SINCE the COVID-19 pandemic onset, and especially after some countries have successfully put it under control, many have been wondering whether the drastic measures used in fighting off the virus have been excessive. Has the strict quarantine of the large part of the world been a necessary measure or a costly mistake?
Or in the words of the president of the USA, Donald Trump: is the cure worse than the disease itself?
The question makes sense since the global lockdown has launched a dramatic rise in unemployment and one of the most significant economic crises in the last hundred years. It is a well-known fact that the recession and the high unemployment rate can take lives and cause many long-term impacts.
The paradox of a successful disease prevention
At the very beginning, it's necessary to bring to mind, especially in the context of the question mentioned above, an important prevention paradox which was pointed out by Germany's leading expert in the fight against the COVID-19, an epidemiologist Christian Drosten, director of the German Institute for Virology in Charité in Berlin. Back in 2003, he was one of the discoverers of the virus that causes SARS.
"In Germany, people see that the hospitals are not overwhelmed, and they don't understand why their shops have to shut. They only look at what's happening here, not at the situation in, say, New York or Spain. This is the prevention paradox, and for many Germans, I'm the evil guy who is crippling the economy," said Drosten for the British Guardian.
The prevention paradox applies to Germany but could apply even more to Croatia
The prevention paradox applies to Germany but could apply even more to Croatia, which is among the most successful countries in the world with a small number of cases and deaths from COVID-19, but also one of the countries with the strictest measures until recently.
The prevention paradox is evident when it comes to vaccine-preventable infectious diseases, such as measles. The more the world fights the measles and the longer they are gone, the more and more people are wondering whether the damage from the prevention, i.e., from vaccination side effects, is even more significant than the measles themselves.
Of course, the damage caused by the global lockdown due to COVID-19 is far more severe than the consequences for vaccination side effects, so the question from the title is also surpassingly more justified. It's easy to be wise after the event, but we have to be careful, i.e., once we realize what we could have done differently, we should not say: "Ok, see, I have been right all along!"
In this text, we are going to try answering the most critical questions related to the justification for the implementation of strict quarantine in collaboration with Aleksandar Dzakula, M.D., public health expert of the Andrija Stampar School of Public Health, and with Branko Kolaric, M.D., an epidemiologist from The Faculty of Medicine in Rijeka.
In case of a new infectious disease pandemic, the most crucial step is to urgently estimate how dangerous it is
But before we seriously dig into the topic, it's important to point out that, for the public health's answer to a new infectious disease pandemic, a critical factor in early stages is to estimate how dangerous a new virus is, which always has a mysterious outset. If the virus is relatively harmless, such as a cold or a milder form of the flu, there's no need for a global quarantine.
But if a virus is significantly more dangerous than the flu, and at the same time, there's no effective vaccination or drugs, it becomes clear that the virus should be stopped as soon as possible. Saving lives is the number one priority. That's the reason why scientists tried to estimate from the very beginning how dangerous SARS-CoV-2 is - how contagious it is, how many serious illnesses it causes, what percentage of infected people develop severe symptoms, does it threaten the healthcare systems, how easily does it spread without symptoms, what is the mortality rate among the infected people, etc.
Kolaric says that people often compare COVID-19 with the seasonal flu, a well-known disease.
"The flu is serious enough for the risk groups to receive vaccines every year, but not serious enough to put the whole world in quarantine. Of course, that applies only in cases of a threat posed by well-known seasonal strains of the flu, and not by a new, very dangerous strain of a pandemic disease. The common cold is even less dangerous, and we will not even take a vaccine for it, let alone put people in quarantine," explains Kolaric.
Mortality rate calculations and mixing apples and oranges
That is one of the reasons the mortality rate of COVID-19 has been under the magnifying glass in the last couple of months. Already well-known even to laymen, case fatality ratio (CFR) is the proportion of deaths from a specific disease compared to the total number of people diagnosed with the disease.
It needs to be clarified that many laymen made many mistakes and compared incomparable numbers. When experts try to determine the CFR at the beginning of an emerging infectious disease epidemic, there is no way to know the exact number of infected people, especially in case of a large number of infected individuals with mild symptoms or no symptoms at all. It is impossible to track down all of them without massive testing. It especially applies in cases of healthcare system overload, doing triage even in testing, i.e., when only patients with severe symptoms are tested.
Only with the progression of the pandemic, the scientifically literate public, through the communication of real experts in serious media, got a chance to get to know the function and the concept of CFR, as well as the other ways of measuring the severity of infectious diseases. For example, it was being said that more testing could give a better picture of the danger of COVID-19, including a serologic test that shows if an individual has antibodies, which would mean a possible infection, even though there are no symptoms. But in fact, that is an entirely different measure called infection fatality risk (IFR), which is mostly being explored with serologic tests in richer countries after the outbreak.
Some have involved the so-called disease-specific mortality in their assessments, which is the third type of measuring that shows how many deaths that are caused by a specific disease (not necessarily infectious) occur in one million people.
Finally, in the last couple of weeks, there has been much talk about the so-called excess mortality. It's important epidemiological information about the rise in mortality in a certain period caused by an infectious disease, whether these deaths are directly or indirectly caused by the disease.
Epidemiologist Kolaric: We had been warned since the beginning that COVID-19 could be much more dangerous than the seasonal flu
Kolaric says that many experts and the World Health Organization have been warning from the beginning that the COVID-19 could be much more dangerous than the flu.
"The Chinese government's reactions have warned us, as well as the events in some European countries. But, speculations have continued nevertheless because it wasn't clear how many infected individuals stayed under the radar, and with that, the mortality rate and CFR of COVID-19," explains our epidemiologist.
New York confirms the severity of the COVID-19
Now there is no more doubt that the COVID-19 is far more dangerous than the seasonal flu, at least until we find effective vaccination and drugs.
No matter what we think, the hotspots in countries which didn't manage to control the virus at the very beginning, are taking many more lives than the most severe seasonal flu.
For example, data shows that New York City, the largest pandemic hotspot in the world, currently has 12,774 deaths caused by COVID-19 among 8,443,713 people, which means that the so-called specific COVID-19 mortality rate is higher than 0.15%. So, COVID-19 has so far taken more than 0.15% of the total population of the city. Not 0.15% of infected people, but the total number of New York City's citizens. It means that the CFR of COVID-19 has to be significantly larger.
It is known that the CFR of the seasonal flu is lower than 0.1%, which means that less than 0.1% of the infected people die, but not 0.1% of the total number of citizens.
It should be taken into account that the pandemic still isn't over, more than 200,000 New Yorkers are still ill, part of them in critical condition and a couple of thousands of excess deaths of unregistered or indirect victims of COVID-19 should also be added to the list. According to the New York Times, official statistics indicate that, in the last six and a half weeks, the mortality rate of New York City alone is even six times higher than the usual average over the previous years (graphics below). It is surpassingly higher than all the possible oscillations in death rates in seasons of especially severe cases of the flu that don't have adequate vaccination.
It's hard to even imagine the numbers in New York City if it wasn't for the quarantine
It should be pointed out that the population of New York is younger than the national average. It should not be forgotten that these numbers are due to strict quarantine measures, which drastically reduced the number of infections caused by COVID-19, but also other seasonal diseases, such as the flu and the common cold. It also reduced the deaths caused by various accidents such as traffic or occupational accidents due to the restrictions of traffic, work, and movement in general. It's hard to even imagine the numbers without implementing quarantine measures.
Finally, without restrictions on movement, the virus would spread like wildfire throughout the neighboring states, where the situation would be similar to the one in New York, at least in large cities with dense populations. Therefore, the severity of the epidemic should be viewed more accurately on the level of individual hotspots than on the state level because the hotspots demonstrate what could happen elsewhere without the measures in due time or with the lack of measures.
Life couldn't have stayed the same; the question is which measures were essential
Similar applies to many pandemic hotspots in many countries, from Italy to Belgium. In other words, there's no doubt that severe measures in the fight against the pandemic were necessary, and life couldn't have gone on normally as if nothing more different than the usual seasonal flu or traffic accidents were happening.
But, there is still one important question open: which measures and how stringent were necessary, and which ones will be necessary from now on, until we find the vaccine.
There is no clear answer; we will seek it for years
According to this text, the simple and straightforward answer to the question is still difficult to offer.
All the advantages and disadvantages of different political answers to COVID-19 from different countries worldwide will be researched and analyzed for years. Looking for the best solutions and strategies is especially sensitive because things cannot be explained simply. The problem cannot be formulated in a simplistic and bipolar way - everything is normal, everyone works and moves, there's no economic fallout, but more people die; or nothing is normal, we all sit at home, the economy suffers, but a small number of people die. The situation is far more complicated than that, too complex to choose to side with different interpretations by educated epidemiological, public health, and economy experts.
But it still doesn't mean that some of the possible answers don't become clearer in time and that they should not govern us. It also doesn't mean that criticism of strict measures should be ignored. Some of them could be valid, even though not very well substantiated, because they challenge the experts to reassess their decisions.
Main lockdown criticism
First, let's specify some of the main criticisms of the lockdown:
Some of the research and experiences suggest that the virus could be stopped even with the implementation of less strict measures
People, economy, and society, in general, can hardly endure stringent measures for an extended period
Stringent measures cause damages to the economy and in other spheres of life which could cost us a much higher price than the disease itself
Stringent measures could turn against us in the coronavirus second wave which could be reduced by boosting the immunity systems
The Robert Koch Institute: The number of cases in Germany started to drop before implementing the complete quarantine
Last week's analysis from The Robert Koch Institute indicates that the virus can be stopped using less strict measures than the complete lockdown. The Robert Koch Institute is the public health institute in Germany that has an essential role in fighting the COVID-19 pandemic. The Institute's scientists have made a new calculation, which demonstrates that the peak of disease spread in Germany occurred on March 18, five days before implementing strict movement restrictions.
Of course, it doesn't mean that the spread of the virus was stopped by itself and that it wasn't the result of specific measures of social distancing. In Germany, all major gatherings were forbidden from March 9, kindergartens and schools were closed on March 13, and the complete lockdown came into effect on March 23. Therefore, according to the newest data from the Robert Koch Institute, it turns out that the peak of the infection in real-time was somewhere in between the first implementation of measures and the complete lockdown. It could be concluded that the measures implemented before March 23 could have been sufficient, i.e., the complete lockdown could have been unnecessary.
The German experts came to these conclusions based on the idea that checking-in, testing, and registering of the infected people is happening after contracting the disease, partly because of the five-days incubation period and partly because of the medical procedures.
It's easier to manage the crisis than leading through the crisis
How sensitive is the real balance of different measures and how we still don't know their effects, is unpleasantly reminded by the fact that this Tuesday the German healthcare authorities announced that the epidemiological situation has started to deteriorate again, barely a few days after the careful relaxation of measures. Basic reproduction number R0, which demonstrates the successful spread of the virus, and which was lower than one last week in Germany (which means that one person infects less than one other person, so the spreading is subsiding), this week jumped to around 1, or even a bit higher.
That's the reason why the public health experts warn that managing the health system and the society in general in the ongoing crisis, is far more demanding and complex than managing the onset of the crisis. It's easy to forbid everyone to move and leave their houses; it's much more difficult to take measures and to make things function with minimum consequences.
Poverty, unemployment, and deaths due to the lockdown
Many global economic experts, including the World Bank and International Monetary Fund (IMF), warn that the worldwide lockdown will cause drastic GDP drop, much higher than expected a month earlier. On average, there will be a drop of 3% GDP on a global scale, and just a few countries will achieve modest growth, such as India and China. GDP drop will affect the most sensitive and the poorest countries. For example, new assessments for Western Balkan countries show that GDP drop could go as low as 11.3% in Kosovo, in the worst-case scenario. In Croatia, Andrej Plenkovic's government estimated GDP drop of 9.4%, but independent economists and analysts are confident that the numbers are going to be much lower. Even the developed Germany expects a severe recession and GDP drop of 6.3% as well as around half a million job losses.
It should be expected that the recession implies a deterioration in health and a shorter lifespan. Still, it should also be pointed out that not all research studies support this intuitively logical idea.
There's a research study that shows that people lived longer in a crisis
Some studies demonstrate that the health of Americans of all ages, including women and black people, improved during the Great Depression from 1930 until 1933, and the average life expectancy in the USA was prolonged for a couple of years.
Some experts believe that this unexpected turn of events can partly be explained by the fact that the beneficial effects of the depression overcome the negative ones, i.e., during economic crises, many risk activities are reduced. For example, during the Great Depression, the poor Americans smoked and drank less, they drove cars less, there were fewer work accidents, less exposure to stress, and they slept longer. The only serious exception to the rule was the rise in the number of suicides, but its share in the total deaths was less than 2%.
The research about recessions in the American Journal of Epidemiology came to a similar conclusion. But, even though during the recession, there were generally fewer heart diseases, it demonstrated that unemployed people faced a much higher risk, and mental health generally deteriorated, especially in unemployed people. Recently, in a discussion about the COVID-19 crisis, our economic analyst Velimir Sonje also warned about this paradox.
But there are also different studies and explanations.
The Lancet's research study showed the rise in the mortality rate in crisis; the strongest risk factor was unemployment
A new study, published in November 2019 in the respectable medical journal Lancet, suggested that the last economic crisis from 2012 until 2017 in Brazil had the opposite effect.
During the crisis, the mortality rate in the adult population older than 15, mainly due to cancer and heart diseases, increased 8%, from 143.1 deaths per 100,000 people in 2012 to 154.5 deaths per 100,00 people in 2017. The authors also found out that unemployment was the strongest risk factor among male, middle-aged Brazilians.
Aleksandar Dzakula: Consequences caused by stress could appear years later, but...
Our talker and public health expert from Andrija Stampar School of Public Health, Aleksandar Dzakula thinks that it could be explained by the fact that some relations in society have been changed in the meantime. Nowadays, we know that the factors affected by a crisis are much broader than just the apparent mortality rate and acute diseases.
"For example, consequences caused by stress could appear years later and affect the physical condition. They don't have to be obvious during the crisis," says our expert.
He points out that the socio-economic condition is undoubtedly the factor that directly or indirectly affects our health.
"That knowledge is known for decades. The measures directed to the problem are built in every health policy, regardless of this crisis. If the pandemic and the crisis it causes really last longer, we can certainly expect consequences on our health in different dimensions. What consequences and to what extent, that's an issue for research. But when we are talking about COVID-19 consequences to date, there's no way to say that the lockdown is worse than the disease itself - it's enough just to look at mortality data in countries where the epidemic spread, and compare it with last years' data. We read and listen about it daily from the news in Italy, Spain, the USA," he adds.
Consequences of the lockdown for school children
There's no doubt that the COVID-19 consequences, just as the ones of the lockdown, will be analyzed for years. One of the most severe damages of the lockdown is the absence of children in schools. The researchers demonstrate that closing schools almost always results in lower educational outcomes.
The lockdown heavily affects the children in developing countries where they cannot easily attend lectures through the Internet and computers.
According to the Economist, closing schools due to the epidemic of Ebola in Africa in 2014 caused a significant increase in unwanted pregnancies and children that quit school.
In the developed western countries, that problem is not that visible, but still, the poorest people will be affected the most. For example, today, in the U.K., more than 50% of students in public schools regularly attend online classes. On the other hand, only every fifth student of state schools equally frequently attends classes.
Similar damages caused by the lockdown could be specified for different segments of society.
The problem of inability to protect healthcare workers
One of the problems which are often addressed by the experts, but rarely by the lockdown critics, is that the fact that we don't have vaccines and drugs for COVID-19 implies that we don't have any possibility to protect risk groups besides social distancing measures. A severe flu season could significantly increase the mortality rate in the population. Still, at least risk groups have a chance to protect themselves with vaccination, especially if they continuously get vaccines throughout the years.
It should especially be considered that healthcare workers cannot be protected without vaccination. It can cause whole departments or even entire hospitals to be thrown out of the system, not just in case the workers get severely infected, but also if they get infected at all, or even if they were only in contact with the infected person. Then they will need to self-isolate to prevent the spread of the infectious disease. That, of course, also includes other parts of the system, from family doctors to emergency rooms, as well as nursing homes.
A lockdown is the safest measure to stop or limit it, at least in the first phase of crisis management.
The Swedish approach - better or worse?
When discussing the most suitable answer, and the best social distancing measures, lockdown critics often mention Sweden as an example. We are not going into details about the reasons why the Swedish approach is practically not possible to implement in the majority of the world - reasons such as the highest number of single people in the world, the young people move out from their family home at a young age, majority of people can work remotely from home, they are used to less social interaction, they have an excellent health system with large capacities, on average they are very disciplined when it comes to health (for example, vaccination coverage is at a very high level although it is not obligatory, only recommended). Many of Index’s articles have already covered this topic.
Epidemiologist: The Swedish people don't have a habit of frequent barbequing, celebrating, partying in large groups...
Epidemiologist Kolaric says that he spent a lot of time in Sweden, so he had a chance to see the differences in cultures, which are crucial for the functioning of the Swedish approach.
"They don't have a habit of frequent barbequing, celebrating birthdays and partying in large groups. Also, you will not see them drinking coffee at all times of the day. It doesn't mean that something is wrong with them or with us. These are simply cultural differences," says the epidemiologist.
It has to be pointed out that the Swedish approach is based on the idea that people, in any event, cannot be held in strict quarantine for an extended period of time, so the measures should be implemented with minimal damage for people's mental health as well as the overall health of citizens and the economy. The Swedish government also counts that people will listen to their recommendations almost as attentively as they obey the laws whose violation is severely penalized. Their strategists also expect (even though they are reluctant to admit it directly) weakening of the epidemic thanks to a large number of young people, especially in the second wave.
However, it should be pointed out that Sweden has a very high mortality rate caused by COVID-19, among the top ten in the world, in whatever way you look at it - in relation to a million people or in relation to the number of infected people. Moreover, economy experts estimate that the Swedish economy will record a fall similar to the fall in neighboring countries that implemented strict measures, more than 9%. On the other hand, it is estimated that China, despite its radical measures, will even mark economic growth.
Be as it may, we can learn something from Sweden, if we understand what is going on there, and why.
"There is no Swedish model, but only the approach and we are all following it."
Aleksandar Dzakula points out that Swedish practice in this situation is often wrongly named the Swedish model, and suggests an approach as a better term.
"Technically, there is no special Sweden model of infectious disease protection; they have simply decided to implement less strict restrictions because of many factors. But they, as well as our experts, have in mind the chain of the infectious diseases spread, i.e., care for risk groups. We could almost say that we have the same model, it only differs in the approach and some of the implementation principles. Naturally, the people who move freely and sit in coffee shops represent a dramatic difference in the perception in relation to our empty streets, but if you look at their basic messages, it also comes to social distancing and the protection of risk groups. If you look at the photographs, you can see that there are almost no elderly people. Finally, Sweden confesses not being able to adequately protect nursing homes. So, we have recognized the same problems; the difference is that their interventions were based on different values and the behavior of the population," explains our expert.
He points out that there is a specific difference between approaches regarding achieving the immunity of the herd as a way of protecting the population and preventing the spread of the epidemic. Still, he thinks that other countries will come to that once they ease the measures.
"There is really a difference in strategies at the onset of COVID-19, but with the easing of the measures in a certain way, all other countries will eventually implement the Swedish approach. In a few days or weeks, maybe we will have the same situation here, even though the situation in Sweden seems strange today, although the real threat from the virus continues," says Dzakula.
He also admits that he doesn't know what is the better solution - implementing strict measures at first, and then gradually relaxing them, popularly known as the hammer and the dance approach, or relaxing the measures at first, and then tightening up the rules if needed, just like Sweden.
"To answer this question with certainty, we will need time and distance of at least one year," he says.
COVID-19 crisis different from well-known economy crises
In discussing economic consequences caused by COVID-19 and the lockdown, it's important to point out that the financial crises caused by the pandemic, although it is going to be difficult, will still not have long-lasting consequences as the previous economic crisis, such as the one in 1930, or the last one in 2008.
Even the estimations of the German economists suggest it. It's estimated that their country should begin to mark 5.2% GDP growth in 2021, and the economy should be back to the status as before the crisis at the beginning of 2022. It's also expected that in this crisis, the enemy is obvious and not of an economical-financial type. Once the enemy is defeated, the confidence in the market will be restored.
Our economists' analyses give a similar forecast. For example, the International Monetary Fund's report indicates that the Croatian economy will weaken beyond the E.U. average because of its tourism dependency, while COVID-19 is causing a drastic fall in tourism. But the tourism would have fallen even more if we hadn't been able to achieve a very favorable epidemiological situation thanks to the strict measures, and the situation is surpassingly better than the majority of competitors in the Mediterranean.
Economy expert Damir Novotny recently spoke to Index and said that, with the end of the pandemic, he expects relatively fast recovery of the Croatian economy with the announced 9% or more GDP drop, which, of course, depends on the government actions.
"It means that we are about to experience the same crisis as ten years ago, but this time our economy is stronger. From a 9% GDP drop, we can recover in one or two years, if the government doesn't make the same mistakes as in the last crisis and deepen it even more. They mustn't raise taxes as they did back then. I hope they've learned something", said Novotny.
"Loose" social distancing measures also lead to economic and social consequences
In its report from April 16, the World Bank pointed out that it's logical that governments at first tried to stop the virus. It's also expected that they will focus on managing the crisis more and more to avoid economic and other damages that become more severe as the lockdown continues.
But public health experts point out that the uncontrolled spread of the virus would also have tremendous health, economic and other consequences.
"The liberalization advocates' impression is that the success of the society is based on capable and productive workers. It is only correct to some extent. The success of the society and its successful functioning are also based on the total welfare of the population. Based on that welfare and the feeling of security, i.e., generally based on optimism, we build our long-term decisions and we act as investors or consumers. So, no economy can successfully function or develop if there is a public service collapse in the society, and if there is a threat to the health or welfare of society. We can then talk exclusively just about the economy's survival, but not about its normal functioning. The health of the citizens is directly connected with the overall welfare of the society, and that connection is bidirectional," explains Dzakula.
The importance of strict measures for flattening the curve and familiarizing with the disease
Some think that the Croatian government could have taken less restrictive measures and that the complete lockdown was not necessary. They argue that our capacities, such as a place in the intensive care unit and respirators, have been empty beyond all expectations.
Dzakula says that during this pandemic, we have all suddenly started to use the term lockdown. This term is usually used in the context of terroristic threats, without the real understanding of its function.
"When we talk about infectious diseases, the lockdown refers to a biological phenomenon of the spread of infectious diseases, which is known to experts as Vogralic chain. It represents the steps, i.e., a link in the chain necessary to the spreading of disease. If we stop the movement of the people in the intervention, and thus put a stop to any of the links, we successfully stopped the spread. Our Law on the Protection of the Population of Infectious Diseases is based on that logic, from which we took measures that we apply even today. From the aspect of managing the healthcare system, the lockdown has many functions: its first function is trying to completely stop the chain of disease transmission, thus stop its spreading; the other function is to slow down its spreading in order to buy time to collect more information, and to strengthen the system so it could answer to increased and specific needs that infectious diseases cause. That's called flattening the curve," explains Dzakula.
Dzakula: Lockdown has given measurable and important results
From the beginning of the COVID-19 epidemic in Croatia, he says, there’s an impression the majority of restriction measures are the product of the Croatian Coronavirus Task Force, i.e., the whole approach is based on thoughtful and ad-hoc conclusions of the professionals.
"However, it is important to point out that the Law on the Protection of the Population from Infectious Diseases regulates the problem of fighting infectious diseases in Croatia. The law anticipates general, special, and security measures, and it's the result of the centuries-long practice in the suppression of infectious diseases in our area. And its content is in effect in a very similar format for almost the last hundred years. So, this is not some expert's whim or improvisation, but the system based on experience and the law; the Croatian system in which, at any moment and across counties' public health institutions, there are 103 epidemiological teams employed and paid. Each epidemiological team consists of one doctor and two sanitary technicians or engineers. This approach has a legal background, an organized system, and resources to implement measures in a fast and efficient manner," explains Dzakula.
He thinks that in the situation we had two months ago when the completely unknown COVID-19 pandemic emerged, all of the mentioned functions - research, intervention, and damage control - absolutely made sense.
"Just compare the amount of information and insights about the virus and its spreading process we had just one month ago, and how much we know today. Also, let's compare how many resources were provided in the fight against the pandemic before the emergence of the first positively diagnosed patient and how many we have today. The lockdown has given measurable and important results," Dzakula concludes.
Epidemiologist Kolaric: We bought some time
Kolaric says that the lockdown has bought us some time in the season of respiratory diseases.
"With relaxed measures, we will get more time in the summer season in which we expect a reduced spread of the virus. In any event, now we know much more about the virus than at the onset of the pandemic. In the beginning, we didn't know how easily it spreads, in which ways, can the children also get infected and spread the disease, how fast can the virus overload the healthcare systems, will it just disappear in the summer season, etc. Now we know much more, so the relaxation of measures is not like winning the lottery. By the fall season, with the expected second wave, we will know much more, and we will be more ready," said the epidemiologist from Zagreb.