ZAGREB, Dec 28, 2020 - In the past 24 hours 316 new coronavirus cases have been registered in Croatia and 68 COVID-19 patients have died, the national COVID-19 response team said on Monday.

The number of active cases is 8,036, including 2,720 hospitalised patients, of whom 256 are on ventilators.

Since February 25, when the new virus was first reported in Croatia, there have been 205,246 cases of infection, 3,739 COVID-19 deaths and 193,471 recoveries, including 2,245 in the past 24 hours.

Currently 30,780 persons are self-isolating. To date 996,935 persons have been tested for coronavirus, including 2,642 in the past 24 hours.

ZAGREB, Dec 27, 2020 - A physician and a nurse working in the intensive care unit of Zagreb's Dubrava hospital, converted into the central hospital treating COVID-19 patients in Croatia, got vaccinated against the disease on Sunday.

The vaccination was attended by Health Minister Vili Beros.

Thirty-five employees of the hospital will get immunised today and a total of 200 doctors and nurses working at the hospital will be vaccinated in the next two days.

Acting hospital director Ivica Luksic said that today was a big day, encouraging in many ways.

"The KB Dubrava hospital and all its employees have been on the front line of the battle against the pandemic from the very first day and for all of us this is a new beginning in the treatment of this disease," he said.

Minister: We will reward KB Dubrava for selfless work done

Minister Beros underlined the role of the KB Dubrava hospital, which has been the most important centre in the country for the treatment of COVID-19 patients since March.

"More than 450 people are treated and 69 receive respiratory support on a daily basis at Dubrava. I learned this morning that 360,000 litres of liquid oxygen is spent an hour in the treatment of our patients. We could not have created such conditions in any other Zagreb hospital," Beros said, adding that if possible, the government would compensate the hospital and all its employees for their selfless work.

"We will consider expansion to include new, research elements and new services. Once this epidemic is over, that will be a sign of gratefulness to all Dubrava hospital employees," said the minister.

Beros said the number of infections in the past two days was small but that fewer tests were performed, noting that it was encouraging that the number of new infections had been declining in the past two weeks.

He said that the number of new hospital admissions today was higher than on Saturday but that there were fewer patients on ventilators than yesterday.

"The number of fatalities is the result of developments in the last 2-3 weeks. That number is expected to start going down in a week and a half because the mortality rate will start following the trend in the number of new infections," said the minister.

December 28, 2020 – Amidst the difficulties of a second lockdown, a socially distanced Christmas and yet more earthquakes, have we forgotten about Croatian healthcare workers? TCN decided to interview a doctor working on the front line of the fight against COVID

During the first lockdown, it was all about the balconies. Saxophonists, DJs, opera singers – we were entertained on social media by a string of balcony-based stunts that somehow showed resilience, community spirit, humour. Zagreb was no exception. A trend of clapping on balconies in appreciation of healthcare workers passed from country to country and was picked up in Zagreb. After the applause finished, people went back inside. Nothing much had changed. It was a nice enough gesture.

Since the start of summer, no such applause has been heard. Perhaps the release from lockdown gave the signal that the lives of Croatian healthcare workers had also become much easier? That certainly wasn't the case. Though the number of people infected with COVID has grown significantly over recent weeks, Croatian healthcare workers have been treating people sick with COVID since springtime.

Croatian healthcare workers are currently busier with COVID patients than at any time before. And yet, there are no more trips out onto the balconies to show our appreciation for them. Perhaps it's now too cold outside? Perhaps some aren't aware how busy Croatian healthcare workers currently are with COVID patients? Are we perhaps guilty of taking Croatian healthcare workers for granted? Or, maybe we have simply put Croatian healthcare workers to the back of our minds as we struggle with our own challenges?

Throughout this year, TCN has been pleased to report many instances of generosity and innovation directed towards the fight against COVID. Certainly, not everyone in the country is guilty of forgetting about the Croatian healthcare workers who are on the front line fighting this disease. But, how much impact do these instances have on the general lives of Croatian healthcare workers? What is it like to no longer hear the nightly appreciation from our balconies? And, just what is life like as one of the many Croatian healthcare workers battling COVID in the year of the pandemic? TCN decided to interview one to find out.

The doctor we spoke with is a resident physician, working at a smaller community hospital in the continental part of Croatia. They agreed to speak with us on the condition that they do so anonymously.

Looking back at the first lockdown, we didn't know so much about COVID back then. We didn't know exactly how it was spread, the different manifestations of the disease, what course the disease took, nor what the recovery could be like. I think the government did a really good job of responding to the threat as they saw it. We had a small spike in cases, but that is minuscule to what we have now.

I think people generally did what they were told because they thought it would be temporary and they could see the sense in starving the disease out.

At the hospital, we were at first caught a little off guard with the amount of PPE we had and some other resources that we needed. For ICU and ventilators, we were well equipped.

Some of the residents were given some paid leave. It was important to put human resources into tiers. Croatian healthcare workers were certainly more predisposed to catching the disease, simply because they were around it every day.

After such great early successes, I was surprised that everything was relaxed later on to allow the tourist season to take place how it did, and for events like the Vukovar commemoration. It felt like it was a calculated risk. The lockdown we are now in is perhaps too little, too late. The disease is out there now, wild. The numbers of infected people are significantly higher.

The difficulty with this disease is that people can be infected and have very few or no symptoms at all. They might not know they are spreading the virus. You might not know you're sitting next to someone who has it.

Even though we're not at the centre of care for a major population area or city, we saw cases of the disease almost immediately. Our community hospital services an area containing around 150, 000 people. The first cases in April came from nursing homes – elderly, vulnerable people, many with pre-existing conditions. We were well equipped to handle it. Now, we are stretched on a daily basis. We fill the beds with sick people as soon as we empty them.

We wear masks and PPE all day, all the time. All Croatian healthcare workers in hospitals currently do this. Every patient who comes in, regardless of their symptoms, we treat them as though they are carrying the disease.

A lot of residents like me, who are working towards getting their specialty, go to do some periods of work in larger hospitals in the bigger cities. Now, many of those residents have been called back to their community hospitals – we are short on human resources.

The hospital has had to restructure itself significantly. Lots of doctors have been asked to provide cover in the emergency department. Over half of that area is now fully dedicated to COVID.

What do COVID patients look like in regards to their symptoms? It depends on their age and risk group, but you see people who look like they have flu or bacterial pneumonia, you see people who are in acute respiratory distress. Sometimes they have neurological changes, some of them look like they have had a stroke. Some people who have been infected and have supposedly got over the worst of the symptoms, come back in after a month or two with blood clotting problems – blood clots in the legs, which have a tendency to travel up to the lungs and cause a pulmonary embolism. That's a pretty big medical emergency. Some who have pre-existing heart conditions come in with a heart attack triggered by them catching COVID – it's more complicated trying to revive someone when you know they have COVID. The presentation of the disease is so variable.

It's not only older people. I've seen young people be admitted with serious reactions to COVID - young, healthy people who have no pre-existing conditions. I've seen young people come in with mild symptoms, they are sent home with antibiotics and steroids. That is the standard treatment – antibiotics to prevent a bacterial super-infection and steroids to prevent an acute reaction by the body's immune system to COVID. - that's what can cause big problems later on, in the course of the illness. But, sometimes that's not enough. I had a young patient just last week - super healthy, worked out regularly, no pre-existing conditions – and his lungs just looked awful. He had to go to the ICU immediately (sadly, this patient later died). That's like no disease I've ever seen before. Really, COVID is a completely new kind of animal.

The new strain of COVID? There is evidence that it can be spread more easily, and that it can affect more younger people, but there is no evidence that it is any more severe. The vaccines will work against it.

We're short on ventilators now. Really, we need two free ventilators at any time, in case there is an emergency admission. We are not currently in the position where we always have two free ventilators – sometimes they are all in use. That's a worry. I worked one shift where the anaesthesiologist said “We just don't have any more space for them – we will just have to put them in the hallway”. I've never seen that before.

I've heard of Croatian healthcare workers, colleagues in other hospitals getting sick with COVID and the hospital asks them to prove they got sick at work. It's pretty clear that's the most likely place they would have got sick because they're working with COVID patients. They were forced to be off work, but only on a lower level of sick pay. If you get ill because of being at work, you get full pay. But, they couldn't prove it, so they didn't get that.

I've been lucky – I haven't caught COVID yet. Well, as far as I know. My pay hasn't gone down, it's gone up – but only because I'm working so many double shifts. I volunteer to provide cover when other members of staff get sick. The specialists – the consultant doctors – they have it worse than us resident doctors. They are more responsible, so they are expected to work more hours. Nobody is pressured or threatened into picking up extra shifts, it's just something that almost all of us just do.

I've read some nice stories about fundraising efforts and donations to Croatian healthcare workers and hospitals in different parts of the country. Everything is appreciated. But, I personally haven't seen any effect of that on our day to day lives at work. Not at our hospital. Maybe there were PPE donations or cash donations, but it hasn't impacted the daily lives of me and the Croatian healthcare workers who are my colleagues. I think I heard that a local garage was giving free cups of coffee if you show your medical ID. Every little is appreciated.

For me and the Croatian healthcare workers who are my colleagues, instead of any kind of personal discounts or donations to staff, we would much prefer if people just took this disease more seriously. Things look very different when you work in a hospital compared to someone outside who maybe doesn't know anyone who got sick.

I came off a particularly difficult double shift a couple of months ago – it was just non-stop COVID admissions, some severe cases. As I was walking home, I walked past a bar that's near to the hospital. They had signs on the walls telling people to keep their distance. But, the bar was absolutely packed – full of young people. It just felt so disappointing. I couldn't help but think of the older relatives they would come in contact with, some who might get really sick.

Instead of people clapping on balconies, I think Croatian healthcare workers would just prefer more general vigilance and personal responsibility – wear your mask, wash your hands regularly, no more parties in the basement. Clapping on balconies is a nice gesture, but ultimately it's an empty one.

How does it feel to know that there are some people out there, in every country, all around the world, who believe COVID is a hoax, or a plot, or not so serious, or that the vaccine is dangerous or something other than what it is?

Well, it's not always the content of the conspiracy theory that appeals to these people as much as it is their inability to accept facts – the truth – because they have little faith in the authorities that are telling them this. Here in Croatia, I think that distrust is quite high – a lot of people are disillusioned with the state and politics, because of corruption. Sometimes over 50% of the population choose not to vote. The dissemination of misinformation over social media doesn't help - if that's where people get their news from. If you look at that example from your own country, where strict measures about movement were put in place by your government, and immediately afterward, the Chief Advisor to the Prime Minister, was caught breaking them to travel across the country with his family to a second home in the countryside, going out on day trips. And he was defended by his colleagues after he was found out! When people see those kinds of things happening, the distrust between people and the authorities just grows.

All of the images in this article are used as illustrations only. None of the places or people depicted are in Croatia or Croatian, except for the first image, a panorama of Zagreb

ZAGREB, Dec 27, 2020 - A member of the government's Scientific Advisory Council, Andreja Ambriovic Ristov, has said that the arrival of the COVID-19 vaccine in Croatia is the beginning of "the end of the abnormal situation we have been living in for ten months."

The first 9,750 doses of the Pfizer-BioNTech COVID-19 vaccine arrived in Croatia early on Saturday morning and the vaccination was set to start on Sunday.

Ambriovic Ristov, who heads the Department for Molecular Biology of Zagreb's Rudjer Boskovic Institute, said in an interview with Croatian Television on Saturday that the situation regarding the COVID-19 pandemic would not get back to normal so soon and that the dynamic of the vaccination would determine how soon herd immunity would be achieved.

It is assumed that immunity requires vaccinating 70% of the population, but there is a possibility that more people will have to get vaccinated, she added.

She noted that people should not relax too soon and that they should comply with the epidemiological restrictions in force.

"The current restrictions cannot be relaxed. They are good, the government made the right decision because two weeks ago, when they were introduced, the number of new infections started to decline. Unfortunately, the decline in hospital admissions is small but the number of fatalities is unfortunately still not going down," she said.

Ambriovic Ristov noted that one would have to live with restrictions until a majority of the population was immunised and until it became evident that the virus was circulating less in the population.

She said that it was not likely that people would be able to stop wearing face masks by autumn, but that the end was in sight.

She said that the vaccine was safe and that vaccination would not change anything in the human genome.

"We will stay as we are, the vaccine is completely safe," she said, stressing that only those with a history of more serious allergic reactions should be on guard.

Researcher: Vaccine won't yield effects before March

Researcher and molecular biologist Ivan Djikic said on Saturday that the vaccine that arrived in Croatia earlier in the day would not yield effects before March and stressed that compliance with epidemiological restrictions in January and February was essential for protection.

Expressing confidence that more than 70% of the population would get vaccinated based on positive results, he said that one should continue to be cautious because the vaccine alone would not defeat the disease.

It will take four to five weeks for the vaccine to yield a positive effect. "January and February are the months when we will have to work together to protect ourselves," he said.

The situation in Croatia regarding the epidemic is unstable, data on new infections are not reliable, the rate of testing is insufficient, he said.

"Croatia is No. 1 in terms of the growth of mortality, No. 2 in terms of the number of deaths and No. 4 in terms of pressure on hospitals. The vaccine will not yield effects before March, only our joint work will," he said, predicting that the situation will become more normal in the second half of 2021 but that life will completely get back to normal only in 2022.

ZAGREB, Dec 27, 2020 - In the past 24 hours 618 coronavirus infections have been registered in Croatia, putting the total number of active cases at 10,033, the national civil protection authority said on Sunday.

A total of 2,691 patients are hospitalised, including 258 who are on ventilators.

In the past 24 hours, 3,628 people have been tested for the novel virus.

There have been 58 coronavirus-related fatalities.

Currently 35,484 people are in self-isolation.

Since the start of the epidemic on February 25, Croatia has registered 204,930 coronavirus cases, 3,671 deaths and 191,226 recoveries, including 2,171 in the past 24 hours.

To date 994,293 people have been tested for the novel virus.

ZAGREB, Dec 23, 2020 - Croatia has registered 2,763 new cases of coronavirus infection after more than 10,000 tests, as well as 66 related deaths in the last 24 hours, the national COVID-19 crisis management team reported on Wednesday morning.

The number of active cases currently stands at 15,957, and there are 2,843 COVID patients in hospitals, 291 of whom are on ventilators.

Since the first case of the infection was confirmed in Croatia, 200,086 people have contracted the disease, of whom 3,394 have died and 180,735 have recovered, including 1,855 in the last 24 hours.

There are currently 47,482 people in self-isolation.

To date, 974,507 people have been tested for the novel virus, 10,194 of them over the past 24 hours.

ZAGREB, Dec 21, 2020 - In the last 24 hours, of 4,614 performed for coronavirus, 766 have returned positive (16.6%), and there have been 80 COVID-related deaths, bringing the death toll to 3,257, Croatia's COVID-19 crisis management team reported on Monday morning.

There are currently 16,105 active cases, including 2,956 patients who are receiving hospital treatment. Of them 294 are placed on ventilators.

Since February 25, when Croatia registered its first case of the infection, a total of 195,728 people have contracted the novel coronavirus, and of them, 176,366 have recovered including 3,208 who have recovered from the disease in the last 24 hours.

There are currently 50,799 people in self-isolation.

Since the outbreak of the epidemic, Croatia has conducted 955,255 coronavirus tests.

ZAGREB, Dec 20, 2020 - Over the past 24 hours, Croatia has registered 1,975 new cases of the coronavirus infection and 76 deaths, the national COVID-19 crisis management team said on Sunday.

The number of active cases in Croatia today stands at 18,627, including 2,976 COVID patients in hospitals, 290 of whom are on ventilators.

Since February 25, when Croatia registered its first case of the infection, a total of 194,962 people have contracted the novel coronavirus, 3,177 of them have died, and 173,158 have recovered, including 3,390 in the last 24 hours.

There are currently 55,417 people in self-isolation.

To date, 950,611 people have been tested, 9,191 of whom over the past 24 hours.

December 20, 2020 – The European Union has so far recorded over 300,000 deaths caused by the coronavirus pandemic, with the second wave being 50 percent more deadly than the first one. It is easily possible that the total number will exceed half a million by the time the pandemic is brought under control. Mathematician, investor, and analyst Nenad Bakic explains why for Index.hr.

In terms of the number of deaths per million inhabitants, the new members of the European Union, the countries of the "new European Union", namely the former socialist countries – including, unfortunately, Croatia – are in the lead. Some of them have several tens of times more deaths in the second wave than in the first.

Confirmed cases of death due to coronavirus in the European Union / Source: ourworldindata.org

What is happening? Why did the virus in the second wave become so deadly in the new European Union members? By studying this example, we can learn a lot about the pandemic in general.

1. The countries of the New European Union (NE), 11 ex-socialist countries, did very well in the first wave, with only one of them among the 13 most-affected. All the governments of these countries attributed the success to themselves. In some countries like Croatia, it was done by gurus who considered themselves ideologues of barbaric imprisonment or, as they ignorantly called it, "quarantine".

Graph 1. Coronavirus deaths per million, until June 30, 2020. Source: Index.hr / JHU CSSE

They are marked in red on the first graph. A lighter shade highlights the small Baltic countries because something strange is happening there, but it doesn't matter. It is the same when we look at it without this separation.

What is the probability that the NE countries were so much more successful in their will than the older, smarter, and more experienced brothers? Maybe it's something else.

2. In the second wave, NE countries were significantly more affected, as we can see in the second graph.

Graph 2. Coronavirus deaths per million, from July 1, 2020 until December 18, 2020. Source: Index.hr / JHU CSSE

Out of the top 8 countries, they occupy seven positions. What is the probability that they are so much more unsuccessful than other countries by their own will? Very small.

Of course, it's easy to recognize a "return to the core value" here – as the virus does what it wants, most countries end up converging to a similar number of deaths. Graph 3 shows the coefficient of variation, which is the standard measure of a set's scatter.

Graph 3. Coefficient of variation, deaths from coronavirus in EU countries per million. Source: Index.hr

Here we can already conclude that the performance of the NE countries as a group has nothing to do with their governments' competencies. The probability that a group with its ability is far above average and then that same group is far below average, especially in a situation like this where the virus spreads across the continent without knowing the boundaries, is zero. Of course, some individual countries are better or worse, both in epidemic management and in treatment.

3. But things are only now becoming very interesting. The number of deaths in the second wave not only offset the one from the first wave but also shifted it. The NE countries as a group are now considerably worse than the rest, as we can see in Graph 4.

Graph 4. Total coronavirus deaths per million. Source: Index.hr / JHU CSSE

They occupy eight of the first 13 places. If we exclude the small Baltic countries, only Slovakia remains in the lower half, but the situation deteriorates quickly, and it could easily get to the upper half.

As we can see, there is something special about the small Baltic countries and Finland. We still don't know what, and it doesn't matter for this analysis either. If we single out those countries, things become clearer, but the analysis works without them.

4. What is the explanation? It can be the following:

• A. It has been shown that COVID-19 is highly seasonal. In NE countries, the epidemic came later in late winter 2020 and therefore could have done much less damage by the time spring came. This is undoubtedly the case with Croatia, as you can see in Graph 5: the reproductive factor R fell below 1 already before the end of March, before the measures were introduced on March 23 in Croatia and could take effect.

Graph 5. Source: Index.hr

The introduction of a movement prohibition and a drop in R below 1 are marked with a red and green line. An international group of the London School of Health and Tropical Medicine made this calculation, in which a member of the Croatian Scientific Council also participated. Somehow they later forgot to let us know that R had already fallen below 1 even then. However, at the beginning of the epidemic, everything was explained with its help, which advanced countries are doing now. From a time perspective, all of this is now obvious, and that first wave seems completely benign compared to this one now.

But let's remember the psychosis in which we lived then when the concept of "Camp Croatia" with GPS tracking and leaving the house every third or fifth day was already announced when the epidemic was already falling. Inexperienced and impressed by the violent measures, we thought they helped.

But why did the epidemic come later? Here I think the key is in international connectivity. I used an imperfect DHL connectivity index and got a great explanation of the difference, which can be seen in the following chart.

Graph 6. Source: Index.hr

Interestingly, even such an imperfect measure of connectivity explains so much of the variation. As we know, the most affected countries are also the most connected: Italy – densely populated Lombardy and workers from China; Italy, France, Spain – tourism; Belgium – the center of the European Union and others; Sweden – far more connected than its neighbors; and a million Swedes went on school holidays abroad in the last week of February.

• B. The first wave was actually far stronger than it seems now because we tested and hunted cases much less. Many countries found that their dark number (undiscovered cases) was several tens of times higher than those found. In our country, depending on the interpretation of the data, 50 to 80 times, in Denmark 80 (at some point). Now the dark number is probably 5 to 10 in most countries, and the current maybe even just 3 because as more and more people are being tested, and more and more people have been exposed to the virus, the significant dark number has nowhere to hide.

Therefore, most of the countries of old Europe became infected in the spring, a part of the population gained immunity, and significantly more than in the NE, which we cannot see well if we look only at the cases.

• C. It is now quite clear that strongly seasonal is not only an epidemic of SARS-CoV-2 virus but also COVID-19 disease. Clinical pictures are, on average, far more difficult now than a month or two ago. Mortality rates in most EU countries have doubled in just a month or two, meaning twice as many people die among those confirmed infected. It is also the insight of an international group of scientists in which Croatians Gordan Lauc, Alemka Markotić, Dragan Primorac, and others also participated. At first, it was controversial, but now it is generally accepted. Those infected in spring (more in the old than in the NE) had a much better chance of surviving.
• D. One explanation indeed lies in the quality of hospital systems. I believe richer countries have more resources. For example, expensive HFOT devices save lives better than respirators (Croatia has now procured a larger quantity).
• E. Other variables could be considered, such as previous flu seasons, the percentage in the population over 80, or the people in nursing homes. Still, I believe they would indicate a lower expected number of deaths in the NE (but I did not check the data).

In general, the NE countries, including Croatia, were not particularly unprepared for the supposedly expected strong second wave. Let's look at how strength and early outbreak surprised even the most advanced countries, with entirely different strategies: from Germany through Denmark and the Netherlands to Sweden. Remember that in almost all countries, politicians said "let's just wear masks, and we won't need any special measures," then "let's introduce some measures, and we certainly won't need lockdown," and so on. Now we have reached a solid lockdown in almost the entire Union.

Even Germany, the first wave model, is experiencing a real drama after a failed soft lockdown that was supposed to ensure a peaceful Christmas. Denmark and some other countries are already overtaking us in terms of the number of infected. It is not impossible for Germany to overtake us, even in terms of deaths.

In some countries, a third or "second B" wave is already being born, under the influence of winter COVID-19. R is contextual, and even if it falls below 1, under the influence of various circumstances, it can return over 1. It seems that our second wave peak was delayed by merging with that (surprising to all) the third wave.

Conclusion

• The development of the epidemic is mostly beyond the reach of the authorities.
• Countries with stronger measures do not fare better than those with weaker ones. For example, Slovenia is the worst in this group, despite introducing extreme measures before the epidemic escalated.
• The introduced travel ban is not useful. The inspiration for it was the spring ban, which was considered our most important measure, and obviously did not affect the epidemic.
• On the whole, we are not somewhat more unsuccessful than others. Indeed, although some have had significantly stronger measures for longer (this is one group we can compare ourselves to, and the other is our neighborhood shown in Graph 7, and only Serbia is better than us), we should consider any success or failure relatively. It is known that some measures work, such as banning gathering, maintaining physical distance, washing hands, ventilation, etc. The introduction of measures should be proportionate to the goal because the disproportionate introduction of measures has severe negative consequences for society. Countries that introduce brutal and unnecessary measures (there are arguments that some brutal measures even encourage an epidemic) can also cause significant collateral damage to their populations' lives and health.

Graph 7. Showing data from October 6, 2020 to December 19, 2020. Source: ourworldindata.org

Let's not forget, the goal in epidemic control is to bring the reproductive factor R below 1, and "zero-covid" strategies have long since been abandoned. Fortunately, in Croatia, R is currently significantly below 1. Let's hope that the data on the epidemic we have are credible and that such a situation will persist.

Of course, the main goal is to save as many lives as possible, although we are often helpless with the virus. Therefore, it is necessary to adhere to epidemiological measures with enhanced protection of vulnerable groups.

To read more about coronavirus in Croatia, read TCN's dedicated page.

ZAGREB, Dec 19, 2020 - In the past 24 hours 2,752 coronavirus cases and 78 COVID deaths have been registered in Croatia, the national COVID-19 response team said on Saturday.

The number of active cases has reached 20,118, including 2,873 patients receiving hospital treatment, 306 of whom are on ventilators.

Since February 25, Croatia has registered 192,987 coronavirus cases, 3,101 COVID deaths, and 169,768 recoveries, including 3,853 in the past 24 hours.

Currently 57,544 persons are self-isolating.

To date 941,420 persons have been tested for the virus, including 10,062 in the past 24 hours.