September 18, 2020 - How to prepare one's mental health for economic crisis, and what to expect? Interview with Tomislav Bunjevac, a psychologist at the  Institute for Organizational and Personal Development in Zagreb.

Q1. What are the historical examples and studies related to mental health changes resulting from the economic crisis? Do we have any research done in Croatia?

It is not easy to assess the impact of the economic crisis on mental health. To quote one of the researchers who addressed this issue on the occasion of the last significant financial crisis, which began in 2008: "During a financial crisis, the state of the economy can be tracked in seconds, and public health data is usually outdated a few years" (Martin McKee, 2014, Health Cuts Have Consequences, Perth).

The economic crisis to which this statement relates is vastly simpler to the one we are facing today.

Maybe we need to repeat what it is about first. The model for the emergence of the current crisis, which has not yet occurred in the history of civilization, is straightforward and probably understandable to everyone. It started with a massive health crisis in the form of an epidemic that turned into a pandemic. At the same time, we have the fact that the global health system and medicine, as a rule, do not have sufficient knowledge about the disease itself (first of all, this concerns the lack of a vaccine and effective therapy). Subsequently, the general lock-down brought an economic and financial crisis that massively threatens the naked existence and survival. That led to a general sense of a complex threat to health and existence.

In this context, the aspects mentioned above of the crisis have negative consequences for the overall quality of life, particularly in the area of mental health. Traditionally, mental health is defined by so-called mental health 'negative' definitions that describe a 'threat' to health. In particular, disorders in cognitive functioning and/or mental illnesses are predominantly clearly defined, and it is sporadic to determine what mental health is.

This anomaly exists because the disciplines traditionally associated with mental health (psychiatry as part of medicine and psychology as an independent discipline) were becoming more critical and developed most during and after a significant mass crisis. Considerable development of these disciplines is evident during the First and Second World Wars, between which there was also a tremendous economic crisis. Accordingly, the interest of those disciplines was mainly focused on 'problems' and 'damage' caused by the situation, so most research is related to mental disorders and diseases, as well as to psychosocial consequences.

People's health depends on many factors, and it is doubtful to attribute serious health consequences only to factors related to the economic crisis. For example, during the financial crisis, there is no overall increase in mortality. On the contrary, Baumbach and associates noted the downward trend in mortality in eight European countries after the 2008 crisis (Baumbach A, Gulis G. Impact of the financial crisis on selected health outcomes in Europe. Eur J Public Health. 2014;24(3):399–403).

Also, experience shows that during a severe and massive crisis, the suicide rate falls, but after the crisis, this indicator returns to the pre-crisis state, or it even increases.

There are no general systematic studies in Croatia aimed at studying the relationship between economic crisis and mental health, although there are some studies on partial aspects of that relationship. Most often, it is about the relationship between socio-economic and material status and quality of life. These studies attempt to gain insight into the relationship between unemployment and quality of life and mental health aspects.

Q2. What are the most vulnerable groups of people whom we should pay particular attention to? 

As always, when it comes to times of crisis, when the likelihood of experiencing unpleasant, threatening, and traumatic experiences increases, there are groups of people who are more at risk than others. Those are usually people who, before the crisis, did not develop active and positive ways to deal with the problems, stress, and risks that the crisis brings. Entrepreneurs can be expected to be less risk-averse than others because they are somewhat more prone to taking risks and more active, which increases the likelihood that they perceive a crisis more often as both an opportunity and a challenge.

Q3. Should 'normal' people, with no symptoms or history of problems so far, be concerned for themselves? 

I don't think there is a need to ask if 'normal' people should be concerned about their mental health. It is essential for most 'normal' people that they assess their threat as accurately and realistically as possible, in terms of their existence and maintaining the lifestyle they are used to. Then, to evaluate their capabilities and reserves as accurately as possible, plan their needs and expenses within a reasonable time frame. At the same time, it is vital to avoid the experience of one's helplessness (so-called 'learned helplessness') and adapt the expectations to reduced opportunities during a crisis. As a rule, the smaller the gap between our capabilities (which usually decrease during a crisis) and our expectations (which is reasonable to decrease during a crisis), the less negative consequences for a person can be expected.

On the other hand, there is also a social solidarity mechanism that helps us in crises. This mechanism can significantly reduce adverse effects.

Q4. What are the most common disorders, and how long can they last? 

One of the most severe consequences is an increase in the number of suicides. In a study that followed the 2008 financial crisis, 26 European countries saw a rise in suicides by at least 5%. (Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet. 2011; 378(9786):124–125).

In the US, during the post-2008 recession, of an estimated 4.750 suicides, 1.330 of them could be attributed to increased unemployment. (Reeves A, Stuckler D, McKee M, Gunnell D, Chang SS, Basu S. Increase in state suicide rates in the USA during the economic recession. Lancet. 2012; 380 (9856): 1813–1814).

An increase in the suicide rate was demonstrated in states with low pre-crisis unemployment, where there was a significant increase in unemployment after the crisis. However, those are only indirect indicators, based on which it is impossible to talk about a clear, direct cause-and-effect relationship.

Some authors have concluded that between 1970 and 2007, in 26 EU countries, every 1% increase in unemployment leads to an increase in the number of suicides by 0.79% under 65.

Besides suicide, the most common consequences are depression (in Greece, the prevalence of depression doubled between 2008 and 2011). Furthermore, those include negative mood swings, increased anxiety, an increased number of psychosomatic problems (pain, neurological problems, gastrointestinal problems, sleep disorders, and sexual functioning disorders), and addiction issues – primarily, increased alcohol consumption. In Spain, it turned out that the prevalence of the above problems in 2010 was significantly higher compared to 2006.

The significant impact of the crisis also considers reducing the use of most medical services (in Greece, during the financial crisis, 15% fewer people sought medical assistance, although they were free, and 14% fewer sought dental services).

Q5. In Croatia, as during the last crisis, small and medium-sized businesses were significantly affected. Many of them had to close the company and stay out of work. What preventive measures can be taken to protect oneself from upcoming stressors best? 

Entrepreneurs, in particular, must adapt their expectations to opportunities. Among entrepreneurs, some have their own survival experience during and after the financial crisis (2008), which lasted longer in Croatia than in most other countries. Those who have experienced this already have some psychological defense mechanisms, on the one hand, and some desirable entrepreneurial competencies that can help them survive this crisis.

Also, between 2015 and 2019, for most entrepreneurs, the business was conducted in the context of making a profit (as indicated by statistics from annual reports for Croatia).

The best preventive measures for entrepreneurs are creating reserves during periods when the business is in a positive state, maintaining the readiness and waiting for a crisis, and planning for survival in adverse circumstances (crisis).

Q6. Are there specialized institutions or departments that would address precisely the problems that create unemployment and lack of income? If not, why and what can be done? 

As far as I know, there are no such specialized institutions. When it comes to the consequences of compromised mental health, most mental health professionals are in the health system (for the most part) and, one smaller part, in the social security system. There were some programs that the Croatian Employment Service conducted in collaboration with NGOs (for example, The Association of the Unemployed), which offered advice to the unemployed persons. The content was most often related to job search support. But those programs had ambiguous results.

Q7. Do we have any other countries' best practices, how to deal with the psychological consequences that the crisis leaves on the labor force? 

I do not know if there are any 'mass' and comprehensive 'state' programs for examples from other countries. Therefore, it is doubtful to talk about the 'practices of other countries.' Perhaps the most similar programs were partly implemented in some countries and related to the reintegration of war veterans into civilian life (USA, South Korea).

But perhaps we can talk about differences in common social values, upbringing, traditions, and climate in society. In this crisis, too, those differences are bound to show up. However, these are primarily phenomena that change very slowly and whose importance is underestimated in some countries/societies (for example, in Croatia). Thus, in different countries, people will dominate with psychological and psychosocial consequences, as defined by tradition, upbringing, and values. Suppose these values and traditions are dominated by 'proactive' ways to deal with stressful situations, positivity, optimism, social solidarity, and general social positive values. In that case, the effectiveness in dealing with the crisis will be higher, and there will be less damage.

It seems that the dominant phenomena in Croatian society, even before this crisis, is the one of 'learned helplessness,' which is the least sound basis for overcoming the consequences of any and, in particular, crises such as this one.

From the other side, it is known that many organizations (primarily from the so-called real sector) invest heavily in development and improvement programs for their crucial employees. Traditionally, these programs place great emphasis on contents that help to deal with organizational or work stress as effectively as possible. It is often about developing and improving resilience to various organizational changes, especially those related to organizational stress.

People who have completed such high-quality programs can certainly develop better mechanisms to overcome this current crisis.

Unfortunately, such programs were very rarely used by small and medium-sized business owners.

Q8. Some research shows that in crises, people are better at recognizing opportunities and becoming more innovative. Are there any positive results that be provoked by a crisis at some people? 

Some twenty years ago, a general trend called 'positive psychology' was promoted. It also emerged as a reaction to the aforementioned century-old tradition and the dominance of the so-called 'medical model' in psychiatry and psychology, according to which these two disciplines mainly dealt with consequences defined as 'damage' (disorders and diseases).

Positive psychology focuses primarily on psychosocial health and emphasizes the importance of achieving quality of life. In this context, one of the most important starting points is defined as follows: any situation we find ourselves in can be described as an 'opportunity' or 'challenge' from which we can learn something and come out stronger, more positive, better, and more satisfied. Of course, that is not easy. In this case, commitment to such a goal, motivation, participation, endurance, perseverance, and belief that the goal can be achieved is expected.

Also, any significant change (such as this crisis) forces some people to look for different solutions that can be innovative. Daily experiences confirm that idea.

Q9. A survey conducted by the Glas Poduzetnika Association on coping with stress and mental health gave interesting results. About 50% of entrepreneurs still manage stress well and effectively. More than 18% use conversations with family and friends to relieve stress, while 20% use, to a greater extent than before, alcohol or some psychoactive drugs or some pills. It is also interesting that a minimal number (less than 1%) said they use professional help from a psychologist or psychiatrist. Do we have comparable data to compare entrepreneurs with the general population?

Concerning these results, it would be interesting to apply the same questionnaire to some other samples in the Republic of Croatia. That would allow us to compare the entrepreneurs' results with the general population's or employees in some public sector segments. Perhaps based on such results, a more constructive discussion of the various characteristics of the work in the so-called 'real' and 'public' sectors could be formulated. I believe that such results would show that this situation is 'no easier' for anyone than it is natural that people from different sectors face this crisis and its consequences in different ways. 

A small percentage of the use of professional help from psychologists or psychiatrists (less than 1%) may be: a) due to our social values and social climate (low propensity to seek such help), b) the general phenomenon of seeking services from the health system, or c) the general avoidance of physical contact with professionals, as many people have not yet reoriented to 'online' counseling and treatments.

However, there is no doubt that the need for such types of help will grow, especially as the crisis stops (as it has always been throughout the history of crises).

Q10. Assuming that the condition worsens in the next period, what would you recommend? How does one take care of their mental health?

First, the most important thing is to maintain your business and minimize the damage as much as possible. At the same time, within the limits of what is possible, it is crucial to redefine your business's goals and expectations. Also, if possible, focus on finding alternative and/or innovative ways to do business. While doing so, it is essential to focus on the potential positive aspects and, if possible, accept this crisis as a challenge or opportunity. That is an approach that will guide us in the direction of positivity. In this context, it may be useful to discuss issues with friends who are entrepreneurs and family members and ask for their opinion and support. 

If our ways of dealing with it don't help us, or we think we're feeling bad, it might be helpful to search the Internet for useful information. Access to such content is effortless, and we should not underestimate the usefulness of such content. Even when we think that these tips are trivial, if we approach them with confidence, determination, and positivity, they can be useful for us.

If that does not help us, it would be a good idea to seek advice from consultants (the best would be psychologists) who already have experience working with people from the business, organization, and entrepreneurial field.

Only if all that does not help us we can ask for help from clinicians.

Here the best would be to see a psychologist/clinician first. If they can't help us, the psychologist/clinician may eventually refer us to a psychiatrist. Then the psychiatrist can prescribe our therapy, and, if we are talking about more severe problems, he is the only one who can determine the pharmacotherapy (medication) for us.

September 18, 2020 - The official koronavirus.hr website has published updated recommendations and instructions for crossing the Croatian border.

Recommendations and instructions of the Croatian Institute of public Health for passengers crossing the state border of the Republic of Croatia.

Important note: Valid till 30th of September 

The Decision on temporary prohibition of crossing the border crossings of the Republic of Croatia (NN 74/20) prohibits or restricts the crossing of passengers through border crossings, of which are exempt:

1. EU nationals (irrespective of their place of residence), the Schengen area and Schengen associated countries, as well as members of their families and third-country nationals who are long-term residents under Council Directive 2003/109/EZ of 25 November 2003 on the status of long-term nationals of third countries and persons entitled to stay under other EU or national Directives or having national long-term visas.
2. The temporary prohibition on entry into the Republic of Croatia from third countries, with the exception of passengers referred to in point 1, shall not apply to:

2a) Health care professionals, health researchers and associates, nursing professionals and persons requiring urgent medical treatment
2b) Cross-border workers
2c) Carriers of goods and other transport personnel to the extent necessary
2d) Diplomats, police officers in the performance of their duties, civil protection services and teams, staff of international organisations and international military personnel in the performance of their functions
2e) Transit passengers
2f) Passengers travelling for tourism or other business reasons or having other economic interest, and passengers travelling for the purpose of education
2g) Passengers travelling for urgent personal reasons (e.g. they own a property in the Republic of Croatia) or have any other immediate personal reason
 
Instructions for the health supervision of passengers entering the Republic of Croatia from third countries:
a) For all passengers entering the Republic of Croatia from third countries, under exemption from the prohibition to cross the border referred to in point 2g, health supervision with 14 days quarantine/self-isolation is mandatory.
 
Quarantine/self-isolation can be shortened to seven days if a passenger does a nasal and pharynx swab at his/her expense seven days after entering Croatia and gets a negative PCR test result for SARS-CoV-2.
 
b) The obligation of self-isolation for passengers entering the Republic of Croatia from third countries does not apply to passengers referred to in points 2a, 2b, 2c, 2d, and:

2e) Transit passengers:

• For transit passengers, the border police will, after they have been granted entry, check whether they have left the territory of the Republic of Croatia within 12 hours
• This rule can only be applied if the departure from the Republic of Croatia to a neighbouring country enables it to enter. 

2f) – Passengers entering the Republic of Croatia for tourism or other business reasons or having other economic interest, as well as persons travelling for educational purposes.
 
These passengers may enter Croatia without the obligation of self-isolation upon presentation of a negative nasal and pharynx swab test for SARS-CoV-2, not older than 48 hours (starting from the time of taking the swab until arrival at the border crossing), or with the obligation of 14 days quarantine/self-isolation if they do not have a negative PCR test.

If third-country nationals have a test older than 48 hours when entering Croatia, they will be allowed to enter Croatia, however, they will be obligated to self-isolate and re-test themselves in Croatia at their own expense. The above can be applied to passengers and crew members on yachts. Persons who do not present a negative PCR result are subject to a mandatory 14-day quarantine / self-isolation measure.

Persons who have a negative PCR test, and are on the self-isolation list, whether they’ve been on the list for seven days, as stated in point 2g, or have re-tested themselves in the case they have a test older than 48 hours when entering Croatia, are to be removed from the self-isolation list. 
 
Passengers entering Croatia without the obligation of self-isolation shall comply with the following measures during the first two weeks of their stay in Croatia:

• During the first 14 days after entering the Republic of Croatia, exits from accommodation are limited only to the necessary ones: performance of work if it is a business reason for entering the Republic of Croatia, performance of necessary activities with continuous intensified implementation of hygiene measures.
• During the necessary exit from accommodation it is recommended to use a mask or covers for the nose and mouth, maintain physical distance from other persons (minimum 1.5 meters) and conduct hand hygiene.
• Hands wash as often as possible with warm water and soap and/or use a hand disinfectant that needs to be rubbed in the palms. Avoid touching the face, mouth, nose and eyes.
• Avoid the use of public transport. In a means of transport, it is desirable that a person is alone or exclusively with persons sharing a common accommodation.
• Gatherings should be consistently avoided
• During business meetings it is necessary to meet as few people as possible, ensure a physical distance of 1.5 meters and availability of disinfectants, and avoid unnecessary meetings.
• Payment services are performed by non-cash card payments or on-line services.
• Every morning it is necessary to measure the body temperature if it is higher than 37.2C, the measurement should be repeated after 10 minutes, and if the temperature is higher than 37.2 C it is necessary to stay at home/in accommodation and contact a doctor in a tourist or COVID-19 infirmary or a territorially responsible epidemiologist.
• In case of symptoms of acute respiratory infection (cough, sore throat, fever, short breathing/difficulty or loss of smell), it is necessary to stay at home/in accommodation and contact a doctor in a tourist or A COVID-19 infirmary or a territorially responsible epidemiologist.
• In case of sudden onset of severe, life-threatening symptoms, contact emergency medical service at 194.

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September 18, 2020 - The latest official COVID-19 in Croatia weekly report has been released by the Koronavirus government website, covering September 8-14.

CIPH report for the previous 7 days and daily report for the Republic of Croatia on the 14th of September 2020. 

There are currently 22 testing places in the Republic of Croatia that perform RT-PCR analysis and collect samples. All processed samples enter national Croatian Health Insurance Institute platform, which is accessible to all county public health institutes. County public health institutes submit data about positive cases, sources of infection and hotspots as part of their daily reports to the Croatian Institute of Public Health. The Croatian Institute of Public Health collects information about hotspots, hospital treatment of COVID-19 positive persons, COVID-19 positive patients on respirators and the deceased. You can find more about the test centers available at the link.

Epidemiological indicators on 14 th of September: 
Cumulative 7-day incidence rate for the Republic of Croatia: 37,1/100 000

• Cumulative 14-day incidence rate for the Republic of Croatia: 81,4/100 000
• Counties with a cumulative 7-day incidence rate greater than 50/100 000 inhabitants: Brodsko-posavska, Dubrovačko-neretvanska, Požeško-slavonska, Splitsko-dalmatinska, Virovitičko-podravska, Zadarska
• Counties with a cumulative 14- day incidence rate greater than 100/100 000 inhabitants: Dubrovačko-neretvanska, Požeško-slavonska, Splitsko-dalmatinska, Šibensko-kninska, Virovitičko-podravska, Zadarska
• Total number of tests in the last week: 31 861
• Share of positive tests in the total number of tests in the last week: 4,8 %
• Total number of tests and share of positive tests in total number of tests: 225 014, 6,04 %
• The number of new cases in intensive care per 100,000 inhabitants in the last 7 days: 0,4/100 000
• Number of deaths in the last week: 26
• Total death rate per 1 000 000 population: 55,5/1 000 000

Epidemiological situation in Croatia
In a two-week period from 1st of September to 14th of September all counties recorded new cases of COVID-19 disease. The highest number of new cases are recorded in the Splitsko - dalmatinska County, followed by the City of Zagreb and Dubrovačko-neretvanska County. The lowest number of new cases were recorded in Međimurska and Varaždinska County. The Splitsko - dalmatinska County also has the highest 14-day rate, followed by Dubrovačko-neretvanska and Požeško-slavonska County.

Figure 1. 14-day rate by counties

Epidemic by weeks, from 19 th – 29 th week of the epidemic
In the period from 29 th of June to 13th of September 2020, the number of cases per week (from the 19 th to the 29th week of the epidemic) was from 460 to 1,948 and the rate from 11.3 to 47.6 per 100,000 inhabitants. The number of tests performed per week was ranged from 7,957 to 24,722 and the share of positive tests in those tested per week ranged from 4.3 to 12.5%. During this period, the weekly number of cases and the percentage of positive tests in the weekly number of tested varied. An overview is given in Table 1.

Table 1. Overview of the number of confirmed cases by weeks, from week 19 ^th – 29 ^th

In the period from 29 th of June to 14th of September 2020, the number of cases per week (from the 19 th to the 29th week of the epidemic) was from 460 to 1948. The number of deceased varied from 1-16 and showed increase in the 29th week of the epidemic. The share of deceased on the respirator ranged in the weekly number of deaths from 16.7-60%. The mean age of deceased was 75 years or more, except in the 21 st week of the epidemic, when the mean age of death cases was 72,7 years.

The death rate ranged from 0.1 in the 19 th week of the epidemic to 0.3 in the 23rd and 28 th week of the epidemic with an increase in the 29 th week of the epidemic when it was 0.6. An overview is given in Table 2.

Table 2. Overview of patients on respirator and deaths by weeks, from week 19 th – 29 th

Table 3 shows the incidence of the 7-day rate in the two last weeks with a limit of 50/100 000 inhabitants, which in some countries is taken as one of the criteria in assessing the epidemiological situation. In most counties, the 7-day rate is generally stable or slightly declining.

Table 3. Overview of 7-day incidence rates per 100,000 population in the last week

Clinical aspects - hospitalized, on a respirator and recovered in the last week
Figure 2 shows the relationship between the daily number of confirmed cases and the daily number of hospitalized cases. Number of hospitalized cases per day ranged between a minimum of 17 and a maximum of 42, while the share of hospitalized cases in the total daily number of confirmed cases ranged from 9.7% to 26.2%.

Figure 2. Overview of the daily number of confirmed and hospitalized cases (8.9.-14.9.)

Figure 3 shows the proportion of hospitalized in the total number of weekly cases. In the last week, 230 people were hospitalized, which is 14% of the total number of patients in the given period. In the same period, 16 people were put on a respirator, which makes 1,1% of the total number of confirmed cases.

Figure 3. Relation of the total number of confirmed and hospitalized cases (8.9.-14.9.)

Figure 4. Total number of cases, recovered, deceased and active number of cases from 18.6.- 14.9.

Died from COVID-19, 8 ^th of September – 14 ^th of September 2020, age and sex

A total of 120 people died in this wave of epidemics. Most of the people who died had significant comorbidities or were of advanced age. The mean age of the deceased in this wave of epidemics is 76.4 years. Forty-eight people died on a respirator.

An overview of the situation is given in Table 4 and Figure 5.

Table 4. Distribution by age and sex of the deceased persons

Figure 5. Age and sex distribution of deaths from COVID-19 in the period 29 th June – 14th of September 2020

In the last week, 26 people died, of which 10 (38.5%) were on a respirator. The distribution by age and sex in the last weeks is shown in Table 5, and by counties in Table 6.

Table 5. Distribution by age and sex of the deceased people in the last week

Hotspots

In the last week, new cases were recorded in all counties of continental Croatia, but mostly in the City of Zagreb, Brodsko - posavska and Zagrebačka County. The highest 7-day rates on 14 ^th of September were in Požeško - slavonska, Virovitičko - podravska and Brodsko – posavska County. There is still influx of patients whose source of infection is associated with holidays on the Adriatic, but their share is significantly reducing. The number of wedding celebrations at which patients were registered increased, but at most there was no large spread among the guests. A larger influx of patients was recorded at wedding celebrations in Brodsko - posavska, Varaždinska, Bjelovarsko - bilogorska and Vukovarsko - srijemska Counties. In Požeško - slavonska County, patients are recorded in connection with the prom dinner and the sacral event. In the City of Zagreb, a grouping of patients was recorded in connection with an organized event in the Splitsko - dalmatinska County. The grouping of patients was recorded in health care institutions in the City of Zagreb, Brodsko - posavska and Virovitičko - podravska Counties and institutions for social care in Sisačko - moslavačka County. Cases of the disease have also occurred in schools, but there has been no significant spread among students and staff. Part of the sick people are cases imported from abroad and there is a large proportion of contacts of sick people.

Coastal Croatia

Cases of ill persons have been recorded in Coastal Croatia like in all counties as well. The highest number of patients was recorded in the Splitsko - dalmatinska, Dubrovačko - neretvanska and Zadarska County. The highest 7-day rate is in the Splitsko - dalmatinska, Dubrovačko - neretvanska and Zadarska County. In the Splitsko - dalmatinska County, smaller groupings were recorded in two monasteries. In the Primorsko - goranska County, a significant number of patients was recorded this week as well, related to an organized cultural event in the open air and a smaller grouping of patients was also recorded in the preschool institution in the Istria County. In Zadarska County, there are two kindergartens in self-isolation and a class in one school building. Groupings of patients were also recorded at the workplace in Dubrovačko - neretvanska County and Šibensko - kninska County. The patients were also recorded in a home for the elderly in Ličko – senjska County. There were patients from wedding celebrations in Zadarska County and Ličko – senjska County, as well as in the continental part of Croatia. Although sick people have appeared at multiple weddings, there wasn’t a great spreading among guests. A significant proportion of patients are contacts of previously recorded cases.

Age-sex distribution of patients in the last week

In the previous week, a total of 1,517 people fell ill - approximately the same number of males, 732 (48.3%) and females, 785 (51.7%). The same distribution by sex is present in most age groups, except in the age group 1-6 years where twice as many girls were recorded and in the age group 41-50 years of age where more women became ill than men.

By age groups - 160 children fell ill and they make the smallest share (10.5%) in the ill people in the past week. The least affected were children under 1 year of age, a total of 2, and children in lower grades of primary school, a total of 15. The most affected were children of secondary school age, a total of 33. In general, adults made the largest share in the total number of patients last week 1142 (75,3 %).

In contrast to previous weeks, there is a shift in the age of patients towards higher age groups. The largest share, 21.9% (332 cases) are people aged 51-65, while a one - fifth of patients (145 or 18.9%) in the last week are young adults aged 19 to 30 years. The lowest number of patients in the age group is 66 and older (215 or 14.2%), although this number is not negligible because it is in this group of patients that the highest number of concomitant comorbidities is observed, which are associated with increased risk in COVID-19 from the development of a more severe clinical picture.

The full view can be found in Figure 6 and Table 6.

Figure 6. Distribution of patients in the last week by age groups

Measures
Measures to maintain physical distance, maintain hand hygiene and disinfection are still in force. Also, it is mandatory to wear face masks or medical masks indoors for all health workers and professionals, employees who work in social care system and the ones who work in hospitality facilities


Decisions of the Headquarters

• September 8 - Decision about amendments to the Decision about the introduction of necessary epidemiological measures for the Brodsko - posavska County
• September 8 - Decision about the introduction of new epidemiological measures for the area of ​​the City of Otočac
• September 9 - Decision about amendments to the Decision about the introduction of necessary epidemiological measures for the area of ​​Zadarska County
• September 9 - Decision amending the Decision about the introduction of necessary epidemiological measures for the area of ​​Splitsko - dalmatinska County
• September 11 - Decision amending the Decision about the introduction of necessary epidemiological measures for the area of ​​Dubrovačko - neretvanska County
• September 11 - Decision about the introduction of necessary epidemiological measures for the area of ​​Virovitičko - podravska County
• September 11 - Decision about the introduction of necessary epidemiological measures for the Zagrebačka County

CIPH recommendations

• Recommendations for the prevention of COVID-19 infection in the activity of multiplex cinemas in shopping malls
• Instructions for the implementation of the state matriculation exam during the coronavirus epidemic (COVID-19) autumn deadline - August and September 2020
• Supplement to the recommendation for the prevention of COVID-19 infection in the catering industry of nightclubs
• Possibilities of conducting extracurricular classes related to the COVID-19 pandemic
• Instructions for prevention and suppression of the COVID-19 epidemic related to the work of preschool institutions, primary and secondary schools in the school year 2020/2021.
• Recommendations for manufacturers of textile masks intended for schools
• Guidelines for the prevention and control of the COVID-19 epidemic in student dormitories with regard to the COVID-19 epidemic in the school year 2020/2021.
• Recommendations for the operation of dance schools during the coronavirus epidemic (COVID-19)
• Recommendations for the operation of art schools during the coronavirus epidemic (COVID-19)
• Priorities for testing for SARS-CoV-2, on contact handling, completion of isolation and self-isolation (Consolidated revised recommendations)
• Diseases and health conditions that may increase the risk for more severe forms of COVID-19 disease
• Selected health and organizational issues related to the work of preschool institutions, primary and secondary schools in the school year 2020/2021
• Recommendations for teaching at higher education institutions in the period of the COVID-19 pandemic with the application of anti-epidemic measures
• Organization of rest and food - Work of preschool institutions, primary and secondary schools in the school year 2020/2021 - additional clarifications
• Visors cannot replace masks except when a student / person has a problem with hearing impairment - Work of preschool institutions, primary and secondary schools in the school year 2020/2021 - additional clarifications

Recommendations and measures on global and EU level

Europe

On 10th of August 2020, ECDC released an updated version of the risk assessment. ECDC has additional documents and information available: 

• https://www.ecdc.europa.eu/en
• https://www.ecdc.europa.eu/en/covid-19-pandemic

The number of cases and the 7-day cumulative incidence of COVID-19 confirmed cases worldwide can be found on the ECDC dashboard:
https://qap.ecdc.europa.eu/public/extensions/COVID-19/COVID-19.html
 
Austria
Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz - https://www.sozialministerium.at/Informationen-zum-Coronavirus/Neuartiges-Coronavirus-(2019-nCov).html
 
Netherlands
Government of the Netherlands - https://www.government.nl/topics/coronavirus-covid-19
National Institute for Public Health and the Environment - https://www.rivm.nl/en/novel-coronavirus-covid-19
 
Germany
Rober Koch Institut - https://www.rki.de/DE/Home/homepage_node.html
 
Slovenia
(gov.si) - https://www.gov.si/en/topics/coronavirus-disease-covid-19/
National Institute for Public Health – Slovenia - https://www.nijz.si/en
 
United Kingdom
gov.uk – https://www.gov.uk/coronavirus
NHS - https://www.nhs.uk/conditions/coronavirus-covid-19/
 
World
WHO provides comprehensive information and documents. WHO COVID-19-Dashboard:

• https://covid19.who.int/
• https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update i Weekly Surveillance Report:

• https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
• https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/weekly-surveillance-report

Sources of information
https://www.hzjz.hr/
https://zdravlje.gov.hr/

Information about the global epidemiological situation
More about COVID-19 in other countries can be found and learned on the ECDC website: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases

The WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Health Policy have at their disposal the COVID-19 Health System Response Monitor (HSRM). There is information available about European countries and ways to respond to this epidemic. The focus is on health systems and public initiatives: https://www.covid19healthsystem.org/mainpage.aspx

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September 18, 2020 – Six items of Croatian protected produce are among the 100 European items to go on sale in China

Six items of Croatian protected produce are among the 100 European items to go on sale in China. In a reciprocal deal, 100 Chinese products will also be recognised and recommended on the European market.

Dalmatian prosciutto © TZ Vrgorac

Baranja kulen, Dalmatian prosciutto, Drniš prosciutto, Lika potatoes, Dingač wine and Neretva mandarins are the premium six Croatian protected produce chosen to be among the European 100. All of the Croatian protected produce is already recognised at a national and at an EU-level and designated its status based on its unique place of origin.

Dingač wine © Silverije

Neretva Mandarins

The European products will be specially marked and receive special privileges when they go on sale in China. Alongside the Croatian protected produce, other items on the European list are French champagne, Greek feta cheese, Italian Parma prosciutto, Italian mozzarella, Irish whiskey and Portuguese port. On the Chinese list of products are distinct varieties of rice, bean and vegetable products, some of which will already be popular with Europeans who eat or cook Chinese cuisine.

Drniš prosciutto © Tourist Board of Drniš

The full list of Croatian produce protected at an EU-level currently includes Istrian olive oil, Dalmatian prosciutto, Pag cheese, Lika lamb, Poljički Soparnik, Zagorje turkey, Korčula olive oil, Istrian prosciutto, Sour cabbage from Ogulin, Neretva mandarins, Slavonian honey, Drniš prosciutto, Cres olive oil, Pag salt, Baranja kulen, Bjelovarski kvargl, Varaždin cabbage, Pag lamb, Šolta olive oil, Meso 'z tiblice, Zagorje mlinci, Krk prosciutto, Lika potatoes, Slavonian kulen, Krk olive oil.

Baranja kulen, featured within a traditional Slavonian platter © Romulić & Stojčić

Lika Potatoes

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September 18, 2020 - The recent successes of Infobit, Riimac Automobili, Nanobit and Infinum show the potential of the Croatian private sector. Time to unleash the Croatian entrepreneur?

Even though we have only physically met once, one of my favourite people to follow on social media in Croatia is serial entrepreneur Andrija Colak. Co-founder of Croatia's most successful franchise (Surf'n'Fries - now in 5 continents), as well as the innovative smart umbrella, Kisha (which he cheekily sent to President Putin after the World Cup Final to avoid any presidents or prime ministers getting wet due to unexpected rainfall in the future), Andrija kindly agreed to a TCN interview last year in which I asked him about the positive aspects of doing business in Croatia:

In terms of positives... well if you are up for an adventure you have come to the right place :-) Or... if you really want to test your concept and it survives in Croatia, you can conquer the world! hahah! Actually, I'm not joking.

Successful entrepreneurs here tell me that they have succeeded here not because of Croatia, but DESPITE Croatia. So many others have given up with the bureaucracy, high taxes and nepotism, take their concepts abroad and succeed there. 

But some decide to stay and try their luck here - after all, you cannot beat the Croatian lifestyle. 

I sometimes feel that I live in two countries in Croatia. The first Croatia is the same one which is familiar to all its residents, with the worsening economic situation, polarising politics, constant complaining, corruption, and negative mindset. No wonder people are emigrating. 

But the other Croatia is a totally different place, one where only positivity exists, and where I have decided to spend an increasing amount of my time and energy.

The Croatia of the Croatian entrepreneur. 

Despite the obstacles and the negative stigma attached to entrepreneurs in Croatia, these forward-thinking individuals are quietly achieving miracles DESPITE Croatia. One only wonders what could be achieved with the system supporting their efforts. Two stunning announcements in the last 24 hours are the latest in a series of great news from the Croatian entrepreneurial world, and they give a glimpse of what Croatia 2.0 can deliver to this country. And the thousands of jobs that have been created as a direct result of the business ideas of just a few individuals in a country which is in economic crisis is quite staggering. Indeed Rimac Automobili announced last week that it has hired an additional 150 workers during the pandemic, as tens of millions of jobs were being lost worldwide. Just over a decade ago, Rimac was one man in a garage. Today, the company is closing in on 1,000 employees.  

Here are just four things that have happened in the last few weeks, the first two in the last 24 hours (all are links to TCN articles with full details. 

Swedish Gaming Giant Takes Over Zagreb Company Nanobit for Almost One Billion Kuna

Car Magazine: Rimac Automobili to Takeover Bugatti

Infobip: Croatian Company Raises 200 Million US Dollars for Investment

Porsche Digital Croatia Plans to Employ 100 Experts in Next 3 Years in Infinum Partnership

The eco-system of Croatian entrepreneurial excellence is growing, and I come across this excellence daily in my second Croatia. A meeting last week at Human, for example, who earlier this year beat Google at the prestigious Webby awards, considered the Oscars of the industry. In December I was in Berlin to se Bagatin Clinic collect the award for best international cosmetic surgery clinic 2019. And one only has to spend a short time with Nenad and Rujana Bakic and their STEM revolution and exciting partnership with Google.org to know that the seeds of the future are being sown extremely well. 

Fresh from his successful initiative to introduce the digital nomad visa to Croatia, which has the potential to make a significant contribution to Croatia's economic numbers, Dutchman Jan de Jong and partner Jerko Trgolic are turning their attention to agriculture, with an initial project to grow tomatoes in northern Croatia, using Dutch technology and Croatian land and labour. The first phase will create 72 jobs in an economically depressed part of northern Croatia.

So many seeds, some of which have blossomed such as Rimac, Nanobit and Infobip, and SO many more that could do the same if they were getting the support they deserve rather than punishing taxation and bureaucracy. I have no idea how many jobs Rimac, Infobit, Nanobit and Infinum have created alone, but it is in the thousands. Imagine if the system was conducive to allowing other such ideas and concepts grow in Croatia - how many more tens and hundreds of thousands of jobs would be created? 

Last year, I met an American consultant for the medical tourism industry at a conference in Zagreb, and we talked about what needed to happen for this Croatian industry to progress (an industry with huge - here I go saying the hated 'P' word again - potential). He told me that the role of government was to provide the legislative framework for the industry to thrive, perhaps bring some financing, but most importantly, then get the hell out of the way

For many years, I bought into the story that Croatia was an economic basket case, with no prospects for employment, and that the emigration was inevitable. But in this second Croatia, the world of the Croatian entrepreneur, the situation is completely different, and the opportunity is there, even more so if we can unleash the Croatian entrepreneur to fulfil his or her true potential. 

And we have a very good precedent of how quickly and effectively change can be introduced. An open letter to the Prime Minister from a Dutchman on LinkedIn on July 11 asking for the introduction of a digital nomad visa started a process which resulted with the prime minister tweeting his plans to introduce the visa just 44 days later, with an amendment to the Foreigner's Act introduced to Parliament the following day. Things are moving smoothly behind the scenes, and my understanding is that this legislation should be in place by January 1. 

Croatia a bureaucratic country? It clearly doesn't have to be. 

Unleash the Croatian entrepreneur, and watch many more seeds like Rimac, Nanobit and Infobip start to bloom all over the country. 

Learn more about foreign entrepreneurs making a success of life in Croatia. 

September 18, 2020 - By launching e-Services in the City of Supetar, which enables citizens never to receive and send forms and requests to the City Administration, Supetar became the first city on Croatian islands to implement these services, which are a fundamental part of the Smart City Supetar concept.

Dalmacija Danas reports that thanks to the mentioned benefits, citizens can perform numerous administrative processes from their own home without the need to come to the City Administration office.

What is very interesting in this project is that the City of Supetar applies and adapts concepts and technologies related to smart cities to the island environment that has its own characteristics and needs and differs in many ways from the needs of larger cities such as Zagreb and Rijeka.

A special challenge was the need to establish a perfect balance between the technological possibilities that allow us to advance technology daily and the local population's specific needs. It should also be emphasized that the City of Supetar, as a small community, has limited financial and technological opportunities. Still, regardless of all the island's challenges, the digitalization process progresses with big and safe steps.

The decision to develop and implement the Smart City strategy came after thinking about implementing processes in the City Administration as transparently and simply as possible, and how they would be mutually beneficial for both City Administration employees and our fellow citizens. In this situation, it was out of the question to buy ready-made solutions because they are not in line with the needs of the City of Supetar, but to make maximum adaptation to the local community, which automatically meant significantly more time and effort.

In practice, it looked like they had to review all the processes carried out within the City Administration and the relationship of the administration to the citizens, and based on that, create a modern and contemporary city that saves citizens time and maximum facilitation of various administrative processes that have so far required significantly more time.

The Law on Islands, which regulates and defines the management and development of Croatian islands, placed great emphasis on smart cities and islands, which was a great driver and a kind of motive for the City of Supetar to take the initiative and become the first island city in Croatia which has an operational plan for the development of a smart city - Smart City Supetar 2019 - 2023 and already available and launched services within the concept of Smart City Supetar. The operational plan was adopted by the City Council of the City of Supetar in 2019.

Considering the overall strategy of the Operational Plan, two basic goals have been set that the City of Supetar wants to achieve: digitalization of the administration that is currently underway and the introduction of a ferry application to reduce congestion during the summer and for all guests and passengers to have all available information with them.

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September 18, 2020 -  The latest news for flights to Croatia as easyJet maintains 11 lines to Croatia in October, and Croatia Airlines flies to 15 European destinations. 

Croatian Aviation reports that British easyJet has made some changes to its flight schedule. Numerous lines that were announced for October will now stop flying at the end of September. The company will keep 11 lines in October, mostly with a minimum number of weekly operations.

Lines to Zadar and Pula

The company will cut off traffic on two routes to Pula, from Bristol and London Gatwick, by the end of September, while the line from London Luton made its last flight last Saturday (September 12).

It is the same at Zadar Airport. The last flight to Zadar will be operated by easyJet this Saturday (September 19) on the route from Luton, while the route from Gatwick ended with traffic last Saturday. easyJet operated in Pula and Zadar in previous years in October, but this year will not happen.

Lines to Split and Dubrovnik

By the end of September, easyJet will cancel two lines to Split: from Belfast and Amsterdam. The following lines remain in operation:

Split - Basel (until 24.10),

Split - Bristol (until 24.10),

Split - Geneva (until 24.10),

Split - Glasgow (until 25.10),

Split - Gatwick (until 31.10),

Split - Luton (until 24.10),

Split - Manchester (until 27.10.).

Traffic on the mentioned lines will be modest in October, as the company generally announces one flight a week. As for Dubrovnik, easyJet will cancel only one line, Dubrovnik - Geneva, at the end of September, and the following will remain in traffic:

Dubrovnik - Bristol (until 28.10),

Dubrovnik - Edinburgh (until 24.10),

Dubrovnik - Gatwick (until 31.10),

Dubrovnik - Manchester (until 24.10).

The company will also operate on these routes once a week through October, and further cancellations are also possible, depending on the booking for each flight.

Slobodna Dalmacija reports that in October this year, Croatia Airlines will continue to connect Croatia with the most important European capitals and transport hubs, and air connections within Croatia will continue to be provided to passengers on domestic scheduled flights. 

During October, the national airline's aircraft will directly connect Croatia with 15 international destinations (Amsterdam, Vienna, Berlin, Brussels, Düsseldorf, Frankfurt, Copenhagen, London Heathrow, Lyon, Munich, Paris, Rome, Sarajevo, Skopje, and Zurich). Passengers from these traffic hubs are provided with favorable opportunities for connecting flights worldwide, especially on the flights of Croatia Airlines partners from the Star Alliance.

In international regular traffic, Zagreb will be directly connected to 12 European destinations; from Split, it will fly to 10 European capitals, from Dubrovnik to two international destinations. From Rijeka, it will continue to fly to Munich.

In domestic scheduled traffic, Croatia Airlines planes will connect Zagreb with five Croatian airports (Split, Dubrovnik, Zadar, Pula, and Bol on the island of Brac), and flights on the Osijek - Split and Osijek - Dubrovnik routes will continue.

During the peak of the tourist season, the company's planes directly connected Zagreb with 14, Split with 11, and Dubrovnik with 7 international destinations.

It should be emphasized that passengers' flight safety is still a priority in the business of Croatia Airlines. All protection measures, which the company implements against the coronavirus epidemic, are fully compliant with public health authorities and aviation authorities' decisions and recommendations.

The entire aircraft crew must use protective equipment and means (masks, gloves, disinfectants), air enters the aircraft's passenger cabin from the atmosphere and is purified with the most modern filters, and the aircraft is continuously disinfected. Also, passengers must wear face coverings and masks throughout their stay in the passenger cabin, and disinfectant wipes are readily available.

It is worth noting that due to the epidemiological crisis, Croatia Airlines offers its customers flexible conditions regarding the purchase of tickets and travel. In particular, passengers have at their disposal an unlimited number of changes to travel dates, free of charge, as well as a refund in the form of a voucher that can be exchanged for a new ticket within a year of issue.

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September 18, 2020 - Stillfront Group has acquired Zagreb company Nanobit for at least $100 million (or 1 billion kuna). 

Index.hr reports that Nanobit has become part of the Swedish Stillfront Group, one of the world's leading gaming companies in the free-to-play segment. The transaction will be conducted in two tranches, with Stillfront initially buying a 78% stake for $100 million. After two years, Stillfront will buy the rest of the stake in Nanobit at a price that will depend on Nanobit's earnings before interest, taxes, and depreciation (EBITDA) in 2021 2022. The total amount Stillfront will pay at the end of the transaction will be up to $148 million, adjusted for the cash balance.

Stillfront is a leading free-to-play company that brings together 14 gaming studios around the world. It employs more than 800 people, and its main markets are the US, Germany, the Middle East and North Africa, and France and Canada. Headquartered in Stockholm, the company is publicly listed on the Nasdaq First North Premier Growth Market. Their rich portfolio of games is characterized by loyal users and games currently for many years.

Nanobit was founded 12 years ago in Zagreb by Alan Sumina and Zoran Vucinic without capital, without an office, and with only two computers. Today, Nanobit is present with its games in more than 150 countries worldwide, employs 125 highly educated employees, and is one of the most desirable Croatian employers. Nanobit games have been downloaded more than 145 million times in total, and are played by over 10 million active players from all continents of the world monthly. The most popular games are My Story, Hollywood Story, and Tabou Stories.

The world's most influential media have ranked Nanobit on the list of fastest-growing companies in Europe for many years. This year alone, Nanobit has localized its games in as many as six new languages, namely German, French, Spanish, Italian, Russian, and Japanese, and standard English, thus penetrating more than 15 new markets.

Today, Zagreb is the global center of one of the fastest-growing industries in the world, points out Alan Sumina and Zoran Vucinic from Nanobit.

"The mobile gaming industry is growing rapidly and globalizing, and if we want to remain No. 1, we must move forward. By joining the Stillfront Group, Nanobit gains additional momentum that will allow us to continue growing and developing new ambitious plans and projects. It is quite natural, given that we are in a position to choose a strategic partner, to choose the one that fits into our culture and long-term vision. All those qualities that we nurture internally - entrepreneurial spirit, independence, and innovation - we saw in the Stillfront Group's leadership.

We look forward to working with other successful studios within Stillfront, which will further accelerate the development of both Nanobit and Stillfront Group, and our employees will have the opportunity to work with the best in the world," said Alan Sumina and Zoran Vucinic.

Nanobit will continue to operate as before but is now owned by the Stillfront Group. The headquarters remain in Zagreb, and the company will continue to implement ambitious development plans in the future.

"By acquiring a talented team at Nanobit, Stillfront is expanding into the narrative lifestyle gaming genre, further strengthening its gaming portfolio and increasing reach with a gaming audience. Over the past 12 years, Alan and Zoran, together with their team at Nanobit, have built an impressive gaming studio with a solid niche in the exciting genre of lifestyle games. We look forward to working with them to take the company to the next level. The core gaming portfolio has achieved impressive growth over the past year. We see strong growth potential in the future, including promising new games in development," said Jörgen Larsson, CEO of Stillfront.

The sale is expected to be finalized by September 30, 2020. 

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