Policy responses for Slovakia - HSRM


Policy responses for Slovakia

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

The Ministry of Health published an updated pandemic plan, which describes the procedure  in the event of pandemic (see 1.2 Physical Distancing for prior regulation). The plan was approved by the government on August, 11, 2020. It  defines the escalation of the pandemic into four phases, clarifying responsibilities of individual authorities and institutions, and thresholds for each phase. The decisive factor  will  be the occupancy of individual departments of hospitals (unlike the moving median in the past). In addition, the transition between phases will be decided by the hygienist or the pandemic commission.

Based on that, the situation is categorized as stages 0 to 4:
Stage 0: A pandemic is declared by the World Health Organisation. The Public Health Authority (ÚVZ) is expected to propose the declaration of an emergency situation. Preventive transmission measures will be introduced : e.g. isolation at home or at the hospital. Mass gatherings may be limited. Each ministry should secure its own stockpile of personal protective equipment for a minimum of 30 days.
Stage 1: The numbers of infected and hospitalized people rise. Police controls on borders close to outbreaks in neighbouring states should be introduced. It suggests closing localities where outbreaks have occurred and securing emergency supplies, public order and security, as well as medical care.
Stage 2: More than 50 percent of hospital beds at clinics designated for infectious diseases are occupied and the number of new outbreaks continues to increase. Local counter-epidemic measures for closing shops and bans for organizing public events come into effect. The plan also suggests securing accommodation capacities in isolation facilities, to prepare measures to re-introduce temporary border controls and to transport Slovak citizens back home. Schools should be closed during Stage 2  and the state should also secure medical care for nursing home clients.
Stage 3: More than 75 percent of hospital beds in clinics designated for infectious diseases are occupied. If the situation continues worsening and the number of infected people is still on the rise. A national emergency will be declared and measures from the previous stage will continue. This includes the disinfection of places with many people, as well as pavements and places close to quarantined localities. More hospitals will be asked to set aside beds for patients.
Stage 4: A gradual return to the inter-pandemic period and the lifting of measures. A national emergency would be cancelled during this stage.

Furthermore, to aid pandemic commission and all stakeholders in making and understanding all measures, the pandemic plan devises so called “traffic lights”. Traffic lights simplify the monitoring of the current epidemiological situation by flashing  green, orange and red.  Green will indicate that the situation is under control, orange symbolizing deterioration and red a critical situation. 

The traffic lights will be applied regionally. Regional traffic lights mean that regional hygienists will assess the local spread of e.g. COVID-19. Decision on individual measures and scope will be made based on an analysis of data in several categories, according to which districts or entire regions will switch to a different  colour. Each colour has different set of suggested measures.
The pandemic commission decided on September,4, 2020, to tighten measures in the 17 most affected districts. The two most risky districts (red zones), were Michalovce and Bratislava I.
In all red and orange districts, the pandemic commission proposed to take the following measures:
• Prohibition of indoor indoor events from 11 pm to 6 am, except for weddings for up to 150 people.
• Prohibition of mass events outdoors for more than 500 people and indoors for more than 250 people.
• Recommend the local municipalities and public health authorities to issue a ban on alcohol consumption after 10 pm.
Source: Ministry of Health  (2020) Pandemic plan in the event of pandemics in Slovak Republic (Pandemický plán pre prípad pandémie v slovenskej republike) [Online] Available at: https://www.health.gov.sk/?pandemicky-plan-pre-pripad-pandemie-v-sr  [Accessed 25 August 2020].

The Ministry of Education prepared its more detailed ‘traffic light’-plan for schools and boarding schools, announced on August 18, 2020. These measures are an extension of overall pandemic plan and measures that Public Health Authority have to enforce. 
The school traffic light consists of three phases and determines the degree of risk in  classroom and subsequently in the schools. The green phase means that there is no confirmed case at school, the orange one that there is a suspicion of COVID-19 in one and more persons at school, and the red phase means that the disease is confirmed in two students or one teacher or staff member.         
Schools in the green phase will operate with no interference. If any of the students develop symptoms of COVID-19, the school isolate them and contact their parents. Each phase has a dedicated set of hygiene measures and determines an extent to which any service (educational or commercial) operate within school premises.
Face covering required for secondary and secondary schools
For the first two weeks of the school year, face covering will be compulsory for primary, secondary and high school students. It is not mandatory for kindergartens and children in the first grade to wear a face mask in the classroom, but all students must cover nose and mouth in the common areas of the school. After two weeks, this measure will depend on the current epidemiological situation and the traffic lights status.    
University dormitories
Student dormitories, like schools, will have designated isolation areas for symptomatic  student.
Everyone who comes from a risk (“red”) country must go to quarantine and needs to undergo a RT-PCR test by the lastest after five days. If the dormitory does not have quarantine areas, it has to help students to find an isolation area. Students will pay for five days of quarantine outside the boarding school / dormitory. The state will pay for the COVID-19 test 
Source: Ministry of Education (2020) Guidelines for schools and educational facilities (Manuál opatrení pre školy a školské zariadenia). [Online] Available at: https://www.minedu.sk/manual-opatreni-pre-skoly-a-skolske-zariadenia/  [Accessed 25 August 2020].

As described in Section 1.1 – Health Communication, the Minister of the Interior is leading the national response to COVID-19 in close cooperation with the Prime Minister and other ministries.

Since the pandemic outbreak, the Slovak Republic has adopted 3 legislative acts:
1. Law on certain emergency measures in relation to the spread of dangerous contagious human disease COVID-19 and in the judiciary;
• changes in deadlines (postponing) and adjusting various administrative procedures in the judiciary;
• changes in data protection - data may be made available to the Public Health Authority at the time of "the exceptional circumstances"  and of "the state of emergency" in the field of health for the purpose of collection, processing and storage to the extent necessary for the identification of persons in order to protect life and health (valid only during the period of emergency, max. until 31 December 2020).

2. Law on social insurance:
• extends the range entitlement to sickness (in case of quarantine measure or isolation order) and nursing benefits during the time of "the state of emergency" declared in relation to COVID-19. 

3. Law on Education (Education Act)
• changes in minister's competences during extraordinary circumstances.

The State Institute for Drug Control will prioritize applications for clinical trials of drugs and medical devices intended for the treatment of COVID-19.