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УДК 616.24-002:578.834.1(574) DOI 10.53065/kaznmu.2021.41.35.060
L. Zh. Alekesheva1, K.K. Toguzbaeva1, K.O. Dzhusupov 2
1 Asfendiyarov Kazakh national medical university 2 Department of Public Health, International School of Medicine, Bishkek, Kyrgyzstan
alekesheva.l@kaznmu.kz +7 707 217 1331
ADDRESSING COVID-19 IN KAZAKHSTAN: WHAT ARE THE EFFORTS AND CHALLENGES?
Resume: COVID-19 has strained the healthcare systems of many countries worldwide including the Republic of Kazakhstan. To cope with the pandemic, Kazakhstan mounted a plan containing three strategic objectives: 1) Preventing the outbreak of the disease; 2) Ensuring optimal care for all patients, and 3) Minimizing the impact of the pandemic on health systems, social services, and economic activities. However, the uneven distribution of financial resources across regions, irregular consumption of medical services, and inconsistent health indicators hamper these efforts. Other issues are the lack of medical forces, the unexpectedness of the situation, lack of knowledge on coronavirus infection, and powerlessness in front of this new disease. There were difficulties in mass testing as stigma and fear from quarantine forced people not to get tested. The euphoria enveloped the country after abolishing the emergency state after an intense lockdown which resulted in increased cases. A second lockdown was urgently introduced in June 2020 to take control of the situation. The number of patients and those infected gradually began to decline. The pandemic showed the fragility and inter-dependence of the health system-planned vaccinations against many infectious diseases were postponed. Medical examination and provision of medical services to patients with chronic, oncological diseases, planned hospitalization were temporarily halted. Many doctors and nurses became infected and ill. The country's COVID-19 epidemiological situation is somewhat under the control and supervision as of this writing. However, to give any forecasts for its completion is still too early. Kazakhstan is preparing to vaccinate against coronavirus infection. First of all, risk groups, medical and social workers, and people with chronic diseases should be subject to vaccination. Until herd immunity is not formed, Kazakhstanis must keep caution when the restrictions are taken off to prevent an explosion of new disease cases. Key words: coronavirus infection, morbidity, preventive and anti-epidemic measures
Introduction
COVID-19 has strained the healthcare systems of many countries worldwide [1], including the Republic of Kazakhstan [2]. Kazakhstan started taking precautionary measures to prevent the import and spread of coronavirus infection when the first cases were recorded in Hubei province, China. Kazakhstan mounted a plan containing three strategic objectives: 1) Stop transmission, prevent the outbreak and spread of the disease; 2) Ensuring optimal care for all patients, particularly the critically ill; and 3) Minimizing the impact of the pandemic on health systems, social services, and economic activities. This article aims to provide a critical commentary on the COVID-19 trajectory, the ongoing efforts to combat the pandemic, and the challenges facing its responses in Kazakhstan.
The first few cases and deaths
Two Kazakhstan citizens - a 46 years old man and a 36 years old woman coming from Germany tested positive on March 13, 2020. They were both hospitalized in an infectious hospital. On the same day, the third and fourth cases were detected. On March 12, a returnee coming from Milan to Nur-Sultan by Moscow tested positive. The fourth infected person arrived in Alma-Ata from Germany and was admitted to a hospital for treatment. On March 26, the first death from coronavirus in Nur-Sultan was confirmed. Currently, in all regions of Kazakhstan, there is an import of coronavirus infection [3].
The number of infected patients and the highly affected regions
According to official statistics, as of January 3, 2021, 158,302 confirmed cases (PCR+) were registered in Kazakhstan, with 145,194 recoveries (91.7%) and 2,262 deaths (1.4%). There were - 45,991 COVID-19 (PCR-) cases of pneumonia with signs of coronavirus infection with 33,298 recoveries (72.2%) and 513 deaths (1.0%).4 Almaty, Hur-Sultan, Shymkent, Akmola region, and Aktobe region, with 18939, 18777, 5523, 7481, and 3711 cases
respectively, have a higher number of cases than other regions.
As the epidemic process was studied, the tactics of treatment, sanitary and anti-epidemic measures and statistical reporting were changing. There was a separate registration of symptomatic and asymptomatic patients. Then statistics were displayed separately for pneumonia with signs of coronavirus infection, the coding according to ICD 10 [3].
On 03/01/2021, 7 cases of pneumonia with signs of coronavirus infection were detected, and four deaths were registered. Atyrau region is included in the "red" zone, where strict regime-restrictive measures are maintained. On January 3, 2021, 149 people fell ill per day, five patients from the city of Atyrau, and 144 cases were identified as a result of screening at the Tengiz field. Out of them, 25 people had severe symptoms. In the infection hospital at the Tengiz field, currently, 290 patients receive treatment at home, 91 - in the central regional infection hospital, 38 -in district infection hospitals, 778 people are being treated, 43 patients recovered per day [4]. In the identified epidemic foci, an epidemiological examination is carried out with the establishment of spatial and temporal boundaries, the identification of contact persons, the establishment of a possible source of infection, disinfection, laboratory examinations are carried out, a set of measures to eliminate and localize the emerging focus of infection.
Policies initiated to curb the pandemic
Kazakhstan employed a four-stage strategy to curb the pandemic. Based on the first stage of this strategy initiated in January 2020, the sanitary and epidemiological control at checkpoints across the state border was strengthened. The authorities conducted the training exercises. The medical monitoring for persons arriving from China was provided. The 72-hour visa-free stay for Chinese citizens in Kazakhstan was suspended, and the air traffic between China and Kazakhstan was stopped. Furthermore, the
government extended the sanitary prevention and control measures to healthcare facilities, kindergartens, schools, boarding schools, and nursing homes. Medical workers were trained in diagnostics, epidemiology, and prevention of a new infection [5]. On January 31, 2020, the second stage of amplification was launched. The sanitary and epidemiological service specialists were moved to the quarantine stations at all the boundaries further. The laboratory staff passed additional training in diagnostic COVID-19. Moreover, the first clinical treatment protocol and algorithms for anti-epidemic measures were developed. The third stage of the strengthening was associated with the arrival of citizens of Kazakhstan. Upon their arrival, passengers had to pass a health screening and testing and pass a 14- day quarantine. On March 1, 2020, the fourth stage of amplification was introduced, allowing passengers coming from category 1a countries (France, Italy, Spain, Germany) to enter the country, however, under a 14-day quarantine in a hospital and then under medical supervision for ten days. In this stage, persons arriving from countries of category 1b (PRC, South Korea) had to be placed in 14-day home quarantine. Persons coming from countries of the second category (Philippines, Qatar, Great Britain, USA, India) were under medical supervision at home for 14 days, followed by ten days of phone checkup. Persons returning from the third category countries (epidemiological^ "clean") were under distant medical supervision by outgoing phone calls within 24 days. In this stage, air traffic to Iran was suspended, and the number of flights in South Korea was limited as the two countries were hardly hit by the pandemic [6]. Challenges and Efforts
The pandemic has posed problems to the healthcare system of Kazakhstan. The uneven distribution of financial resources across regions, irregular consumption of medical services, and inconsistent health indicators remain some of the country's main problems despite some improvement in recent years. Almaty and Nur-Sultan's residents have advantages in access to medical care since most of the high-tech national clinical centers are concentrated in these two cities. On the other hand, medical services in remote regions of the country are significantly hampered due to the geographical dispersion and sparsely populated territory. Thus, the government opted to use telemedicine to provide medical services for the country's remote regions [7]. Other issues are the lack of medical forces, the unexpectedness of the situation, lack of knowledge on coronavirus infection, and powerlessness in front of this new disease, generating a negative mood in the medical community. At first, there was not enough personal protective equipment (PPE), and medical workers did not know how to use them. In total, 120 cases of occupational exposure to coronavirus among healthcare workers were registered. Among them, 67 cases of infection among healthcare workers were reported. The government allocated funds to encourage and compensate for the damage caused by the pandemic on medical workers' health [8].
With the surge of new cases, the primary healthcare level was overloaded. The health system translated into "COVID" mode almost stopped other essential health services for the patients with chronic diseases, planned hospitalization, and routine immunization. Moreover, there were difficulties in mass testing as stigma and fear from quarantine forced people not to get tested, which led to underestimating the actual number of cases. Hence, for the epidemiologists, it was challenging to trace COVID-19 contactees in many cases. Some parts of the population did
not believe in the existence of the virus and the disease, leading to citizens' negative attitude to health and hygiene. Another challenge facing responses in the country is widespread disinformation associated with the COVID-19 pandemic through social networks. The official website on COVID-19 was open to reduce disinformation. There is a whole section dedicated to fakes and fact-checking [9]. At the same, disinfection mode and restriction measures, especially the burial of corpses, and national lockdown, did not improve the population's attitude in following preventive measures conducted by the authorities.8 The national emergency state was introduced from March 16 to May 11, 2020 [10]. Based on that, educational institutions and most offices turned to distant work mode. Non-food facilities, cinemas, and other crowded public places were closed. Observatory, provisional, and infection hospitals were deployed with 24-hour sanitary posts. Kazakhstanis were prohibited from leaving the country, except diplomatic service employees and border settlement residents to seek medical assistance. However, the entry of Kazakhstani from the other country and the departure of foreigners were allowed. The Government allocated funds to support people who lost their jobs during an emergency. Groups at risk were given food rations. The population received masks free of charge, and many organizations provided their employees with sanitizers and other hygiene products. The euphoria enveloped the country after abolishing the emergency state after an intense lockdown. The mild stage started as the people did not follow social distancing seriously, which resulted in an increased COVID-19 incidence rate. Most reported cases were familial infection. The health system was overwhelmed, facing the lack of medicines, beds, and ventilators in hospitals, alarming and frightening people. The number of pneumonia cases with negative PCR tests dramatically increased. According to the WHO, after the first lockdown was lifted, Kazakhstan became a country with an accelerated infection transmission [2]. A second lockdown was urgently introduced in June 2020 to take control of the situation. The number of patients and those infected gradually began to decline. The coronavirus infection situation resembles a "swing": an upward curve when the rules are violated and down when they are followed. Thus, the course of the epidemic process confirms the need for social distancing, mask regime, and hand hygiene as the primary measure to prevent coronavirus infection. To date, the consciousness and alertness of Kazakhstan's population have grown significantly. People have begun to approach their health, mask regime more consciously, and commit to a healthy lifestyle [4]. The pandemic showed the fragility and interdependence of the health system- planned vaccinations against measles, rubella, mumps, and other infectious diseases were postponed for children under 1-year-old. Medical examination and provision of medical services to patients with chronic, oncological diseases, planned hospitalization were temporarily halted. Many doctors and nurses became infected and ill. People avoided visiting polyclinics as much as possible. It negatively affected the health of the entire population of the country. But by the epidemic season of influenza, people were ready to receive a vaccine against flu: coverage exceeded the same period of the last year at times, but the incidence rate in October-December did not exceed the average annual values [4]. Kazakhstan sought to improve its testing capacity to strengthen its efforts. Today, there are 46 diagnostic laboratories of COVID-19 in Kazakhstan, with eight mobile laboratories for PCR testing and 15 fixed and five mobile
PCR devices. A range of private laboratories contracted for these studies considerably lifted the burden from public laboratories. Since March 1, 2020, 662291 PCR tests have been carried out, with a test positivity rate of 4.8% (80996). Despite available good laboratory services, there are difficulties in collecting and delivering the biomaterial from the patient, interruptions to the supply of consumables, fatigue and burn out of laboratory personnel, and the risk of intra-laboratory infection. The seroepidemiological studies of COVID-19 and monitoring of circulating SARS-Cov-2 strains were conducted in cooperation with the WHO [4]. Conclusion
Efforts and challenges to contain the spread of COVID-19 in Kazakhstan are nuanced. The country's COVID-19 epidemiological situation is somewhat under the control and supervision as of this writing. However, to give any forecasts for its completion is still too early. There are still
symptomatic and asymptomatic cases and deaths from SARS-Cov-2 being registered. Hur-Sultan and Almaty are introduced into a yellow zone with continuing quarantine measures and strict control of their implementation. The lowest incidence rates are in the country's southern regions, where the situation is stable, and the easing on restrictive measures is possible. The uneven distribution is associated with external and internal migration of the population, including the tourist flow. Tension and fatigue persist in society, but people have become more responsible for their health and hygiene, and the number of misinformation and fake news has decreased. Kazakhstan is preparing to vaccinate against coronavirus infection. First of all, risk groups, medical and social workers, and people with chronic diseases should be subject to vaccination. Until herd immunity is not formed, Kazakhstanis must keep caution when the restrictions are taken off to prevent an explosion of new disease cases.
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Л.Ж. Алекешева1, К.К. Тогузбаева1, К.О. Джусупов2
1 Казахский Национальный медицинский университет им. С.Д.Асфендиярова 2 Высшая Школа медицины, Международный университет Кыргызстана
БОРЬБА С COVID-19 В КАЗАХСТАНЕ: КАКОВЫ УСИЛИЯ И ПРОБЛЕМЫ?
РЕЗЮМЕ COVID-19 нанес серьезный удар по системам здравоохранения многих стран мира, включая Республику Казахстан. Чтобы справиться с пандемией, Казахстан разработал план, содержащий три стратегические цели: 1) предотвращение вспышки болезни; 2) Обеспечение оптимального ухода для всех пациентов и 3) Сведение к минимуму воздействия пандемии на системы здравоохранения, социальные услуги и экономическую деятельность. Однако неравномерное распределение финансовых ресурсов по регионам, нерегулярное потребление медицинских услуг и различия в показателях здоровья препятствуют этим усилиям. Другие проблемы - это нехватка медицинских сил, неожиданность ситуации, отсутствие знаний о коронавирусной инфекции и
бессилие перед этой новой болезнью. Были трудности с массовым тестированием, поскольку стигма и страх перед карантином вынуждали людей не проходить тестирование. После отмены чрезвычайного положения и строгой изоляции страну охватила эйфория, которая привела к резкому увеличению числа случаев заболевания. Чтобы взять ситуацию под контроль в июне 2020 года был экстренно введен второй локдаун, постепенно стало уменьшаться количество больных и инфицированных. Пандемия показала, насколько хрупка и зависима система: была отложена плановая вакцинация детям до 1 года, временно приостановлено медицинское
обследование и оказание медицинских услуг больным хроническими, онкологическими заболеваниями,
плановая госпитализация. Многие врачи и медсестры заразились и заболели. На момент написания этой статьи эпидемиологическая ситуация в стране с COVID-19 находится под контролем и надзором, однако давать какие-либо прогнозы относительно его завершения пока рано. Казахстан готовится к вакцинации от коронавирусной инфекции, в первую очередь вакцинации должны подвергаться группы риска, медицинские и социальные работники, а также
люди с хроническими заболеваниями. Пока коллективный иммунитет не сформирован, казахстанцы должны проявлять осторожность при снятии ограничений, чтобы предотвратить взрыв новых случаев заболевания.
Ключевые слова: коронавирусная инфекция, заболеваемость, профилактические и
противоэпидемические мероприятия
Л.Ж. Алекешева1, К.К. Тогузбаева1, К.О. Джусупов2
1С.Ж.Асфендияров атындагы К,азац улттыцмединалыцуниверситетi 2Медицина жогарымектеб1, Кыргызстанныц Халыцаралыкlуниверситетi
KДЗАK£ТАНДАFЫ COVID-19: КДНДАЙ МЭСЕЛЕЛЕР БАР ЖЭНЕ КДНДАЙ ОТШ Ж¥МСАЛДЫ?
Тушн: COVID-19 элемнщ кептеген елдершщ, онын, iшiнде Казахстан Республикасынын, да денсаульщ са;тау ЖYЙесiне ;атты со;и;ы бердi. Пандемиямен куресу Yшiн Казахстан Yш стратегиялы; ма;сатты ;амтитын жоспар ;урды: 1) аурудын, ершуiне жол бермеу; 2) барлы; нау;астарга оцтайлы кемек керсету; 3) пандемиянын, денсаулы; са;тау ЖYЙесiне, элеуметтiк жэне экономикалы; ;ызметтерге эсерiн барынша азайту. Алайда айма;тарга ;аржы ресурстарынын, тен, белшбеу^ медициналы; ;ызметтердi тутынудын, ретсiздiгi жэне денсаулы; керсетюштершщ эр TYрлi болуы буган кедергi келтiредi. Бас;а мэселелер - ол медициналы; ^штщ жетюпеушшп, жагдайдын, о;ыстан пайда болуы, коронавирусты; инфекция туралы бшмнщ аздыгы жэне осы жаца аурудын, алдындагы дэрменаздж. Жаппай тестiлеу кезiнде ;иынды;тар болды, ейткенi стигма мен карантинге деген ;ор;ыныш адамдарды тестiлеуден етпеуге мэжбYр етл. Тетенше жагдай алынып тасталганнан кешн елде эйфорияга душар болды, бул ауру санынын, KYрт есуiне экелдь Жагдайды ба;ылауга алу Yшiн 2020 жылдын, маусымында жедел TYрде екiншi локдаун енгiзiлiп, нау;астар мен жу;тырган адамдар бiртiндеп азая
бастады. Пандемия, б1здщ ЖYЙенiн, ;аншалы;ты элсiз жэне тэуелдi екенiн керсеттi: 1 жас;а дейiнгi балаларды жоспарлы TYрде вакцинамен егу кешнге ;алдырылды, созылмалы, онкологиялы; аурулары бар нау;астарды медициналы; тексеруден еткiзу жэне медициналы; ;ызмет керсету уа;ытша то;татылды. Кептеген дэртерлер мен медбикелер инфекцияны жу;тырып, ауруга шалды;ты. Осы ма;аланын, жазылу уа;ытында елдегi COVID-19 бойынша эпидемиологиялы; жагдай ба;ылауда жэне КЭдагалауда усталуда, алайда онын, ая;талуы туралы Кдндай да бiр болжам жасауга элi ерте. Казахстан коронавирусты; инфекцияга ;арсы вакцинацияга дайындалып жатыр, ен, алдымен ^уш-натер топтары, медициналы; жэне элеуметтiк ;ызметкерлер, сондай-а; созылмалы аурулары бар адамдар вакцинациядан етуi керек. Ужымды; иммунитет ;алыптас;анга дейiн, ;аза;станды;тар аурудын, жаца жагдайларынын, бур; етпесiн болдырмау Yшiн шектеулердi алып тастауда са;ты; танытуы керек. ТYЙiндi сездер: коронавирусты; инфекция, аурушацды;, профилактикалы; жэне эпидемияга иарсы шаралар
