Romania Government Virus Outbreak - Copyright George Calin/AP Photos
Countries across Eastern Europe have so far escaped the worst of the coronavirus pandemic, but many believe it is only a matter of time before the number of cases, and the number of fatalities, rises drastically in the region.
If and when it does hit, the ability of healthcare systems to withstand the onslaught is very much in question, especially given the experiences of richer, better equipped countries like Spain and Italy. Beyond the availability of health and safety equipment, one worry is the effect of years of brain drain, as doctors and nurses left for better paid jobs in Western Europe.
In countries like Romania and Bulgaria, which joined the European Union in 2007, as well as Poland, which joined a few years earlier, the effects of free movement on their healthcare systems has been particularly pronounced.
"If weíre talking about Romania, there are some specialties which are specifically hit by the brain drain, and one of the biggest areas is intensive care," said Vlad Mixich, a Romanian doctor and healthcare analyst, whoís also an independent expert on the board of the European Agency for Safety and Health at Work.
"I think we can describe it like a perfect storm because there is a lack of physicians trained in intensive care, because many of them went abroad, while at the same time there is a huge need of intensive care specialists in the context of the coronavirus epidemic," he added.
According to Solidaritatea Sanitara, one of Romaniaís largest healthcare federations, the countryís public healthcare system has a deficit of almost 40,000 healthcare workers today, equivalent to 17.46 per cent of staffing needs at public hospitals.
Itís a similar issue in neighbouring Bulgaria, where, by some estimates, between 250 and 300 doctors leave the country every year to work abroad. Poland lost at least 7 per cent of its nurses and doctors through migration between 2004 and 2014, and other countries in the region have faced similar loses, which were often exacerbated by the last financial crisis.
"Due to the previous medical brain drainage from Latvia we are quite afraid of the situation in the future," said Jevgenijs Kalejs, the chairman of the Latvian Hospital Association, who added that Latvian hospitals have closed all planned activities to concentrate on combatting the virus. The country is yet to experience its first coronavirus-related death.
At the same time, doctors who remain are generally older, and therefore at higher risk from the virus.
According to Mixich, the average age for a family doctor in Romania is somewhere between 50 and 60, and many of them are older, putting them at higher risk. "One in five people infected with coronavirus in Romania right now is a healthcare professional," he added.
The brain drain isnít the only source of concern. Healthcare systems in Eastern Europe are, on the whole, less well funded than those in more affluent parts of Europe, meaning resources could quickly become stretched and overwhelmed if the virus spreads more widely in the coming days and weeks.
"Itís not only the brain drain but more generally," said Pascal Garel, the chief executive of the Brussels-based European Hospital and Healthcare Federation, which has members in 30 countries across Europe. "Compared to the western part of Europe, usually they spend much less on healthcare from their GDP than other countries. The situation in Romania is dramatic in terms of the percentage," he added.
Romania has the lowest spending on healthcare as a percentage of GDP in the EU, according to the latest available figures from Eurostat, with countries like Latvia, Poland and Slovakia also bringing up the rear.
The fact that many people have returned to the region from working abroad as the economic impact of coronavirus hit will also likely have adverse consequences, especially in more rural areas, which have often struggled to attract doctors and nurses.
In Romania "weíre talking about tens of thousands of people, and many of them went back to the villages where they were born, and where their old parents are living," said Mixich. "If the epidemic hits a village, or a small city, it will be a real problem to ensure enough medical personnel to take care of the people there."