'ASYMPTOMATIC CARRIERS CREATE TRANSMISSION CHAINS'

 Filenews 6 September 2020 - by Giannis Antoniou

At any time the data can be reversed and the risk of virus outbreak is always possible, the Director of Medical and Public Health Services, head of the Epidemiological Surveillance Unit of the Ministry of Health, Dr. Elizabeth Konstantinou, tells "F". It underlines as a worrying fact the infection of young people aged 20 – 40 years, who are usually asymptomatic. Because they have intense activities and are not limited, they have many close contacts resulting in creating transmission chains with an increased risk of spreading the virus.

-Are we facing a new wave of infection or are the cases detected considered isolated?

-At this stage, according to the epidemiological data to date, it appears that the situation had a slight deterioration during the period July-August. However, following early interventions and additional health measures by the Ministry of Health, the situation in Cyprus is currently fully controlled. Of course, this should not lead to complacency either from the citizens or from those responsible. At any time the data can be overturned. The risk of virus outbreak is always possible. Most cases are currently imported from other countries. However, with the regular laboratory checks of incoming passengers in the Republic of Cyprus and the re-evaluation of the epidemiological picture of the countries, we seek to exclude the possibility of a resurgence of the pandemic in Cyprus.

-The case of other countries, as well as recent cases in Cyprus, show how volatile the situation is. What is it that worries you the most?

-What seems to be worrying is the infection with the virus of young people aged 20 – 40 years who are usually asymptomatic. These people have intense daily activities resulting in many close contacts. Also these individuals are difficult to limit until the end of the incubation time of the virus, which is 14 days. In this way they create transmission chains with an increased risk of the virus spreading in the community. We are particularly concerned about the opening of borders because of imported cases, which are mainly asymptomatic. Furthermore, I am concerned about possible fatigue in the world leading to a relaxation in the observance of sanitary measures.

-In addition to personal hygiene measures, what should be the line of defence of each individual citizen but also at the collective level?

-Clear guidelines and precautionary measures are given through the Health Protocols issued by the Ministry of Health to prevent and address the effects of coronavirus in all areas. In fear of unforeseen data on the outbreak and spread of the virus and in particular its effects on vulnerable population groups, the line of defence of each conscientious citizen individually for the protection of all of us is to maintain physical distancing, to make mandatory and correct use of masks where provided, to avoid gatherings with large and uncontrolled numbers of people, to diligently disinfect spaces and objects of common use and to educate our children about behaviour under these circumstances.

Approaches by the Ministry of Health and the Infectious Diseases Epidemiological Surveillance and Control Unit to case management are adapted to the situation at national and local level. Despite the government's already burdened work, Cyprus is treating the pandemic in an exemplary manner on the basis of guidelines from the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation (WHO). In fact, it has received credit from the ECDC and from various countries for the strategy of strict tracing, a difficult process carried out by the Office of which I am head.

- Until now, few were aware of the existence of the Epidemiological Surveillance Unit. What are its main responsibilities?

-Indeed, the work of the Infectious Diseases Epidemiological Surveillance and Control Unit is not widely known. The Unit was established in 2003 at the same time as the creation of the European Centre for Disease Control (ECDC) and constitutes an infrastructure vital for the Ministry of Health and public health of citizens. Its main responsibilities are: Epidemiological monitoring and control of infectious diseases in the Republic of Cyprus in cooperation on a regular basis with similar international organisations such as ECDC and WHO, risk assessment for immediate prevention and response measures in cases of epidemic or pandemic, research, education and communication with both health professionals and the public and finally , the evaluation and strengthening of vaccination programmes.

- But the pandemic came and brought new responsibilities.

-The Unit is more responsible than all other services with the issue of pandemic due to competence even before outbreaks in Cyprus. In this context, laboratory epidemiological surveillance, the coordination of clinical laboratories, the issue of epidemiological bulletins and the re-evaluation of the epidemiological picture of the various countries with regard to COVID-19 disease also fall within the competence of the Unit. All cases are also monitored. The ultimate objective of the Unit is to coordinate everyone and respond in a timely manner in relation to the treatment of old and new infectious diseases, especially if they involve a risk of transmission and threaten public health.

- Are health services checking? There has been a lot of discussion about the effectiveness of controls at marinas and airports.

-The regulatory framework to prevent the spread of COVID-19 is established by the Ministry of Health. The competent services responsible for monitoring the implementation of this framework are the Health Services of Medical and Public Health Services, the Cyprus Police and the Department of Labour Inspection. In this context, the Health Services in cooperation with the Police carry out intensive checks to monitor the implementation of the measures and the findings of this programme are communicated in a press release to the media. In addition, after the opening of airports, ports and marinas, more scientific checks are carried out. A programme based on three pillars shall be applied to controls:

1. Countries shall be assessed and categorised into three groups according to the epidemiological risk.

2. There are 4 services (The Medical and Public Health Services, the Port Authority, the Civil Aviation Department and the Cyprus Police) that cooperate on the checks on the arrival of passengers.

3. In addition to the above measures, a random check shall be carried out upon arrival of the passengers.

Based on the information obtained from ecdc and the results of the above audits, a weekly reassessment of the categorization of countries is carried out. The points of entry into the Republic of Cyprus are crucial, which is why the Department of Medical Services, in cooperation with the other services, makes every effort to avoid the entry of cases into the Republic.

Early tracing, laboratory checks and quarantine

-Of the last cases detected in Cyprus, very few have been sick to the extent that they require medical attention. Does that mean anything, or is it a co-ownership?

-The last cases in the period July 2020 - August 2020 mainly concern young people aged 20-40 years. These individuals usually have very good physical condition without underlying diseases. That is the main reason why I attribute the low number of admissions to our hospitals. A factor that according to the latest risk assessment by ecdc, is important for the risk assessment of each country from the virus.

-Unlike the first wave of the pandemic there is now no element of surprise, there is time to prepare.

-During the first wave of the pandemic, both the Member States and the competent ECDC and WHO organisations had the time to study the behaviour of the virus and prepare themselves by taking appropriate health measures. Therefore, with the triptych "early detection – laboratory testing – quarantine" an effective mechanism has been created to prevent the spread of the virus in the community.

Coverage of the Cypriot population with the vaccine

-From your contacts with the European Centre for Disease Prevention and Control (ECDC), what picture prevails at European level?

-ECDC informs about the current threat to human health from COVID-19 disease and supports us in our efforts for preparedness and rapid response. All publications published by ECDC aim to support a pan-European communication approach, currently focused on the completion of vaccine studies, in order to enable it to be provided. The Centre has been alarmed and concerned that for more than five weeks, during the summer months, epidemiological indicators in many European countries have increased on the basis of measurable indicators. In general, the Centre is alert, updating its epidemiological data, protocols and/or recommendations.

- And globally? Attention is now turning to the vaccine. Obviously until it's ready, we're going to have to learn to live with the virus.

-At both global and European level, all public health mechanisms are being put in place and not only around tackling/intercepting and combating the pandemic. All experts and non-experts are currently researching, studying and learning the new virus. There is generally a lot of concern around the issue, but I do not consider the enemy to be invincible. International organisations and all states strive to contribute to tackling the pandemic in every way and equally. Surely the completion of studies on the manufacture of a vaccine effective against coronavirus will be the solution to the problem, which is expected to take place around December. Also the discovery of new anti-ing drugs would help a lot. At this point I mention that Cyprus participates in the Joint Procurement (Joint Negotiating Initiative) of the European Commission, for the supply of the vaccine, with all the manufacturers, which ensures its guarantee for Cyprus and actions are being taken to cover the whole population. In this hope, until such a vaccine is implemented, we must continue to protect and safeguard public health. Our daily lives have been adapted to the ways of dealing with the virus invasion by us. We have now learned to live with the virus, waiting for spring without the virus or more correctly with weapons to deal with it.