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, recommended the third dose of the vaccine and wearing the mask.
From the start of the pandemic caused by COVID-19 until now, 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. World Health Organization, estimates that around 12,689 people have lost their lives in our country during the years 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 used to happen that some patients with Covid die from cardiac arrest, and there have been many cases, about 40% of which the cause of death is written as cardiac arrest on the death record even though the patient may have been admitted to the COVID ward", he says, adding that various pulmonary problems are also written on the death certificates because Covid mostly affects the lungs. "In other cases, other problems that the patient had even though he was admitted to the Covid ward were written." he concludes.
Answering how the loss of life from Covid-19 was certified in the Covid wards, Saliasi says that the certification was done by specialists. "Based on all the parameters that emerged either from the scanner or from the various analyses. In cases where the patient has had 90% of his lungs affected by Covid, it is normal that he did not die from anything else, but from Covid. Specialists gathered, looked at the card, discussed and finally decided". 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
About 13 lives lost, is WHO's estimate regarding the loss of lives from Covid-19 in our country. In this number given by the World Health Organization, citizens who have changed their lives due to causes indirectly related to COVID-19 are also included. But this is not the only document of an institution that highlights a great imbalance between the officially reported figures and the deaths in the country during the pandemic. "Monitor" magazine would publish A report of the European Commission for 2020, which stated the fact that Albania had the highest increase in deaths in 2020 in Europe as a result of the spread of the Covid-19 pandemic, with 27%. According to the calculations of the European Commission, the additional deaths for 2020 in the EU were 12.8% higher than the annual average of the years 2016-2019. On the other hand, in the Balkans, after Albania, there were Bosnia and Herzegovina and North Macedonia with an increase in mortality 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 the INSTAT figures, which do not lie, which show that there was a marked 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.
INSTANT itself would declare that during 2020 27,605 Albanians lost their lives, while in 2021 the numbers would reach around 30. These numbers are several thousand higher than the average mortality for the years 2017-2018, which was about 22 thousand.
Mr. Dasho talks about the manipulation of figures, which according to him has no benefit for the citizens. "I think it's just politics to show that the pandemic has been properly managed, when in fact, in the analyzes that have been done repeatedly, they show that serious mistakes have been made in the management of the pandemic in Albania". he says, listing some of the mistakes, starting with bringing the family doctor into the game too late, as well as regional hospitals, the concentration of care in the hands of emergency medicine and tertiary hospitals. "Which caused citizens not to take proper care", he says, adding that there was also a load of the so-called "Covid" hospitals, while the regional hospitals remained empty for months, which caused the patients who were in the Covid hospitals to have an unfavorable ratio between the staff and the 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 infection figure and the second element is the 'loss of life', these are the two main figures, the others are secondary as figures". says the professor who, in a detailed argumentation, says that the number of tests were few and you cannot compare this with other countries. "Even within Albania, they are very unequally divided. So, if you go into the statistics, I see that three-quarters of the tests were done in Tirana, meanwhile, in all the other districts, almost 2,5% were done, what about the district", he says, giving an example to make it clearer. "Fieri has 2.5% of 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 made for the 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 underestimations that have been made and if you see the reports, they say that Albania is the country, not to mention the biggest loss of life in Europe [in proportion to the population], one of the 3 most the big ones", he explains. "So if we say today at the global level, there may be one in two cases that have been reported, that is, one has been reported to have died, 1 has not been reported. In Albania, 1 was reported, 4.38 others were not reported".
"The state has the accounts of excess deaths that we derive from the INSTAT report. It's pure mismanagement and lies on a high level," concluded Professor Alimehmeti.
What could have been done differently?
"It's too broad a question to answer in the context of 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 in the company where he works, they are developing such processes in many countries of the world, where governments and Ministries of Health are very open.
Weak health system, burden on citizens
In a document published by World Bank emphasis is placed on the expenditure per capita on health in the Western Balkans, where this figure is significantly lower than the average of the European Union, where an average of 3.127 thousand dollars is spent per capita. In the Balkans, Serbia ranks higher than all countries in terms of health expenditure per capita with $812, followed by Bosnia and Herzegovina with $681. Next is North Macedonia with 539 dollars, Montenegro with 508 dollars and Albania in last place with 307 dollars per capita.
"For example, for the region as a whole, in the lack of funds for the health system, families often suffer, direct expenses (out of pocket) which are high. For example, this goes from 37 percent in Serbia and Montenegro to 50 percent in Albania", the documents say. Meanwhile, the high costs of treatment for Albanian families, the pandemic caused by Covid-19 brought them to the fore 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 took medicines starting from Favipiravir, Xarelto, Plaquenil, Remdesivir and some other types since I got through it a little easier and did not need such medical protocols. Just for Remdesivir for my parents and wife, I may have spent at least 5 thousand euros, because for one dose I paid 150-300 euros, plus the cure was 10-12 doses", says the 45-year-old.
Dr. Aurora Dollenberg, who is also the President of the Federation of Albanian Doctors in Europe, says that the pandemic highlighted the need for an essential reform of the Albanian health system. "The pandemic proved that the health system should be as decentralized as possible in such a way that the service is good, not only in Tirana, but also in big hospitals in big cities, but good in small towns, even in villages should be good, be it 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 point of contact for all patients who turned to him to have an orientation of patients who needed 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.
