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Press Conference on the current epidemiological situation 2/3/2021 Minister of Health Marek Krajčí

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Unofficial Translation

Press Conference on the current epidemiological situation 2/3/2021

Minister of Health Marek Krajčí

Good evening, let me inform you about the current epidemiological situation at the territory of SR.

As always let me show a brief comparison with our neighboring countries. Situation in Slovakia sees a gradual slight increase in the last couple of weeks when it comes to the number of infected people. Similar trend is seen in our hospitals. In the Czech Republic there is another wave demonstrated in new increase of cases. Similar situation seems to be in Hungary, and due to relaxation of measures there is slight worsening also in Poland and Austria.

If we look at the numbers, the most significant increase is in Czech Republic. When it comes to Slovakia, our numbers increased from 526 to 562 compared to last week. Hungary, Poland and Austria all also see an increase in their numbers of newly infected.

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These are three graphs showing mobility in Slovakia. The mobility shows the intensity of contacts between people, and such contacts increase the probability of the spread of the disease Covid-19. The mobility is slightly increasing ever since the New Year, it is not a dramatic increase, but the mobility is nevertheless increasing from week to week. This can be explained by a so-called pandemic fatigue – despite the measures, people are not following the rules. I am grateful to those who keep adhering to rules, thanks to whom the situation is not worsening dramatically as in neighboring countries, but we still see many people ignoring the measures, and many cottages are full at the moment in Slovakia, even though they should be empty, and we see the violations of rules also in other aspects of life.

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The current situation in numbers shows that almost all indicators are worsening, the most significantly the situation in our hospitals, where we again see a record in numbers of hospitalized. There is a very high number of ventilated patients – 376 at the moment, and I want to thank also to European Commission, thanks to which the Romanian paramedics are helping us with the ventilated patients in Bratislava´s Center for Heart Diseases. We are vaccinated by a speed allowed by the deliveries of new vaccines, we have administered almost half a million of vaccines already. The reproduction number, thanks to people who comply with measures, is kept stabilized at certain level – in range between 1.0 - 1.05. The positivity of tests is also not increasing, it is kept at the level of around 20% for PCR tests and 1% for antigen tests. The 7-day average of performed tests is 243 794, it is a sum of both PCR and antigen tests.

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This is the development in the numbers of positive cases. The blue curve shows the sum of PCR and antigen tests, and the red curve shows the PCR tests only. As you can see the curves show a slightly increasing trend.

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As I said the situation in hospitals is very serious. When it comes to age structure, we see a gradual decrease of hospitalizations of patients who are being vaccinated. In monitored period, there is a decrease in hospitalizations mainly in age groups 81-90 and 71-80.

The number of visits of emergency services in households show that week after week, more and more patients with Covid-19 are being transported into our hospitals. In the last week, this number has increased from 2653 to 2931, and while last week we talked about an improving effect in some regions, this is not longer true.

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Bratislava regions which showed improvement last week, is now showing increasing trend to 375 visits. The situation in also worsening in better regions such as Banska Bystrica region and Zilina region, and also in Trencin region or Prešov region. Košice region, after seeing record increase last week has now stabilized.

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This very sad graph shows that the numbers of deaths do not improve in Slovakia, quite the opposite. In the last days, the average number of deaths is 108 a day. Already 7388 deaths are confirmed in total by the Health Supervision Office.

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You often ask about the deliveries of the vaccines – this table shows how many doses of vaccine were already delivered to Slovakia and how many are expected to arrive in March.

Thanks to the help of the European Commission, which temporarily lent us 100 000 doses of Pfizer/Biontech vaccine, we will be able to vaccine 413 100 people by this vaccine in March.

When it comes to Moderna, unfortunately, the deliveries are much lower than promised, and we expect only 75 600 vaccines to arrive. AstraZeneca also has lower deliveries than contracted, so far we are promised to get 356 864 doses in March. Yesterday we also received the first doses of Sputnik V vaccine, which will now wait for around two weeks in warehouses in Šarišské Michalany, where they will go through batch control and they will be released for vaccination only after this process is finalized. We will then inform about the further strategy of vaccination. I expect we will launch a registration form sometime at the end of next week, for those who will be interested to get vaccinated with this vaccine, according to which we will then know how to distribute the vaccines into vaccination centers.

We have the most vaccinated in Bratislava region, followed by Trnava region, and then in other regions, the vaccination process is more or less same.

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The vaccination in the week from 27 February until this Friday – it shows how the vaccination will be carried out this week. We have only 45 726 available appointments for the public for the vaccination with Pfizer and Moderna vaccine. We vaccinate in 77 vaccination centers – we could be vaccinating at much more places if we had higher deliveries of the vaccine. The current vaccines are mostly used for re-vaccination with second dose, basically only clients of social service facilities are receiving the first dose too. When it comes to AstraZeneca vaccine, there were 27 172 spots made available for this week and the vaccination is taking place at 37 vaccination centers.

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This graph shows the vaccination rate in age groups. Of course the highest share of vaccinated is in age group of 80-89 and we need to already open the registration form also for the lower age group as we see that the vaccination share of the critical age group 70-79 is below 15% at the moment. In the social service facilities, already 45% of clients are vaccinated, out of which 7% is already vaccinated with second dose.

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Here we see the relation of deaths and the age. This is nothing new – we know already the disease has the highest rate of mortality in the higher age groups.

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This is the currently valid vaccination strategy, which has experienced lot of criticism in recent days. Let me address this criticism – the vaccines Pfizer and Moderna, which are used in Slovakia without upper age limit were used to vaccinate people 75+, but in recent period we only used them to re-vaccinate as we did not have enough of these vaccines. The AstraZeneca vaccine was, based on recommendations from Council of experts and public health offices, indicated only for people aged 18-55. Given this vaccine arrived to Slovakia and we needed to decide on how to use it, we decide to use it for these groups – teachers and caring persons of severely disabled, and given there was a large number of free capacities at the end of last week, we decided to open the vaccination process with this vaccine also to other groups of people – such as shop assistants, drivers of mass transportation and taxi drivers, as these are people who provide services and come into contact with large amount of other people and thus can potentially become super spreaders of the disease or get threatened by the disease themselves. This was not limited by age, as we originally did not put the age limit on teachers providing presence form of teaching either.

However, as you might have heard, last week a study was published which causes changes in vaccination strategy of other EU countries as well. I therefore also asked our Council of experts to re-evaluate our vaccination strategy. It has had a meeting today and these are the results.

The vaccination strategy will be changed in this way from next week Monday, as slots are already planned for this week. With vaccines from Pfizer and Moderna, we will vaccinate people 70+, thus decreasing the age limit for possible registration from 75 to 70. When it comes to AstraZeneca vaccine, our experts suggest to increase the age limit for the possibility to use this vaccine to 70, however they recommend the consultation with the doctor. This is because this vaccine can have more side effects and thus the health condition of the patient

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should be considered. It is thus up to decision of the attending doctor and the person himself/herself. The studies confirm very good results of this vaccine, which is protecting against infection and death very effectively. Thus from next week, we will adhere strictly to age again and all exceptions are stopped. With AstraZeneca we will vaccinate people in age group of 60-70 and with Pfizer or Moderna people 70+.

We still assess the epidemiological situation in Slovakia based on the Covid Automat system approved by the Government. When it comes to the individual indicators, these are still not showing any improvement.

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A 7-day average of new cases is still above 5000.

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The numbers of hospitalizations, as I noted already, are still increasing unfortunately. It reaches new records every week, currently it is 4042 patients hospitalized with confirmed or suspected Covid-19.

The reproduction number still does not show positive trend, but so far it is been kept at the level of 1.0-1.05.

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Consequently, Slovakia as whole is in black zone of Covid Automat, so the joint measures for this zone apply to the whole territory.

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When it comes to situation in districts, it is also worsening from week to week, we now only have 3 red districts in Slovakia- Tvrdošín, Kežmarok and Medzilaborce. Other districts are either in dark red or black zone.

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We currently have 30 districts in black zone and 46 districts in dark red zone.

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And as I mentioned, only three districts in red zone.

When it comes to the expected trend in individual districts, it is mostly stabilized and only in some there is negative trend.

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When it comes to new measures applicable from tomorrow, based on Government resolution and also discussions with the Minister of Education, schools will be opened only for children of parents who cannot work from home due to nature of their work. In black districts, as until now, the schools are not recommended to be opened, and only kindergartens and school clubs for the children of critical infrastructure employees should be opened. Headmasters of schools are thus, based also on negotiations with their municipality, allowed to close their schools in these black districts. Of course, the local crisis staffs, together with regional health offices, can also decide on closure in dark red districts, based on their local situation. What also changes from tomorrow is that the travelling between districts for visits of nature will no longer be possible. It will be possible to only visit nature within one´s district, and in black districts a 7-day test will be required for such activity, except for children up to 15 and pensioners above 65. The curfew is also being strengthened and between 20:00-01:00 there is a total curfew, with exception of going to work or to doctor.

You can ask your questions now.

Questions:

Q: When it comes to the measure related to schools, was not this supposed to apply only from Monday, as announced by the Ministry of Education?

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MK: I can only comment on what we have agreed on today and what is written in resolution – it should be applicable already from tomorrow. But as I said, it is up to decision of Minister of Education, it will be as he will announce, as it will also depend on the decision of regional health offices and local authorities.

Q: The current measures should last for 3 weeks and if these will not work, people should prepare for the hard lockdown. What should this mean?

MK: This is what the experts recommended but honestly I do not have the exact definition of how this should look like and what should be considered as critical infrastructure. It will be all defined in the upcoming period, also depending on the epidemiological situation. But in simple terms – all those who can be home will have to stay home.

Q: When it comes to Sputnik vaccine, doctors criticize that the responsibility will be left on doctors. Why did not you keep the responsibility on state?

MK: I did what I could do – the Ministry annually gives hundreds of such exceptions for unregistered medicine. In all such cases, it is up to decision of doctor whether he/she uses such experimental treatment, and thus also takes the responsibility for such treatment. I do not exclude that we will, maybe by some additional legislation, change this so that doctors do not have to be afraid to use this vaccine. On the other hand, I think that doctors will want to use this vaccine to save lives. The producers of other, registered, vaccines do not want to take the responsibility for the side effects of their vaccines too, in this case it might be even better, because Sputnik is properly registered in Russian Federation, thus the Russian side might also take some responsibility for its use.

Q: Doctors also ask why did you not decide to administer this vaccine as part of experimental study, which would be an easier solution?

MK: This discussion is still not closed, we talked about it today too. I do not exclude the possibility of such option, it is one of the alternatives. I needed to take the decision to grant an approval for use as part of the agreement with the Russian side which wanted to have the guarantee that the vaccines will be really used and not just kept in some warehouse.

Q: Do you consider the yesterday´s welcoming of the vaccine, which is widely criticized by your coalition partners as a proper way of communication?

MK: We were honestly happy that the citizens of SR will have such opportunity, as there is high interest in this vaccine. I personally considered it as a propagation of the vaccination itself.

We wanted to express gratitude that it has arrived and to those who managed the negotiation process. I did not see this as a geopolitical question, but as mere celebration of the vaccination process and of the new possibility of our citizens.

Q: The new measures were approved by Government on Sunday and this is first time these are being somehow presented to public. At the same time, the government has approved the recommendations of the experts after the round table. Not all are however mirrored in the government resolution. When will these additional measures start to apply?

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MK: The Government Office already sent the notice to individual ministries to implement these recommendations. I myself had several meetings at our ministry already, when we discussed how to implement the measures under our competence, and we will try to implement them into real life as soon as possible. When it comes to, for example, the

“Instructions for the patient”, I asked my colleagues to work on it – so we will be able to publish the complete guide for the patient on how to act, where to call, what to do if he cannot reach his GP, etc.

Q: When it comes to Sputnik vaccine, are you sure Russians are really interested in registering their vaccine at EMA, as the news confirm that they have not yet requested the registration at the European Medicines Agency.

MK: I can only tell that the Russian Federation had left the inspectors of EMA to their production premises to start the inspection of their production process. I suppose this is part of their interest to register the vaccine at EMA.

Q: Why did you still leave the long window in curfew between 1 to 5 am, as also a half an hour window would be enough to comply with the legislation.

MK: This window between 1-5 was there from the beginning, it is, as you rightly noted, because of the constitutional and legal reasons, as the curfew should not last 24 hours. We do not expect much mobility in this time, so we decided to leave this window as it was set before.

Q: Will it be able to register for vaccination in accordance with the new vaccination order from Monday?

MK: Yes, I suppose I will publish the new decree on vaccination order by the end of this week, so to apply from Monday.

Q: Some people might now vaccinate with Sputnik vaccine and then, if the European passports will not accept such vaccination certificate, they might want to vaccinate again with different vaccination sometime in summer. Will there be such possibility?

MK: I would personally not recommend this from medical point of view. The Sputnik vaccine has a very good efficiency, and at least in Slovakia, but I suppose that within whole EU as well, they will have the same position as those vaccinated with other registered vaccines.

Q: You mentioned people might be able to already register for Sputnik vaccine next week. Are there any criteria set already as to who will be able to get vaccinated with this vaccine?

MK: We want to see the interest in this vaccine to set the vaccination centers and distribution of the vaccines. This will be thus probably a different form for only showing interest in the vaccination, and subsequently based on this interest we will define where to establish the vaccination centers, and only then will these registered people be contacted with the date of vaccination and the address of the vaccination center.

Q: Can people from critical infrastructure still register for vaccination or are the capacities already full?

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MK: Critical infrastructure is being vaccinated only in three vaccination centers – St. Michael Hospital in Bratislava and Kosice and Ružomberok hospital, thus hospitals belonging under the Ministry of Interior. Only those interested in AstraZeneca vaccines are being vaccinated and only those who can get vaccinated in one of these three centers. The vaccination process of critical infrastructure is under auspices of Ministry of Interior, and it will only go very slowly, as it is limited to these three centers.

Q: When it comes to the measure that from tomorrow only children from parents who cannot work from home will be able to come to schools, it was also supposed to be conditioned upon tests distributed into households. How is this logistically settled – when will these test arrive?

MK: This condition is not yet in the government resolution, this is only in the proposal from experts – we thus want to go in this direction. These self-tests will the nasal antigen tests we discussed several times, we already asked Office for Standardization, Metrology and Testing to approve the use of these test for the self-use. Tests are already being procured by the European Commission and on their way to Slovakia. We order 35 million of these tests, thus these will present a huge change in Slovak testing strategy. This is thus all under the process and we will inform about this when we will have the tests here.

Q: What was the price for these tests?

MK: It was a very good price - 3.50 Eur per test from company Siemens, and 3.70 Eur from company SD Biosensor. As I said the procurement was done by European Commission.

Q: When it comes to the transportation of our patients to abroad, we know that Germany and Poland have already offered their help. How should this work and when could it be expected?

MK: These two countries offered help with hospitalization of our patients. We already started to offer to our patients in border areas with Poland the transportation to this country. There is no much interest in being moved to these hospitals. The situation in norther Slovakia is also not so critical right now. If it worsens, we will be of course grateful for this help – it should be 200 available beds from Poland. The same offer is from Germany, however in case of this country there is of course larger geographical distance and the patients will need to be transferred by air when it will be needed.

Q: When it comes to the responsibility for patients registered with Sputnik, are you also considering using any compensation fund at the level of state?

MK: We are considering this option, we are currently assessing how the vaccination with this unregistered vaccine is different from vaccination with registered vaccines, and we are willing to address this difference also legally.

Q: Is there any progress with production of vaccines in Slovakia?

MK: We held talks with producers of mRNA vaccines and their production capacities are already distributed among countries so there is no interest from their side. We are however negotiating the possibility of producing the Sputnik vaccine, specifically in Šarišské Michalany, these discussions are ongoing.

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Q: With Sputnik vaccine there is also a recommended fasting of no alcohol and cigarettes for 40 days. What do you think about it?

MK: I think such fasting is a very good thing, so I will definitely recommend it. But I will let the Council to decide on this issue.

Q: There are still no controls at the borders. Is this going to change from tomorrow?

MK: This is probably a question for different minister. Minister of Interior assured us repeatedly that they do maximum for protecting the borders, it is also in my interest, that people coming to SR respect rules by Chief Hygienist.

Q: Is it fair that the schools might only start following the rules from Monday?

MK: Again this is question for Minister of Education, as the resolution does not specifically state this measure. It is up to Minister to implement it. The experts wanted us to implement the measures as soon as possible, of course. Also, there were some uncertainties regarding the schools in black districts. I really want to ask headmasters to not open schools there even for presence working parents, as the situation is very serious in these and spread of infection in children collectives could be very dangerous.

Q: Can the Ministry of Education also allow the opened schools to accept children of parents working on home-office too?

MK: According to the resolution, schools should only accept children whose parents can demonstrate they cannot work from home, they should show the relevant certificate from their employer. In black districts, only school clubs with lesser children should be opened for children from parents from critical infrastructure.

Q: How are the negotiations with other EU countries regarding the registered vaccines continuing?

MK: The discussions are constantly ongoing. Some countries have some vaccines in warehouses, namely the AstraZeneca vaccine, due to higher presence of side effects, their people do not want to use it. If some countries would want to give up some vaccines, however, these should go into common bazaar, where they should be evenly divided within the interested member countries. We are following this process, but no vaccines were yet put into such bazaar. However, Slovakia, Czech Republic and Austria were lent 100 000 vaccines due to bad situation, but this is only for one month, and in April we will need to return these vaccines back.

Q: How can Sputnik be given exception for use when such exception for use of unregistered medicine is only given if there are no available alternatives. And as we know we do have other registered alternatives.

MK: It is specifically defined in the decision, it is due to critical lack of registered vaccines and that is how it was possible to grant such exception.

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Q: I heard it is also possibility that Sputnik will be used in Slovakia as part of fourth clinical trials of this vaccines. Can you explain how this work, as three trials are needed for registration of the vaccine?

MK: This vaccine has completed three clinical trials, and that is why it can request registration already. However, any vaccine can also make the fourth phase, in which the effectivity of vaccine is further evaluated.

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