3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
From December 10, an emergency medical situation has been declared in Latvia, because available physical resources are not sufficient to manage the current or forecasted numbers of COVID-19 cases, as stated by the Cabinet Regulation No. 948 “Regulations for the Organization of the Disaster Medical System”. This means that:
1. Medical facilities are allowed to be more flexible in using their resources to provide care to both COVID-19 and other emergency patients. In particular they will be allowed:
• to create regional networks for special hospital cooperation and allow for a more rapid involvement of second- and third-tier hospitals in the admission of patients and to take over patients from regional and university hospitals,
• medical institutions will have more opportunities to manage resources, for example by deploying physicians from other specialties in departments treating COVID-19 patients,
• Suspension of existing regulations or contractual arrangements is possible to modify work schedules and leave of absence to mitigate workforce shortages.
2. Planned care services are postponed or cancelled while emergency services are maintained. The following prioritisation of services applies:
1) Day care services are halted, except for services that are provided to ensure continuity of therapy (chemotherapy, biological medicines, organ replacement therapy); radiation therapy; health care services in haematology; methadone and buprenorphine replacement therapy; healthcare for patients who need to continue or complete inpatient emergency treatment; invasive cardiology; invasive radiology.
2) Inpatient health care services are cancelled or postponed, except for:
• acute and emergency medical care; oncological, life-saving care and surgery with the shared perspective that postponing an intervention may result in disability;
• health care services for certain patients with diseases as cancer; HIV / AIDS; tuberculosis; contagious skin diseases and sexually transmitted diseases; and patients treated in traumatology and psychiatric hospitals;
• acute and subacute rehabilitation services for persons for whom the suspension of such services may cause a risk of disability or incapacity for work, including children for whom the suspension of rehabilitation services is associated with a significant deterioration of functioning.
Outpatient health care services, including specialist consultations, continue to be provided.
Rollout of COVID-19 Vaccine Distribution
On December 28, COVID-19 vaccinations started at 10 hospital vaccination points in Latvia. The first vaccines are given to healthcare professionals treating COVID-19 patients and to professionals working in Emergency Medical Services (EMS), followed by all other health care workers, social care center staff and clients, followed by people with chronic illnesses and people over the age of 60, as well as emergency services staff, educational staff and people in prisons. During the first delivery, Latvia received 9,750 doses of vaccine, which are provided to a total of 4,875 health care workers. It is planned that the vaccination of all other residents of Latvia will take place starting from the second quarter of 2021.
On January 28, 2021 the Government approved the vaccination plan that sets out a number of key principles: the creation of a unified list of persons to be vaccinated; the creation of a unified appointment system to plan workload and opening hours of vaccination centers and management of vaccination records; the centralized supply of vaccines and stockpile management; and harmonized public communication.
On February 5, the Covid-19 vaccine early appointment website www.manavakcina.lv was launched and five days later the free hotline 8989 started, which is open on weekdays from 9:00 to 17:00. The hotline is operated by ten customer service operators of Riga East Clinical University Hospital. When making a call, citizens are required to identify themselves with their name, a personal code and provide their telephone number and/or e-mail address. Vaccination sites are both state and municipal medical institutions, as well as private - family doctor practices. Off-site vaccination teams will be created. If necessary, vaccination could be carried out in pharmacies or in large non-medical facilities. A Vaccination Project Office has been established in the Ministry of Health in which five professionals with experience in the implementation of national and international events are working.
Vaccinations will be provided according to prioritisation of population groups. Priority is given to people whose lives or health are most at risk due to Covid-19. The top priority groups are listed first:
• health care workers (caring for Covid-19 patients, carers in hospitals, outpatient and educational settings, GPs, pharmacists, etc.);
• patients with serious medical indications or waiting for serious manipulations (eg oncology, waiting for surgery, long-term hospitalization, etc.).
• social care center staff and clients;
• people over 70 years of age with certain chronic diseases and their households as well as people caring for the seriously ill at home;
• employees of educational institutions, employees of operative services, employees of the NAF, Prisons and the State Probation Service, critical employees of energy supply;
• persons in special institutions (imprisonment, shelters),
• critical employees of the branches, staff of religious organizations
• employees of companies facing daily large numbers of people, employees of the most important companies in the economy
• all other residents.
In order to protect patients and medical practitioners from possible COVID-19 infection, health care services have been be partially restricted in public and private health facilities until the end of the emergency situation. Day care, short-term surgery services and ambulatory services are suspended in public and private medical facilities. Additional restrictions are applied for childbirth: the partner/accompanying person is not allowed to be present during childbirth.
Emergency medical care, including the necessary examinations and counselling will continue to be provided. This means that the patient's access to help, for example in the case of sudden pain, is not restricted. Family doctor practices are also remaining open. Where possible, medical advice will be provided remotely.
Primary care providers have an increasing role in monitoring and counselling patients in quarantine and self-isolation and after discharge from hospitals. Designated hospital beds and yards have been made available and re-organized to deal exclusively with COVID-19 patients. Remote video and telephone consultations are provided.