Policy responses for Serbia - HSRM


Policy responses for Serbia

3.2 Managing cases

On July 24, the Prime Minister Ana Brnabic stated that there are approximately 1,500 free ventilators in Serbia, of which 1,030 are in the central warehouse, and that they are sent as needed to general hospitals. There are more than 400 ventilators in hospitals and 45 were sent from the central warehouse recently (https://www.srbija.gov.rs/vest/en/159195/approximately-1500-ventilators-available-in-serbia.php).

On October 9, the head of Serbia’s Health Insurance Fund said that the authorities had procured the remdesivir anti-virus medication which is used to treat COVID-19 patients. As it is a very expensive medicine, it will be issued only under medical commission decisions (http://rs.n1info.com/English/NEWS/a658834/Remdesivir-available-in-Serbia.html).

Drugmakers US Pfizer and German partner BioNT applied on 2 December for the registration of their coronavirus vaccine in Serbia. The application request was agreed in a meeting between the representatives of the drugmakers with Serbia’s Prime Minister Ana Brnabic and Health Minister Zlatibor Loncar.

The first 4,800 doses of the Pfizer vaccine arrived in Serbia on 22 December. The first tranche of vaccines  will be received by users of nursing homes. The import licence for vaccines of the companies Pfizer and Biontech was issued on 17 December.

Initially, the first point of contact advised to patients with symptoms of respiratory infections who had travelled to COVID-19 affected areas were epidemiologists in district Institutes of Public Health whose phone numbers were published in the media or provided to travellers arriving to Serbia. With the increased number of patients, on 18 March the Ministry of Health established designated examination rooms for patients with symptoms of respiratory infections in all Primary Care Centres in Serbia as the first point of contact.

According to the changed logarithm, since 1 April all citizens with symptoms similar to that of COVID-19 should go for a check-up at the local primary care health center, where they will undergo diagnosis, measuring of temperature, taking a complete blood count and X-ray, after which they will be advised by the doctor whether to go in self-isolation or to take other steps. The primary care centers are open from 07.00h to 22.00h and after 22.00h citizens can go to the Infectious Diseases Clinic or to general hospitals (https://www.srbija.gov.rs/vest/en/152999/citizens-with-coronavirus-symptoms-to-be-checked-at-community-health-centres.php).

A COVID-19 Self-Checker system has been launched on 1 April, which works on the basis of a simple log in with a citizen’s personal health insurance number and the medical card number (https://www.e-zdravlje.gov.rs/landing/). The goal of this system is to reduce waiting times at medical centers.  Findings obtained through the COVID-19 Self-Checker are automatically sent to those doctors at COVID-19 offices, which have been set up at primary care health centres (https://www.srbija.gov.rs/vest/en/153035/coronavirus-self-checker-available-as-of-today.php)

An infectologist at the designated hospital decides if the patient needs hospitalization or treatment is possible at home in self-isolation. If the health condition of the patient does not require hospitalization, epidemiologists discuss with the patients if adequate conditions for treatment at home as defined in the algorithm exist. If the epidemiologist assesses that there are no adequate conditions for patients to receive care at home, the patient is admitted in a designated hospital.

As of 28 March, there have been changes in the hospitalization policy, meaning that all identified cases with the mild form of the disease will be hospitalized mostly in the improvized hospitals in sports and fair halls. On 7 April the government decided to implement compulsory hospitalization for all patients tested positive to COVID-19 to be hospitalized in either regular or temporary hospitals (based on clinical presentation and severeness of symptoms), with no further possibility of receiving health care and treatment at home. (https://www.rts.rs/page/stories/sr/%D0%9A%D0%BE%D1%80%D0%BE%D0%BD%D0%B0%D0%B2%D0%B8%D1%80%D1%83%D1%81/story/3134/koronavirus-u-srbiji/3914957/koronavirus-zaraza-bolnica-lecenje-kod-kuce.html).

Before the beginning of the outbreak, there has been a special protocol established for the treatment of COVID-10 patients in designated hospitals, in accordance with the state-of-art knowledge and principles of clinical management of this type of patients. In order to improve the approach and to align the protocol with the experience from Italy, the main clinicians-infectologists from all designated hospitals and from some other health institutions have attended the online consultation with the WHO EURO expert Dr. Dina Pfeifer, who was the team lead of the joint WHO-ECDC team which has visited the Italian health authorities and institutions. These online consultations were organized by the WHO Country Office.

In addition, a team of medical doctors from China, upon the request of the Government of Serbia, undertook a consultancy and supervisory visit to Serbia in order to inform the decisions of the Serbian health authorities and to share their valuable experience in fighting the COVID-19 outbreak and they have strongly influenced the clinical management protocols, including certain unlicenced treatments that are currently being tested not only in Serbia but all over the world. In April, the pharmaceutical company Galenika started production of chloroquine. The whole produced quantity of 372,000 tablets were handed over to the ational Health Insurance Fund (HIF) for further distribution on 21 April. The director of the Health Insurance Fund stated that chloroquine was declared an essential medicine in China in late December 2019 in the fight against infection and that ithas become part of all therapies to treat COVID-19 patients (https://www.srbija.gov.rs/vest/en/154751/production-of-chloroquine-of-great-importance-for-serbia.php).

Serbia has also expressed its interest to participate in the SOLIDARITY protocol coordinated by WHO, which is a randomized double-blind study of experimental treatment protocols, including several drugs: Lopinavir/Ritonavir, Remdesivir, Interferon, Chloroquin and Hydroxy-chloroquine.

On 24 March, the Government adopted the decision that during the state of emergency, medical devices that are not manufactured in accordance with the prescribed standards may be procured and used for the effective control of the epidemic and the treatment of patients with COVID-19 disease (http://www.pravno-informacioni-sistem.rs/SlGlasnikPortal/eli/rep/sgrs/vlada/uredba/2020/41/1/reg).

On 18 April, the Governmental Crisis Headquarters/Crisis Response Team for the response to the COVID-19 outbreak decided to change the segment of protocol for discharging the patients from COVID-19 hospitals.  A patient being treated for COVID-19 at a hospital, or in a temporary facility for the accommodation and treatment of patients with COVID-19 infection, will be discharged after the first control test (PCR swab finding) shows a negative result and if the patient is in a good general condition.  The patient will be obliged to continue compulsory home isolation for a further period of 14 days. The second control test (PCR swab finding) will be taken after the expiration of the mandatory home isolation, i.e. after the expiration of 14 days from the day of discharge by the competent health centre.

On 21 April, the Minister of Finance, on behalf of the Serbian government, signed the Agreement on joint procurement of medical supplies, by which Serbia acceded to the multilateral agreement, signed by all EU Member States. The purpose of this agreement is to jointly procure medical supplies, which are urgently needed in order to combat the coronavirus pandemic and to meet future medical needs. Under the agreement, medical supplies which may be the subject of joint procurement are all medicines, medical devices and other goods and services intended to combat cross-border threats to health. By participating in this agreement, Serbia is given the opportunity to obtain the necessary medical supplies at lower prices, as well as to use, in addition to domestic experts, the expertise of specialists from the European Commission and other signatories to the Agreement in the provision of high-quality equipment and medicines.

As one of the awarded projects on the Serbian Innovation Fund, the SME Heliant developed a platform for fast messaging in the context of the COVID-19 pandemic. The HERMES-COVID solution provides communication between key players in the health system and healthcare professionals. This solution provides an opportunity for the Government of the Republic of Serbia, the Ministry of Health and public health institutes to use this tool to safely, technologically advanced and in real time, forward the right to the screens of health workers, important messages and instructions, and in the way they are used to receiving official information. In order to facilitate communications between the Serbian government’s crisis management team and frontline medical units, ‘HERMES’ instant messaging software is available on a national scale. Over 30,000 doctors and nurses are able to receive messages and instructions in real-time from the crisis management team (https://oecd-opsi.org/covid-response/instant-healthcare-messaging-platform-hermes-covid/).