May 10, 2020 — Croatia’s Health Minister Vili Beroš has emerged as an unexpected star during the coronavirus. Often commended for partially orchestrating the Civil Protection Directorate’s response to the pandemic, the publicly humble and professorial neurosurgeon shies away from taking credit.
But with parliamentary elections likely this summer, the minister has become an unexpected trump card in the ruling Croatian Democratic Union's (HDZ) electoral ambitions.
Beroš spoke about Croatia's pandemic response, healthcare system and his role in the elections — including rumors he’ll be HDZ’s candidate for Mayor of Zagreb — in an interview with Jutarnji List.
How long is the working day of the Minister of Health at the time of the corona?
Oh! I got up at 5:30 a.m. and the night before I came home very late. It’s not exactly like that every day, but mostly it doesn’t go any differently. There is not only coronavirus, but also a number of other things that need to be done.
In recent days, I have been focused on reopening the health care system. There is always a danger of the virus entering, so it is important that nothing is overlooked, that patients and employees are not endangered, and that the system works at the same time.
The numbers say we won the battle with the coronavirus. Have we won the war, or what must we do so that a possible second wave does not surprise us?
The numbers show that the epidemic in Croatia is on a downward trajectory. This is what we have always wanted, that the number of infected and sick people is getting smaller day by day and that the infection is coming to an end. However, this still does not mean that, as you say, war has been won, because the infection is still going on in our country, but also in most countries in our environment.
As long as there is a real danger of its spread and a possible flare-up of the second wave, there must be no relaxation of either the citizens or the health system.
In addition, until a suitable vaccine and cure for coronavirus is found, we must all adapt our daily lives to the new conditions, take care of our own protection, but also the protection of others, avoid risky behaviors in public, maintain personal hygiene and do everything to whatever is possible to avoid possible infection.
Can we relax and how much? Are you afraid that this could ruin everything that has been done in the fight against coronavirus in recent months? The pressures are great. It seems like everyone would open everything right away!
There are relaxations of measures in everyday life and they will be in line with the further development of the epidemiological situation, but there is no relaxation for anyone, neither for the citizens nor for us health professionals. We see that even the slightest relaxation and inattention immediately bring the newly infected and the sick.
We have done a lot so far and we can all be happy and proud of it, but it would be a great sin to spoil it all with reckless moves and easy understanding of the situation in the days ahead and return to the beginning or worse.
Coronavirus is a new virus, a new world plague, it has a lot of unknowns and with previous experiences with it we need to be very careful.
We can defeat it, but it takes the common strength of all of us. We are witnessing what happened recently when only four people returned from abroad or the latest case on Brač, where a double-digit number of cases was recorded in just one day. This can very quickly, unfortunately, change the epidemiological picture. Such things can cause a chain reaction.
We follow what is happening in countries that started with faster opening, such as Denmark or Austria, where there were no major problems, and we are also in communication with world experts. They all warn of the possibility of a new wave. That's why caution is never enough.
Some resent you for opening churches, but not theaters, for banning work on Sundays, claiming it’s all done for political gain?
As the Minister of Health, I had the least influence in these opening measures. I left the decision on what is best to epidemiologists and ministries who gave recommendations on when and how to “loosen” a measure. It doesn’t matter, for example, how to open theaters, unless maybe it’s a monodrama. Not only must the audience be protected, but also the actors, because the performances require their interaction.
At the beginning of this epidemic, I pushed the profession to be careful so even now it's all the result of their thinking. I am more for talks and agreements, but provided that the result is containing the disease. The right measure is sometimes difficult to find, but it is important to give a general epidemiological framework.
You had moments during the epidemic when ‘everything went great’, but probably also those when tensions were rising. Uncertainty in the procurement of equipment at the beginning of COVID-19 in Croatia was certainly a very stressful circumstance.
From the beginning, we had the situation under control because we very quickly detected the zero patient who brought the virus from Italy, and then all other direct and indirect contacts, and therefore it was possible to keep the flow of infection under control.
On the other hand, we have had and still have very professional people in the health care system, especially in the epidemiological and infectological part, so this has also contributed to Croatia dealing with the epidemic effectively so far.
We had uncertainties and tensions over the procurement of equipment like all other countries, because the pandemic found the whole world with greater and urgent needs than the existing stocks and capacities of manufacturers at that time. The most important thing is that with the efforts of the entire Government and Prime Minister Andrej Plenković, we managed to overcome these obstacles as well.
Do we have enough equipment today to welcome a possible new wave of COVID-19?
We have enough equipment for the needs of our health system. We have more than 800 respirators, and we expect more soon as part of joint procurement in the European Union. We have protective equipment such as suits, masks, visors and gloves, as well as the necessary disinfectants in stock, but they are also constantly renewed in accordance with needs.
Having experience with the procurement of equipment, we must think about renewal and domestic production, because we must not be completely dependent on imports tomorrow. I believe we can do it.
Do you still think that we should have gone with these very restrictive measures? Swedish epidemiologist Johan Giesecke claims that we have exaggerated, that is, that at some point those who have closed up will fare worse. According to him, it is best to ‘close’ only the elderly, and the rest to ‘freely infect’ so the economy doesn’t suffer.
It would be nice if there was a universal recipe for organizing the defense of the population from a pandemic infection like this. There are so many approaches and ways to fight the virus. All this is still going on and it is not over so there is no one who could say, “This approach is the best.”
We in Croatia did what the epidemiological profession considered the most effective and this, to our happiness and satisfaction, proved successful when it comes to controlling the infection, measuring the number of infected, sick, isolated, cured and, unfortunately, dead.
Our economy has suffered all this time. However, we have committed ourselves to preserving people’s lives and health, believing that this is the most important thing. But we have also created the conditions for the gradual opening of economic activities whenever and wherever possible. Time will tell if we have chosen the best approach, but I personally believe that we did the best we could, and the results give me the right to do so.
Could we have prevented the entry of COVID-19 into homes for the elderly, and many are wondering how ‘no one is to blame’ for the spread of COVID-19 in the Split home for the elderly in Vukovarska?
When you look at the homes that the virus entered in relation to their total number in Croatia, and compare it with the situation in other countries, then you can see that we have long resisted its breakthrough into these institutions. There is no country that has managed to prevent the spread to homes for the elderly and infirm.
I wish it hadn't happened, as well as the entry of the virus into the hospital system, but this simply cannot be prevented, because nursing homes, as well as hospitals, cannot be completely isolated from all external influences due to the organization of work of all employees.
Nobody in the world has succeeded in that completely, not even us. If we look at the situation in the world, 64 percent of mortality in Norway was related to old people's homes, in Canada 57, Ireland 55, Spain 52, France 49, Belgium 46, and in Croatia 44 percent.
The coronavirus epidemic has shown many good sides of the Croatian health care system, but also where the bottlenecks are. Can it be expected that healthcare will finally move into an organization that will be at the service of patients, rather than a form without function?
I have been talking about the need to direct the health care system towards the patient since the beginning of my term. I want to get the patient back into the focus of the healthcare system. This means that patients do not need to adapt to the system, but vice versa, so that help arrives on time or when it is needed.
However, this epidemic is also very specific due to the occasional entry of the virus into the health system and the inability of health professionals to perform their work activities due to infection or epidemiological self-isolation. Only the rapid mobilization of health workers from other institutions could enable the continuous provision of health care. So far, we have completely succeeded in such activities.
Some health professionals did not like the opportunity to work ‘where it should be’.
I must admit that I did not receive any expressions of dissatisfaction from health professionals. On the contrary, I think we were all aware of our role.
After the epidemic, even longer waiting lists were created for examinations, diagnostics and surgical procedures. Reportedly, private individuals will also be hired to help clear them up.
At the moment, the analysis of waiting lists is underway and all health care institutions have been given the task to review the real situation with waiting lists and through communication with patients to ensure that what is missed is covered.
Therefore, it will be necessary to adjust the organization of work, additional shifts and work on weekends will be introduced. It is necessary to know, however, that the functioning of the health system will be adapted to epidemiological requirements in the future, until the end of the epidemic.
We will therefore need to have more precise answers to some very important questions such as, for example, who works how much, which means the introduction of staffing norms for employees, and with the help of computerization waiting lists should be arranged so that there is no duplication or triplication of orders.
In cases where it is established that the public health system will not be able to provide all the necessary services, the prolongation of which could cause health consequences, as has been the practice so far, part of the private health sector may be engaged to some extent.
Isn't this an opportunity to get additional information on the justification of many hospital visits and tests that are required?
This world crisis is an exceptional opportunity to learn certain lessons. Modern medicine should be based on clinical guidelines that would clearly indicate the need to perform certain both diagnostic and therapeutic procedures. Such guidelines, in addition to affecting the quality of health care delivery, also contribute to system optimization. If I am able, I will direct my efforts towards that goal. This also means that 80 percent of all cases must be resolved in primary health care, and only about 20 percent in the hospital, more expensive, system, which is not happening at the moment.
What will happen to KB Dubrava, which was turned into a respiratory-intensive center due to COVID-19, and now it will no longer be necessary. Namely, this is the only new hospital in Zagreb with a capacity of more than half of the never built hospital in Blato, which has been largely used so far. Can it be expected that, for example, it will merge with KBC Zagreb, which would make it possible not to have to rebuild three clinics destroyed by the earthquake?
KB Dubrava played, along with the Clinic for Infectious Diseases "Fran Mihaljević", the most important role in the care of patients with coronavirus. Thanks to the existing infrastructure, a primary respiratory-intensive center was formed in it.
The conversion of KB Dubrava is temporary during the COVID-19 epidemic. By my decision, after the expert working group of the Crisis Staff of the Ministry of Health adopted a joint consensus, KB Dubrava, along with three other large centers (KBC Split, KBC Rijeka, KBC Osijek) was designated as the primary respiratory-intensive center for the treatment of patients with coronavirus. It was a logical choice because it is a hospital complex with very good traffic access, with a heliport, with the possibility of accommodating about 300 patients who need respiratory help.
Dubrava will be in such a state of readiness until the epidemic passes, until the health profession estimates that we can return to the state before the epidemic. During the reactivation of the health system, polyclinic activity started in KB Dubrava from the beginning of May, and from May 18 it plans to start working on part of invasive diagnostics, and then the operating program. After the end of the epidemic, KB Dubrava will return to its usual activities.
The headquarters has received strong public support since the beginning of its work. You were accepted as experts and even your HDZ background did not matter. As soon as the stories about the upcoming parliamentary elections appeared, the political public and the Civil Protection Headquarters became associated with the political party. Its expertise was called into question. They say that the Headquarters is in the function of politics, that even strict measures have been relaxed so that elections can be held?
The Civil Protection Headquarters has done, and still does, in addition to the entire health system, a very important role in the effective fight against the coronavirus epidemic in Croatia. From the first day, it shares all information about the infection with the Croatian public and citizens, sends them complete and timely messages on how to most effectively protect themselves from the infection, how to ensure that the infection does not spread further, how to organize life and activities in these circumstances.
Holders of activities in the Headquarters are top experts and professionals, not only those who regularly appear at press conferences, but also a huge number of those invisible to citizens.
Don't the results we have speak best about the efficiency of everyone, from citizens, health workers to those services that have enabled life to take place in these not-at-all easy circumstances?
The political coloration is created by the Deputy Prime Minister and the Minister of the Interior, and I, as a Minister, because we are both part of the Government, and the Government is a political body.
When the Government is HDZ, then I see no reason why anyone should be surprised that both ministers are members of that party.
What are your political ambitions? Will you be on the HDZ list in, it seems, the upcoming elections?
My political ambitions are that as the Minister of Health and a member of this Government, I do everything to make the public health system as efficient and accessible as possible for Croatian citizens. The coronavirus epidemic has shown that our healthcare system is ready to deal with all challenges, that we have top experts in many fields, and that with small organizational shifts we can be better and more efficient.
So far, I have been most engaged in the epidemic, but I am devoting more and more time and energy to reducing waiting lists to provide our patients with everything they have been deprived of in the past two or three months, as well as solving all other problems plaguing our health system.
The recent earthquake in Zagreb further shook our hospitals, reduced capacity and imposed on us the urgent need to address capacity. My ambitions, as well as the policy of this Government, are to look for quick and economical solutions in this area. I believe we will show very soon that our plans are not just words.
According to some sources, you will not only be on the list for the parliamentary elections. The party reportedly has bigger ambitions for you. Many say that the HDZ has not had a real candidate for mayor of Zagreb for a long time and that you would be ideal. Do you intend to run?
I am a member of the ruling party, and teamwork is very important in politics. And as a minister, I am part of a successful team. I would like us to gain the trust of voters in the next parliamentary elections to continue to lead the state policy of Croatia.
The president and party bodies decide on the electoral lists, so eventually my place in the elections will depend not only on my ambitions but also on the needs of the HDZ and the electoral strategy. I believe in the success of our party in the elections, and then we will put together teams for new victories.
Are you planning a vacation?
If it's possible. In that case, I will go to my Jelsa. I recharge a lot of energy there. If I succeed, it will be a reward for me to “honor” myself after this “baptism of fire” with a corona epidemic.
