The first case of the novel coronavirus (COVID-19) in Georgia was confirmed on 26 February 2020 whilst the Lugar Laboratory confirmed that a patient tested positive in Batumi on 15 March 2020. This was the first confirmed case of the novel coronavirus in the Autonomous Republic of Ajara.

According to current data, eight patients with confirmed COVID-19 are undergoing medical treatment in Ajara. Two of the patients are in critical condition whilst one of them has been placed on a ventilator. On 1 April, a ten-year-old child who was quarantined in Batumi together with his grandmother tested positive for the coronavirus. Since the child’s family lives in Tbilisi, the patient requested being transferred to the capital. In accordance with the latest information, the grandmother may also test positive for the coronavirus.

Two clinics in Batumi are involved in the system of fighting the coronavirus. Infected people receive treatment at the Medalfa clinic whilst the Batumi Hospital for Infectious Diseases was declared a “Fever Zone” where patients with suspected symptoms are placed and later transferred to Medalfa if they test positive.

There are over 20 quarantine spaces all over the region where more than 20,000 citizens are currently quarantined whilst over 200 people remain in self-isolation. However, a person who is quarantined can fill out a special form that he wants to switch to self-isolation. After respective procedures, epidemiologists will make a final decision. According to the latest data, more than 300 people have already left Ajara’s quarantine spaces.

As of 2 April 2020, the final test results of a supposedly recovered patient were being expected. How is Ajara’s healthcare system dealing with the new challenge, what is their capacity management and how are healthcare workers being protected? The Minister of Labour, Health and Social Affairs of the Autonomous Republic of Ajara, Zaal Mikeladze, answered FactCheck’s questions.

- Q How is the situation of citizens currently quarantined in Ajara’s quarantine spaces being controlled and what preventive measures are being taken to ensure the detection of cases of infection?

A Quarantined and self-isolated people are switched to a unified monitoring centre. Their body temperature is checked twice a day and special charts are filled out which is done by epidemiologists. A group of doctors and nurses make sure not to leave other chronic diseases unattended. People in quarantine spaces are provided with three meals per day, hygiene means and other essential items. A quarantined person can switch to self-isolation. In order to do so, he has to full out a special questionnaire and indicate where he has an isolated space. A special group inspects the place in order to determine the extent to which it meets the required criteria and makes a respective decision.

I would like to add that some owners of quarantine spaces have provided them for free and contracts were signed with others. The government pays for the care, catering and other services provided to the people there.

Q Could you please clarify for our readers what a “Fever Zone” means and what its purpose is?

A This means that people with initial suspected indicators (a suspected indicator means a fever characteristic to viral infections, coughing, travel history or contact with someone who has a travel history as well as with suspected or confirmed patients) are admitted there and they can also come by themselves. Healthcare workers have been trained. The Batumi Polyclinic N1 and the Family Medicine Centre are involved in the process. They have constant communication with citizens. People can call two hotlines, 112 or 144, where Batumi residents are addressed to these two facilities. There, family doctors carry out remote screening which includes filling out questionnaire forms and body temperature control. The decision as to who will move to the “Fever Zone” is made based on these questionnaires. I ask citizens to refrain from visiting the “Fever Zone” on their own initiative since the risk of infection there is high. In addition, I would like to ask everyone not to visit other clinics on their own initiative since those clinics cannot admit citizens with a fever. This is only done by personnel with special training and equipment.

Q There have been talks about partially equipping the newly built republican hospital particularly for COVID-19 purposes. When will this happen and without this new resource, how many infected patients can Ajara’s healthcare system accommodate at the same time?

A Batumi’s republican hospital will be opened at this time for COVID-19 centre purposes alone. This will be emergency, reanimation and intensive care. It will have 100 beds which can be increased to 200. The first payments have already been made to purchase ventilators, beds and other necessary equipment. In the case of a peak growth, we have nearly 1,600 beds and 160 reanimation beds not including the aforementioned clinic. This is three-four times more as compared to the European standard. If citizens follow our advice, we should not have so many infected persons even in the whole country. We are still at a containment phase. The problem is people with no symptoms who can spread the virus. Therefore, I would like to repeat my request for everyone to stay at home and not to put themselves and other people in danger. Staying at home does not only mean not going to work. This is a responsibility for everyone. If people understand that and trust us, the doctors, and follow our advice, we will not have complications.

Q In the case of an increase in the number of infected persons as well as the spread of the virus in mountainous municipalities, will Ajara’s healthcare system be able to handle the management of patients in a short period of time?

A We have healthcare workers in Ajara’s most remote villages – a joint group of a family doctor and a nurse per 2,000 people. It would be better if people have telephone communication with them instead of visits. This is the recommendation. There are Evex clinics in every municipality which are ready to admit patients. Towns and small cities with crowds are more dangerous. Only funerals and other ritual gatherings could be dangerous in the villages and people there try to follow us in this aspect as well. If a hotbed emerges there, we will not leave this burden to the municipalities alone to bear and we will move there and handle the situation. I would like to assure you that we carry out constant monitoring over the entire region.

Q Given the fact that one of the nurses has already tested positive, should we assume there is a big danger of infecting healthcare workers?

A There is no 100% safeguard although healthcare workers have undergone trainings and they know how to work. The aforementioned nurse has not breached the protocol. She had a patient who was very difficult, with psychological problems, and who refused treatment, opposed the medical team and was disobedient. Medications are to be administered on schedule and our healthcare personnel was under a huge risk since the patient did not take the medication, spilled the liquid and so on. Some media breached all standards whilst covering this issue and visited the mother of the infected nurse. She thought someone brought her food and opened the door. This was followed by panic. They let the entire neighbourhood know that the nurse was infected. We are trying to protect their rights. This is intolerable behaviour. We hold consultations with the World Health Organisation and know how crucial it is to ensure the safety of citizens.

Q Since there is an increased risk of infecting family members, are there considerations to allocate temporarily isolated accommodation for healthcare workers?

A We discussed this issue with the WHO. Separate accommodation for healthcare workers is associated with other problems, such as stress, and, therefore, it is up to them to choose. If they desire an isolated accommodation, we are ready to take them there separately. For instance, Medalfa personnel decided to be isolated. We fulfilled that demand and now they have all of the necessary conditions.

Q The risk of infection and virus spread are high among particular adolescents with, let us say, challenging behaviour who are often running away from home. In addition, sex-workers and transgender citizen are in a difficult situation. Many communities, which already had complicated relations with the state, can now find themselves without income, they cannot pay their rent or purchase food and medicine similar to many people. Are any services envisioned for these citizens?"

A I would not like to put these citizens separately. They and other people can call hotlines and provide information as to what kind of assistance they need. They will be verified and if confirmed, the state will provide assistance for them. If someone is left without a subsistence income, he has to address to the local self-government and the state will take this into account. Apart from the state assistance programme, there are NGOs, including Ialkani, which have already provided over 400 families with food, children’s food and hygiene items . I would like to thank them for this. The Red Cross distributed state-made baskets together with the youth regional centre and this indeed helps us. In addition, people form groups of volunteers, raise funds and collect products to help families left without an income. Stocks are constantly being replenished. This process continues unfettered and I think we will not have problem to supply people with food. After the first case was confirmed, we trained several hundred volunteers, some of them remotely. The volunteers follow the safety recommendations and we monitor this process on a daily basis. In regard to underage children with delinquent or otherwise complicated behaviour, let us say, those who are disobedient or who run from home, we are ready to quarantine them if we have reports about these individuals.

Q Is there any problem which has been caused by insufficient resources?

A As you know, we do not have production facilities and we depend on import. The importers, however, are faced with problems. However, since China’s situation has already improved, it is making ventilators specially for Batumi’s republican hospital. On the other hand, we are working with the tests which the Lugar Laboratory has. We have not had a gap. If we have a peak amount, we will do the tests not only at the Lugar Laboratory but also in the Fever Zones. It is possible to do so in Kobuleti and elsewhere. At the present moment, lab workers are being trained and laboratories are being equipped. If necessary, they will be provided with test kits. It would be better to have more contactless body temperature scanners. Private clinics have placed orders for them but delivery failed. It is desirable for grocery stores and other facilities to also have contactless body temperature scanners. In other places, where necessary, such as quarantine spaces and check-points, we have them but village ambulatories do not and import from neighbour countries is complicated.