Jekabpils Regional Hospital was one of the first regional hospitals engaged in treatment of Covid-19 patients also this fall. Margarita Melnikova, the board chairwoman of Jekabpils Regional Hospital run by Jekabpils municipality, admits that the strict lockdown introduced in Latvia in October came several weeks late, while people who are sceptical about vaccines should be convinced with fact-based information about the hospitalizations and the number of Covid-19 deaths, as well as by providing them with information on benefits for health and social life.

Which hospital wards had to be re-profiled in order to ensure treatment of Covid-19 patients?

At present we have four Covid-19 wards and intensive care units [interview is held on November 1 when hospitals faced the toughest situation and the upward curve had not been broken yet] and they have been formed primarily on the account of the infection ward. Reprofiling also affected therapeutic wards, urology ward and TBC ward, while these services are still being provided, but patients of these wards have been regrouped.

After the state of emergency was declared in medicine, several hospitals said that it is not right to suspend all scheduled services, but it would have been better to allow hospitals themselves to decide whether they are able to provide services.

Initially, this decision stipulated that hospitals also provide day-hospital services and some scheduled surgeries, but as Covid-19 incidence and the number of hospitalized Covid-19 patients is growing, an umbrella regulation was adopted.

Of course, each hospital has slightly different organization of profiles. We, for example, have one of the best otolaryngologists who performs day-hospital surgeries also for residents of the surrounding municipalities. Thus, of course, it is easier for each hospital to assess its own possibilities and how Covid-19 situation affects or does not affect the scheduled surgeries.

We are also aware that suspension of scheduled services affects the number of acute patients later.

Also, there were hospitals who criticized the health care sector that there had not been timely information about the necessity for new Covid-19 beds. Did planning not take place in due time?

Looking at what is happening now, of course, we see that we should be able to react fast, expand beds, and it is not a matter of weeks. For example, if the number of beds is insufficient today, we are looking whether new beds can be opened already tomorrow.

But also we should view this from the point of view of vaccination. Unfortunately, Covid-19 wards and especially intensive care units (ICU) mostly receive unvaccinated patients. In our hospital, 90 percent of those patients have not been vaccinated. So, if the Health Ministry had projected a 70 percent vaccination coverage by fall, then, of course, the ministry had planned fewer beds. Unfortunately, the vaccination rate is not sufficient, and scientists, immunologists and infectologists have said that the vaccination is most effective for the first six or eight months.

In my opinion, the so-called lockdown came several weeks late because the infection had already been running its course and spread like a fire.

Have you considered when the situation might come in Jekabpils hospital when you will have to prioritize patients?

The Emergency Medical Service in the Catastrophic Medicine Center’s plan has included the intensive care plan. We have approved this intensive care plan or the so-called priority plan also at the hospital’s board meeting, which means that it is applicable, considering that there are as many intensive care beds as there are. We may expand to the extent allowed by the oxygen supply system, and we hope to improve it and open 13 new beds soon.

However, I would not like to predict and I do not like the negative predictions, I stick to the best plan because our medics are doing everything possible to help everyone they can.

Do you receive funds from the state for care of Covid-19 patients in due time and at the necessary amount?

We receive these funds. Of course, initially we cover the expenses ourselves, but then, after a report is submitted to the National Health Service, then to the Health Ministry and Finance Ministry, the process takes place. This might take several months, but finally we receive the funding. Of course, we would like this process to be faster.

There was a proposal earlier that visitors of medical establishments should take a rapid antigen test before the visit, but you chose a different way, all patients should present a Covid-19 certificate or a negative test result.

We were guided by two aspects. The primary aspect is safety of patients and staff. In any case, a proper test is more credible. Also, if the patient takes a rapid antigen test, it is not clear whether the patient will get to the specialist, which means that the specialist will have "windows" between consultations, which is inefficient use of working time because nobody else can fill it.

If a patient has taken a test in due time, it is clear whether he is able to come to the visit, and a different time can be arranged in advance, and another patient can be booked on this time in case of a positive test.

We cannot afford downtime of medics if a patient has a positive test - the doctor is not paid for this time, and no other patient can come.

What is the situation with vaccination in the hospital - will there be employees who should be suspended from duties?

The vaccination rate is 95 percent. There are some employees who are quite categoric and most believably they will be suspended.

We have discussed the risks and impact of the suspended employees on the work of the hospital. We do not see any significant risks. Thus, even if those employees make a decision not to get vaccinated at all, we still will be able to provide services.

I would say that our hospital has a good vaccination rate.

Can you suggest how to increase vaccination rate in Latvia?

In Jekabpils Regional Hospital, we have been discussing the facts. In respect to new Covid-19 patients admitted to hospital - the share of vaccinated and unvaccinated patients in Covid-19 wards. Facts are those that should convince people.

Of course, we cannot speak about vaccination as a 100 percent guarantee, but it reduces the risk of severe cases. In our hospital, about 90 percent of severe cases are unvaccinated people. If I am not mistaken, of all intensive care patients, there was just one who was vaccinated.

Has the hospital ever had a suspicion about forged vaccination certificates?

If a vaccinated patient is hospitalized or it is a Covid-19 case with medium severity or intensive care, we take antibodies test. One of the cases seemed suspicious initially, but the antibodies later turned out to be positive, so no forgery cases have been detected.

You mentioned shortage of anesthesiologists Which are other staff members that the hospital needs?

Looking at the current Covid-9 beds, we need intensive care service as such - anesthesiologists, nurses anesthetists.

Looking at the next stage when we should open more Covid-19 beds for treating patients with symptoms of medium severity and severe patients, intensive care is even more problematic.

Also, we need certified specialists for the new Covid-19 ward - therapeutic specialists, cardiologists and others. Unfortunately, it is not so that you can put any doctor in a Covid-19 ward and they will be able to work. We should train them, share experience.

In parallel to the fight with Covid-19, there are also large construction works going on in the hospital. What has been done and what has been planned?

We have two projects going on - the first is the European Regional Development Fund (ERDF) project going on and the other is with funding for increasing capacity for Covid-19 treatment. Works in intensive care ward will be completed in the middle of December.

At the same time, ERDF project funds renovation of the hospital admission. The first stage has already been completed.

It is a challenge for the hospital to continue these projects. But we do not gain anything by suspending them - we cannot invest the funds in other directions that would help us treat Covid-19 patients better. At the same time, this will mean improvement for all patients - accessibility, quality, safety. There are still all other patients and services to them should be ensured irrespective of the presence of Covid-19.

Does the hospital have other plans in relation to construction works?

We have prepared reports and financial requirements in relation to the next planning period until 2027, that includes construction, equipment in order to put all hospital wards under one roof. At present patients are placed in three buildings, but we plan to build a new building and link all buildings with a ground tunnel, improving the service quality and safety of patients.

Also, all day-hospital services will be placed in one building, separated from the main hospital.

The infrastructure vision also includes improvements in the yard, car park for employees, the hospital’s kitchen and administration building.

The statutes stipulate that there are three board members, but currently there are two members in the hospital’s board. Does is not make the hospital’s work harder in a complicated situation as there is right now?

Yes, currently we are two members on the board. Since June, we lack a board member with competence in medical treatment. We lack the chief doctor as well, which means more work for us. The other board member Renars Putnins has taken over most of the issues related with medical treatment because he is a doctor, but I am in charge of administrative issues.

We hope that we will be able to find and attract a chief doctor who will also perform, in fact, functions of a board member as well.