Policy responses for North Macedonia - HSRM

North Macedonia

Policy responses for North Macedonia

3.2 Managing cases

A plan for hospital preparedness was developed early on, as were guidelines for case management and the designation of regional centres for admitting patients. Health training sessions were also provided on appropriate patient management and protocols.
A hotline number (0800 002 03) for all questions related to COVID-19 has been functional since 21 March in the Primary Health Care Centre in Skopje. Prior to this, hotlines for general information on measures, health care and other information related to COVID-19 were managed by the “Alo Doctor” Call Centre. The emergency hotlines of the Centres for Public Health/ Institute for Public Health are used exclusively for suspected and symptomatic cases who have returned from high- and medium-risk countries, or who have been in contact with a confirmed case. The Ministry of Foreign Affairs has established its own hotlines for nationals stranded at the borders or in other countries.
Mild cases were advised to stay at home, while more serious cases were initially hospitalized at the Clinic for Infectious Diseases in Skopje. As the pandemic progressed, around a third of deaths were attributed to late admission to hospital because of individuals seeking care too late.
On 25 March 2020, North Macedonia joined the WHO SOLIDARITY Trial which is a large, international study designed to generate robust data needed to show which treatments are the most effective. The trial provides simplified procedures to enable even hospitals that have been overloaded to participate. Several countries from across the globe (Argentina, Bahrain, Canada, France, Iran, Norway, South Africa, Spain, Switzerland and Thailand) have confirmed participation. The trial uses an adaptive design, with five initial arms: 1) Standard care provided to the patients in the country; 2) Remdesivir 3) Lopinavir/Ritonavir; 4) Lopinavir/Ritonavir with interferon beta and 5) includes chloroquine. 
WHO hosted a number of Zoom training sessions for health care workers dealing with COVID-19, focusing on issues such as proper practices in infection control and prevention of virus transmission in hospitals and clinical management of severe respiratory cases. WHO also developed a risk assessment tool to be used by health care facilities with COVID-19 patients, to help determine the risk of COVID-19 virus infection of all HCWs who have been exposed to a COVID-19 patient.

Regional hospital capacity was developed over the summer months, and a plan was also drafted for upgrading hospital capacities ahead of a predicted autumn COVID-19 wave. Preparations aim to strengthen healthcare infrastructure and staff. Each of the country’s 16 hospitals will be equipped with a modular hospital - special ward for COVID-19 and infectious diseases patients to separate them from the rest of the hospital and ensure that other wards can function as usual. Labs throughout the country are being updated to carry out faster PCR tests and young doctors are joining the COVID-19 centers.

As of 23 April, about 50 patients were under treatment with the drug Hydroxychloroquine. Blood plasma treatment and ozone therapy for COVID-19 patients were to begin on 28 April 2020 according to Minister Filipche’s statement. These treatments remain experimental and were not approved by WHO for lack of data on efficacy. At the Zan Mitrev Clinic a patient recovered from COVID-19 through hemofiltration, which is the first registered case in the world. The patient was received in critical condition by the Clinic and immediately operated on, after which his blood was filtered from infective mediators. The patient who was confirmed to have COVID-19 was tested three times after his recovery, all of which came back negative for the virus. The drug Dexamethasone was also used in the treatment of COVID-19 patients in the country. Later on, COVID-19 patients admitted to the Infectious Diseases Clinic in Skopje were no longer put on respirators and were instead switched to ventilators as these gave better results.
With the assistance of the European Union, North Macedonia has gained quick access to the medication used for COVID-19 treatment, Remdesivir, the Government of North Macedonia announced on 14th October 2020. The European Commission has signed an agreement with the Gilead pharmaceutical company to acquire 500,000 doses of “Veklury”, the brand name of the Remdesivir medication, with the possibility for an increase of quantities.