By Dr. Alenka Oven, director of Institute for Long-term care, Slovenia,
9th April 2020
- Impact of the COVID19 outbreak so far and population level measures
On the 12th March 2020 Slovenia declared the epidemic on the basis of Article 7 of the Communicable Diseases Act due to the increasing number of cases of coronavirus infection. The expert opinion of the National Institute of Public Health (NIJZ) served as the basis for declaring the epidemic. There were 96 cases of coronavirus infection in Slovenia at the time.
Population testing and numbers of cases:
Slovenia was one of the first European countries which, soon after the outbreak of infection in China, launched testing to confirm the virus. Testing for SARS Cov-2 infection began in Slovenia on the 27 January 2020, and a total of 30,669 tests had been performed by 7 April 2020. Some people were tested several times, and three people tested abroad.
By the 7th April 2020, the daily tests had reached 1214, there had been a total of 1091 positive cases, of which 111 had been hospitalized, 35 were in intensive care and 40 had died. A total of 189 infections were found among health care workers and colleagues and 219 among nursing home residents.
Patients with COVID-19 are currently treated at the Department of Infectious Diseases in Ljubljana, University Medical Centre Maribor and University clinic Golnik and at other regional hospitals. The isolation centre of the Slovenian Armed Forces has also been established.
Instructions for epidemiological monitoring of ill people and the monitoring of people who were in contact with persons that tested positive were drafted and published. All public health institutions received instructions for treating persons suspected to have contracted novel coronavirus in primary health care and hospitals. The operations in all health institutions at all levels were adjusted to the spread of coronavirus. Before visiting community health centres at primary level, it is necessary to call in advance. The majority of non-urgent and preventive examinations were cancelled and, in particular, all health institutions banned visits. Health professionals are prohibited from travelling abroad and their right to leave and strike is restricted.
The maximum permitted prices of Personal Protection Equipment (PPE) and other medical equipment were determined on 14 March.
The figure below hows the geographical spread of the positive COVID-19 cases in Slovenia so far:
Source: NIJZ: https://www.nijz.si/sl/dnevno-spremljanje-okuzb-s-sars-cov-2-covid-19, 8.4.2020
Population-level measures to tackle COVID-19:
A Slovenian excellence center has started developing a vaccine for the new Coronavirus in cooperation with Slovenian and international companies, research institutes and universities. The main goal of the consortium is to develop a platform which would enable fast creation of vaccines in case of similar epidemics.
On the 2nd April 2020, the National Assembly of Slovenia adopted new COVID-19 intervention measures by passing the “Anti-Corona” act, which supplements and partially revokes intervention measures already in force. Strict measures to control the epidemic were announced on the 29th of March to prevent the spread of COVID-19.
The Chemicals Office of the Republic of Slovenia advises to clean surfaces with ordinary detergent and disinfect them with disinfection products that have antiviral effects indicated in the instructions or on the label.
People are restricted to their own municipality except for work, providing assistance to those needing care, and accessing emergency services, pharmacies and judicial authorities. People can continue to go to their nearest food shop, as well as parks within their municipality. For stores, the first two opening hours and the final closing hour are for groups who are particularly vulnerable to infections – older people, women who are pregnant and people with disabilities; others are not be able to shop during these designated times.
For indoor public places, including shops, facemasks and gloves are required. Homemade masks such as scarves over the mouth/nose are permitted. Shops remain closed with the exception of food, pharmacies, petrol stations, banks, and post offices. Grocery stores are open 08.00-20.00 but closed on Sunday and holidays, while fuel stations, and pharmacies are permitted to remain open on those days.
The government published guidance about preventing infections, available at: https://www.gov.si/en/topics/coronavirus-disease-covid-19/coronavirus-preventing-infections/.
2. Policy and practice measures for the long-term care sector
Preparedness, especially for the aged care sector, for COVID-19 has been a very high priority for the health minister and goverment. We can obtain all information about COVID-19 at the toll-free number 080 1404 (from abroad: +386 1 478 7550) every day between 08:00 and 20:00. Callers’ questions are answered by senior students of the Faculty of Medicine under the supervision of suitable expert services/experts.
In parallel with the adaptation of the health care system to new epidemiological conditions, we are intensively searching for the best solutions for the organization of health care also in nursing homes and health care institutions. One solution is to appoint primary and secondary level regional coordinators to participate in the health care of older people. The head of the Medical Chamber, Zdenka Čebašek-Travnik, has urged the government to use all medical staff, including private doctors and dentists, to restart the country’s healthcare when it begins to gradually exit the coronavirus crisis.
All critical groups in Slovenia currently have enough personal protection equipment (PPE) to get by. However, no accumulation of the equipment is possible yet. More shipments of PPE are expected in the coming days.
Residential and nursing homes
The National Institute of Public Health (NIJZ) drafted detailed instructions for health professionals and epidemiologists. Slovenia is so far well prepared of an outbreak of the novel coronavirus COVID-19, but our hospitals and nursing homes are not expected to be able to handle a great number of patients (in case that a scenario like the ones in Italy, Spain etc. happened). The health and social care personnel have been given concrete information about how to handle COVID-19. All institutions have their own pandemic plans in place.
Another top priority of our goverment was protecting groups at higher risk, such as older people, people with chronic diseases and those with a weakened immune system. Mobile medical teams are conducting coronavirus testing at nursing homes to make it easier for the residents as well as to reduce the workload of certain emergency services.
The goverment is working is to ensure that, despite the infection, older people can continue to stay in care homes and receive adequate health care in parallel. After consultation with the doctor, patients can also be transferred to the hospital if necessary. A complete ban on visits to care homes was introduced due to the increasing number of people infected with coronavirus in Slovenia and to protect the health of residents. Taking suitable measures is the primary concern, task and commitment of all providers of services for older people, with the aim to protect the health of their service users. Where possible, in case of infections in a care home, healthy residents will be relocated to other facilities. In recent days a few families (less than ten) have taken relatives out of care homes.
Where staff in nursing homes become exhausted or overwhelmed, medical teams will be deployed to these homes. There are other measures under consideration, because many homes have been built in a way that does not allow for effective isolation and infection control.
Apart from the Metlika nursing home (50 residents, 5 died), another coronavirus hotspot in Slovenia is nursing home at Šmarje pri Jelšah near Celje (60 residents, 13 employees) in eastern Slovenia, the second biggest outbreak in the country, only preceded by the capital. From this week there have also been outbreaks in nursing homes at Ljutomer (44 residents, 4 employees), Horjul (26 residents).
The biggest problem in nursing homes is the lack of skilled personnel, space constraints and lack of a stockpile of PPE, this will limit their ability to comply with all the instructions and precautionary measures. According to the Department of Labor, there have been 225 confirmed infections of residents in care homes and 72 care home staff (government press conference, 9.4.2020, https://twitter.com/GovorecCOVID19/status/1248174617132519424)
The goverment published Recommendations for cleaning and waste management in domestic care of people with COVID-19 (or suspected COVID-19). Since it is our duty to protect the older population, the NIJZ published recommendation called Epidemic of new viral disease COVID-19 and elderly. Also some other instructions were published.
- Key concerns:
- Nursing homes lack skilled personnel
- Nursing homes have space constraints that will make the effective isolation of residents that are suspected of having COVID-19 very difficult
- Nursing homes may run out of PPE
GOV.SI PORTAL https://www.gov.si/
National Instiute of Pulbic Health https://www.nijz.si/en
 The outbreak erupted after a primary school teacher tested positive for the virus in mid March. Both she and the doctor from Metlika reportedly got infected while on holidays in northern Italy.
Oven A (2020) The impact of COVID-19 on people who use and provide long-term care in Slovenia and mitigation measures. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE. Available at https://ltccovid.org/2020/04/10/the-impact-of-covid-19-on-people-who-use-and-provide-long-term-care-in-slovenia/