnia and Herzegovina and North Macedonia with mortality increases of 17% and 12% each.
For the Public Health expert, Erion Dasho, the real number of deaths from Covid in Albania is from 16000 and may exceed 20000.
" We have INSTAT figures, which do not lie, which show that there has been a significant increase in deaths in 2020-2021, which correspond to the estimates of the WHO and the Institute of Health Medicines," he says, adding that it must be accepted that this is the real number of deaths and not the one claimed by the Ministry of Health.
INSTAT itself would declare that during 2020, 27,605 Albanians lost their lives, while in 2021 the figures would be around 30 thousand. These figures are several thousand higher than the average mortality for the years 2017-2018, which was around 22 thousand.
Mr. Dasho talks about the manipulation of figures that, according to him, have no benefit for citizens. " I think it is just politics to show that the pandemic has been managed properly, when in fact, the analyses that have been done repeatedly show that gross mistakes have been made in the management of the pandemic in Albania," he says, listing some of the mistakes, starting with the very late introduction of the family doctor into the game, as well as regional hospitals, the concentration of care in the hands of emergency medical Services and tertiary hospitals. " Which caused citizens not to receive the proper attention ," he says, adding that there was also a load on the so-called "Covid" hospitals, while regional hospitals remained empty for months, which caused patients who were in Covid hospitals to have an unfavorable ratio between staff and patient.
Even professor Ilir Alimehmeti is of the same opinion, that the figures of reported loss of life are not real.
" The first element is the number of infections and the second element is 'loss of life', these are the two main figures, the others are secondary as figures", says the professor who, in a detailed argument, says that the number of tests has been few and this cannot be compared with other countries. " Even within Albania, they are very unevenly distributed. So, if you go into the statistics, I see that three-quarters of the tests were carried out in Tirana, while in all other districts, almost 2,5% have been carried out, regardless of the district", he says, giving an example to make it clearer. " Fieri has 2.5% of the tests in total, the second district with the highest population in Albania, Tirana has 75%", he says.
And while talking about the loss of life, the professor dwells on the definition that Albania has set of who is considered a victim who lost their life from COVID-19.
" The definition we have made for loss of life was if you die in one of the hospitals officially called "COVID" and the last test was positive. Do you understand what definition this is? So in short, we have one of the biggest underestimates that have been made and if you look at the reports, they say that Albania is the country, let's not say with the biggest loss of life in Europe [in proportion to population], one of the top 3", he explains. "So if we say today at a global level, there may be one in two cases that are reported, so one is reported to have died, 1 is not reported. In Albania 1 is reported, 4.38 others are not reported".
" The state has overstated the number of deaths that we derive from the INSTAT report. It is pure mismanagement and lies on a grand scale," concludes Professor Alimehmeti.
What could have been done differently?
" It's a very broad question to answer in an interview," says Public Health expert Erion Dasho when we ask him this question. "What I have recommended is that we should definitely set up a working group to bring together Albanian and foreign specialists, analyze the Albanian response to Covid and learn lessons ," he says, adding that the company where he works is developing such processes in many countries around the world, where governments and Ministries of Health are very open.
Weak health system, burden on citizens
A document published by the World Bank highlights per capita health spending in the Western Balkans, where this figure is significantly lower than the European Union average, where an average of $3.127 is spent per capita. In the Balkans, Serbia ranks higher than all countries in terms of per capita health spending with $812, followed by Bosnia and Herzegovina with $681. Then comes North Macedonia with $539, Montenegro with $508 and Albania in last place with $307 per capita.
" For example, for the region as a whole, families often suffer from the lack of funds for the health system, direct (out-of-pocket) expenses which are high. For example, this ranges from 37 percent in Serbia and Montenegro, to 50 percent in Albania ," the documents state. Meanwhile, the high costs of treatment for Albanian families, the pandemic caused by Covid-19, highlighted more than ever.
Alban B, 45 years old, says that due to Covid-19 affecting 4 members of his family at the same time, where two of them are in serious condition, the total bill for medications and nurses at home was about 9500 euros.
" We have taken medications starting from Favipiravir, Xarelto, Plaquenil, Remdesivir and several other types since I, who had it a little easier, did not need such medical protocols. For Remdesivir alone for my parents and wife, I may have spent at least 5 thousand euros, because for one dose you pay 150-300 euros, plus the treatment was 10-12 doses ," says the 45-year-old.
Doctor Aurora Dollenberg, who is also the President of the Federation of Albanian Doctors in Europe, says that the pandemic has highlighted the need for a fundamental reform of the Albanian health system. “ The pandemic has proven that the health system should be as decentralized as possible in such a way that the service is good, not just in Tirana, but also in large hospitals in big cities, but good and in small towns, even in villages it should be good, even primary care, which did not play the role it should have,” she says. Dokoresha adds that the doctor should be a point of reference, a contact for all patients who turn to him to have an orientation for patients who need to go to hospitals, for symptomatic forms that could not be treated at home.
Since the beginning of July, infections with Covid 19 have increased 15 times. From the beginning of the month until now, almost 20 new cases of coronavirus have been registered. This has caused the number of active cases to increase 13 times more than last month and 60 times compared to the same period last year. But the loss of life has also increased, mainly according to the OMICORN variants, they are 18 times higher. Meanwhile, the numbers of hospitalizations have also increased compared to a month ago, which have increased 5-fold. What stands out, according to an ACQJ source at the Ministry of Health, is the fact that citizens are not being vaccinated at the appropriate level. So far, according to the same source, 47% of the population has had one dose of vaccine, 45% with both doses, while only 11.91% of the population has taken the third dose.
