Professor Ramaz KURASHVILI: "Georgia is lucky to have world-class virologists with independent thinking"

20.05.2020 (Caucasian JournalProfessor Ramaz KURASHVILI is one of Georgia’s leading medical professionals, Director of Center for Diabetes Research in Tbilisi, Chairman of Union of Diabetic and Endocrinological Associations of Georgia, and a member of Caucasian Journal’s Board
We have asked Professor Kurashvili to share his views about Georgia’s response to COVID-19.

Caucasian Journal: You have large professional experience, not only medical, but also experience in the management and administration of medical institutions. How do you assess the medical and organizational level of the anti-pandemic activities in Georgia?

Ramaz KURASHVILI: The epidemic is far from over, however, we can evaluate the measures taken by the Georgian government and Georgian epidemiological virologists to date. We can say that the State Coronavirus Commission works highly efficiently: Epidemiologists, virologists, infectious disease specialists, family doctors, healthcare organizers, the police, military, media, television have actively joined in the fight against coronavirus infection; it should be noted that all television channels (in particular, Channel 1 of Georgian Television) and the media work smoothly, there are no cases of dissemination of false or panic information. Of particular note is the high authority, level of knowledge and experience of the Leading infectious diseases specialist prof. T. Tsertsvadze, Director General of the National Center for Disease Control and Public Health of Georgia prof. A. Gamkrelidze, Deputy Director of the Center prof. P. Imnadze, all the doctors of those centers that today are treating the coronavirus patients. We should thank the leaders and staff of the Ministry of Health of Georgia and the Autonomous Republic of Adjara, and the Minister of Foreign Affairs of Georgia Mr. D. Zalkaliani. Of particular note is the Prime Minister of Georgia, Mr. G. Gakharia, thanks to his efficiency, openness, and close mutually beneficial cooperation with doctors, it was possible to slow down the growth of the epidemic and to control the situation; time was used effectively to prepare healthcare for a pandemic, to create specialized centers, equip existing clinics and prepare them for patients, purchase and deliver the necessary number of tests, organize quarantine zones two-week quarantine, etc. - i.e. not to meet the blow unprepared.

We are very lucky that our experts are world-class specialists and have independent thinking, who have made decisions often in contrast to WHO recommendations.

Of course, we are very lucky that our experts in the field of epidemiology, virology and infectious diseases are world-class specialists and have independent thinking; that since the first information appeared, they have made independent decisions, often in contrast to WHO recommendations; that border control, termination of communication with countries with a high level of infection, control (isolation, quarantine, etc.) of newly arrived citizens, social distancing measures  (with a gradual tightening, including quarantine, state of emergency, curfew and much more) began to be carried out at an early stage, much earlier than in other countries, and this happened in stages; that the weeks gained as a result of the delay in the development of the epidemic were used to equip clinics (all clinics selected for the treatment of patients with coronavirus infection either exclude patients with other pathologies, or the departments — including the ventilation system — are separated from the rest of the building), training and opening of centers for preliminary admission of patients with suspected coronavirus, training of primary care and rural doctors, production of protective equipment within the country. i.e., all that allows you to control the growth of the epidemic, organize the proper management of patients and avoid excessive workload on healthcare facilities (number of beds, necessary equipment, including ventilation devices, protective equipment, trained medical personnel).

CJ: You are familiar with international medical practice. How effectively, in your opinion, is the global response to the pandemic organized, and is there global coordination? In particular, the role of WHO is strongly criticized. Do you think the international response to COVID is adequate?

RK: More and more often the words of criticism are heard towards WHO! I recall that the Director-General of WHO, at the very beginning, said that WHO had done almost nothing to combat this infectious disease; China announced a serious epidemic to the world and raised an alarm very late; the politicians were the first to speak of a new epidemic, not WHO! The words of US President Donald Trump that WHO is responsible for the magnitude of the pandemic in his country and in the world, and that the United States may cease financial support to WHO, are not without reason. It should be noted that WHO spends money mainly on supporting the third world countries. It should be said that with regard to the real pandemic, leading Georgian epidemiologists, virologists and infectious disease specialists say that from the very moment the world learned about the new virus, they acted contrary to the recommendations made by WHO.

So, hard times are awaiting the WHO! It will have to endure more than one very serious blow, and much criticism!

The effectiveness of organizing a global response to a pandemic, and global coordination of responses to such global crisis leaves much to be desired. Perhaps the reason lies in the fact that after the Second World War all the “crisi” took place away from developed countries, where large international organizations are based - somewhere ”over there” in Asia and Africa; they haven't personally affected many, and relatively quickly stopped. In any case, mankind has lost its vigilance, lived on hope for someone who decides everything, living on the principle of “this will not affect me.” Today much is said about how the balance in the healthcare system of different countries was upset, and funding was reduced. The pandemic revealed the weaknesses of both global and local healthcare systems, the irrational distribution of investments, insufficient training of medical personnel, and inadequate equipment. Large international organizations, both due to the high level of their bureaucratization and inertia, and because of their scale, bulkiness and complex hierarchical structure, were not able to act quickly and efficiently.

The statement, which haunts me and raises a lot of questions, sounds like this: “80% of the global healthcare costs go to infectious diseases and only 20% to chronic ones”. What do we see today?

 I hope that this pandemic will serve as a serious lesson and teach us how to behave rationally, respond quickly and adequately, provide assistance and listen and hear each other!

A lot of things should be reviewed and changed in the structure and functioning of both WHO and the UN Health Committee, and all international organizations of this type. At the end of 100 days, international coordination began to take some acceptable form. I hope that this pandemic will serve as a serious lesson and teach us how to behave rationally, respond quickly and adequately, provide assistance and listen and hear each other!

Life under the conditions of the coronavirus has shown that justified tightening of the rules and requirements, wide public awareness, which are aimed at preserving the life and health of the population, are highly effective. Apparently, they should be continued afterwards, during life without a virus!

Reality has shown that in a pandemic, people with long-term and decompensated or untreated chronic diseases (cardiovascular disease, chronic diseases of the lungs, liver, kidneys, diabetes mellitus) are included in the group with the highest risk of severe viral infection, and mortality among this population reaches the highest levels. As a rule, the age of these people exceeds 60-65 years.

Unfortunately, no one can guarantee that such situations will not recur in the future. Therefore, the prevention of chronic diseases, their early detection, achieving good compensation, identifying risk factors for their development, in particular vitamin deficiency, and as one of them - vitamin D deficiency, and the risks elimination remains top priority task Vitamin D is necessary to maintain immunity, its deficiency is a serious risk factor for the development of a number of chronic diseases, including type 2 diabetes. Therefore, it is extremely important to conduct tests, identify deficits and prescribe treatment (of course, under the supervision of specialists!)

CJ: Thank you very much!

This article was re-published by:
-  Front News International;
-  Front News Ukrainian;
-  Front News Russian.

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