Loss of life from Covid-19, data that will always raise questions…

June once again brought Covid-19 to the attention of all Albanians. For the first time after several months of absence, in Albanian hospitals, 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 met for some time, returned once again, recommending the booster dose of the vaccine and wearing a mask.

Since 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. The World Health Organization estimates that around 12,689 people lost their lives in our country during 2020-2021 as a direct or indirect result of Covid 19.

The increase in mortality by 12,000 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 who went to Brescia, Italy to help Italian hospitals in the battle against Covid-19, says that not always the main cause of the loss in life has been COVID-19, however, it has undoubtedly been a very powerful trigger, exacerbating the health problems that patients have had.

“It used to happen that some patients with Covid died 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 were written down as a cause, 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 chart, 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 has been no reaction.

Victims, experts: The numbers are not real, manipulated

About 13,000 lives lost, is WHO’s estimate regarding the loss of lives from Covid-19 in our country. This number provided by the World Health Organization, includes also citizens who have lost their lives due to causes indirectly related to COVID-19. However, this is not the only document of an institution that highlighted a large 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 starts at 16,000 and may exceed 20,000.

“We have the INSTAT figures, which do not lie, which show that there was 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 what the Ministry of Health claims.

INSTAT itself would declare that during 2020, 27,605 Albanians lost their lives, while in 2021 the figures would reach around 30,000. These numbers are several thousand higher than the average mortality for the years 2017-2018, which was around 22 thousand.

INSTAT data on the loss of life in the last 5 years

Mr. Dasho talks about the manipulation of figures, which according to him has no benefit for the citizens. “I think it is only politics to show that the pandemic has been managed properly, when in fact the analyzes that have been done repeatedly show that there have been serious mistakes 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 and tertiary hospitals. “Which caused citizens not to receive proper care”, he says, adding that there was also a load of so-called “Covid” hospitals, while regional hospitals remained empty for months, which caused patients who were in Covid hospitals to have an unfavorable staff-to-patient ratio.

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 the ‘loss of life’, these are the two main figures, the others are secondary figures”, says the professor, who in a detailed argument says that the number of tests has been low 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, regardless of the district”, he says, giving an example to make it more clearly. “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 on who is considered a victim who lost his/her life to 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 you underwent for the virus was positive. Do you understand what definition this is? So, in short, we have one of the biggest underestimations ever, and if you see the reports, they say that Albania is the country with the largest loss of life in Europe [as a population percentage], one of the 3 biggest”, he explains. “So, if we say today that 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 is pure mismanagement and lies at the highest level”, concludes Professor Alimehmeti.

What could have been done differently?

“It is a very broad 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, to 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.

The weak health system, burden on citizens

In a document published by the 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 spending 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. This goes from 37 percent in Serbia and Montenegro to 50 percent in Albania,”

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 were 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, who went through it a little easier, 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 also good in small towns, even in the villages it should be good, whether primary care, which did not play the role it should have”, she says. The doctor adds that the family doctor should have been a point of reference, a point of contact for all patients who turned to him, in order 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-fold. From the beginning of the month until now, almost 20 thousand 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 due 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 a source for ACQJ near the Ministry of Health, is the fact that citizens are not being vaccinated at the proper level. So far, according to the same source, 47% of the population has had one dose of the vaccine, 45% with both doses, while only 11.91% of the population has taken the booster dose.