From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

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HEPL blog series: Country Responses to the Covid19 Pandemic

Romania’s Response to the Coronavirus Pandemic – the August update (2020)

Alexandru Rusu, Utrecht University, Centre for Pharmaceutical Policy and Regulation
Dani Sandu, European University Institute

The first case of COVID-19 was reported in Romania on 26 February. At the time of our previous report (5 April), the country was in a State of Emergency with 3,864 confirmed cases and 148 deaths. Two cities were under lockdown, travel restrictions were in place just as the country was preparing to celebrate Easter Holidays. The State of Emergency would be further extended until 15 May, and then replaced with a State of Alert, currently in place until 16 August, likely to be further prolonged. At the time of writing (2 August), Romania is facing a surge in infections with 12 consecutive days of more than 1,000 identified infections and a pandemic total of 53,186 confirmed cases, 27,592 healed and 2,413 deaths.

April – August overview

Following two months under the State of Emergency, a first round of rollback measures was introduced on May 15. At this stage, hairdressers, libraries, dentist practices, small shops and museums were reopened, and people could leave their homes without a sworn statement regarding the purposes of travel (still required for travel outside cities). Also, the requirement to wear face masks was introduced for enclosed public spaces, such as shops and on public transport.

A second stage of easing restrictions was implemented on 1 June, by lifting restrictions to travel outside cities, resuming international travel, allowing outdoor sports events without public spectators, outdoor concerts under special conditions and reopening terraces and beaches.

A further elimination of restrictions started on 15 June, when international travel to certain countries was resumed without mandatory quarantine/self-isolation upon return, as well as the reopening of shopping malls (except food areas and cinemas), gyms and kindergartens. In-door restaurants and bars remained closed.

Restriction easing was effectively halted as of 1 August, while mandatory wearing of masks in certain open spaces and limited schedules for outdoor restaurants and clubs were introduced. Moreover, 10 communities around the country are currently under quarantine.

Reflections on COVID19 response in Romania

Currently Romania has the third highest number of new infections over 14 days in Europe, behind Russia and Spain. These figures can be explained by a mix of factors linked to crisis management, political developments and structural characteristics of the Romanian society.

The testing capacity increased significantly to around 20-23K tests/day, but 40% of these tests come from on-demand private sector supply and are likely not well-targeted.

In hindsight, April marked an important junction. While until mid-April public health decisions largely drove political decisions, the end of the Easter Holidays showed the first signs of partisan division hampering technocratic decision making. Challenges to the lockdown and governmental restrictions started to be launched by the opposition parties. Subsequently, May and June saw the Constitutional Court declare as unconstitutional the fines introduced for breaking public health regulations and the mandatory quarantine and hospitalization of confirmed cases. Other mishaps that weakened public support for the government’s restrictions include the decision to allow charter flights of Romanian farm workers to Germany in the middle of the national lockdown; exemptions granted to the Romanian Orthodox Church; as well as cases of public figures breaking restrictions, including the country’s PM. On top of these developments, and as a clear change compared to April, the growth of disinformation and conspiracy theories in the public space contributed to the increase of infections.

Structural particularities of Romanian society adds an additional lens in explaining the status quo: 1) low social trust, especially in small and mid-sized cities, decreases likelihood of cooperation with authorities’ recommendations; 2) the high quota of poverty and/or subsistence farming, which requires people to be out of the house significantly more than recommended is another risk factor; 3) as a counter trend, the significant social isolation of elderly population, especially in the rural countryside, may delay virus expansion in this vulnerable age group.

In perspective, the end of the summer could potentially lead to new crises. For example, when Romanian migrant workers will want to return to their countries of residence, like Italy and Spain, where they currently need to undergo a mandatory 14 day quarantine, they might try to circumvent these restrictions to avoid losing income. The status of schools, closed since March, will be key for parents and employers. At the time of writing, the scenarios considered for the new school year range from: 1) return to in-person teaching with strict hygiene and physical distancing measures in place; to 2) full on-line teaching; or 3) a hybrid scenario where students are split in groups that rotate between in-person and on-line teaching. The forthcoming local and parliamentary elections, planned for the second part of the year, will likely increase political polarization against the government, embolden negationists and lead to events with a high infection potential (such as political rallies and the actual elections).

Romania’s Response to the Coronavirus Pandemic – Original post (April 2020)

Alexandru Rusu, Utrecht University, Centre for Pharmaceutical Policy and Regulation
Alin Preda, Carol Davila University of Medicine and Pharmacy, Bucharest

The first COVID-19 case was confirmed in Romania on 26 February 2020. Authorities responded with a mix of measures focused on prevention and increasing healthcare capacity. These were coupled with fiscal and monetary policies. The Government’s response has been coordinated by the National Committee for Special Emergency Situations (NCSES). The first emergency measure was taken in Romania on 29 January (before the first case was declared in Italy on 31 January) by starting a procedure of international purchase of intensive care units and personal protective equipment. A state of National Emergency was declared on 14 March (with 123 confirmed cases). At the time of writing (5 April) there are 3,864 confirmed cases and 148 deaths.

Preventive measures

The authorities followed an epidemiologic approach with the aim to physically disrupt the contagion. As the number of cases increased, gradual measures were taken.

A public information campaign was kicked-off on 27 February aimed at increasing awareness of personal hygiene, social distancing and use of official information sources.

Physical distancing measures started with the gradual ban of the size of public gatherings (more than 1,000 people on 8 March, more than 100 – 11 March, more than 50 – 14 March) and the suspension of schools (9 March). This was followed by the cancellation of public events and the closure of public places as well as the introduction of a night curfew. On 25 March a nation-wide lockdown was introduced. Currently, movement of persons outside their residence is not allowed, except for purchasing basic goods, travelling to work, obtaining emergency medical assistance, taking care of dependents and pets, in case of death of a family member, and outings for individual physical activity. Restrictions for persons over 65 years old are stricter, with outings allowed only between 11 am and 1 pm. Two cities were placed under quarantine – the north eastern city of Suceava on 30 March and the southern city of Tandarei on 4 April.

In parallel, authorities undertook several measures to reduce the number of imported infection cases. With many citizens living abroad (about 1.3 mil in Italy and 0.6 mil in Spain) and a large number of seasonal workers expected to return due to workplace closure, Romania had a high risk to import the COVID-19 infection. Authorities responded by introducing 14 days home-confinement or quarantine (depending on the country they are arriving from) for persons coming from the affected regions (21 February). Additional actions included repeated public pleas from high ranking authorities, such as the President and the Prime-Minister, asking Romanians living abroad to not return to the country, including for the forthcoming Easter Holidays. These measures were doubled by a series of international travel bans and restrictions. Since 25 March, Romanian borders are closed for foreign citizens and stateless persons (with exceptions, for instance for those transiting Romania over designated transit corridors). All commercial flights to and from most countries have been suspended (with exceptions, such as freight and postal services).

Healthcare capacity

Although Romania is among the top 5 countries in the EU by numbers of intensive care unit beds per capita, it lacks the medical equipment needed to provide intensive care procedures. In this respect, authorities acted to increase financial and human resources in the healthcare sector. Measures include increasing the budgets of the Ministry of Health and the Ministry of Internal Affairs and prohibiting the export of all prescription medicines and medical equipment needed to prevent or to treat COVID-19 patients. Other measures are the construction of a mobile hospital near Bucharest for potential COVID-19 patients and the launch of a recruitment campaign of medical staff by the Ministry of Defense. In parallel, authorities acted to reduce the burden on the healthcare infrastructure. Since 24 March the hospitalizations and consultations in outpatient structures of public hospitals that are not urgent have been suspended.

In terms of procedures, each hospital presentation is managed through a triage process where an epidemiologic risk assessment is performed in line with national procedure. Testing is done for all suspects that are overlapping the case definition, which was updated several times in line with the evolving epidemiologic status of the pandemic.

Fiscal and monetary policies

Several monetary and fiscal polices were taken to tackle the effects of the stalled economy. For example, paid leave for parents in response to the schools’ closure and 75% of gross salary paid by the state to employees temporarily laid off in firms affected by the outbreak. Other policies include a series of tax relief measures for companies and individuals and VAT exemptions on COVID-19-related imports. Monetary policies include a cut in the interest rate by 0.50 percentage points (to 2%). Additionally, the National Emergency decree introduces the option to cap prices on medicines and medical equipment, on strictly necessary foods and on public utility services (such as electricity and gas).

Reflection on COVID-19 response in Romania

Romania’s response to the COVID-19 pandemic was driven by the need to tackle two major vulnerabilities: 1) a high exposure to imported cases via Italy, and 2) a lack of sufficient intensive care medical equipment. The response was based on a political consensus to defer crisis decision making to the NCSES experts and to accept the introduction of relatively harsh measures early on. For example, Romania was one of the first countries in Europe to introduce school closures as early as March 9, with only 17 confirmed cases. In comparison, Italy had introduced school closures on March 5, with 3,858 cases. The increasingly stringent measures with the drastic economic impact were not criticized by any politician, central media channel or major company. Of note here is the high level of public confidence in the head of the NCSES, a long serving public official recognized for his lack of political affiliation and competence in emergency situations.

The ongoing political crisis was swiftly resolved in the face of the looming pandemic, with the Parliament reinstating in March the same minority Government that it had voted down in February. Moreover, the Parliament unanimously adopted the National Emergency decree.

At this moment, it appears that the spread of the pandemic was encouraged by a mix of poor enforcement/ observance of the physical distancing measures alongside the exposure of untrained and unequipped medical professionals to COVID-19 susceptible patients. The difference between the causes that led to the quarantine of the two cities is a good illustration.

Tandarei was placed under quarantine as a precaution, due to the poor observance of self-isolation requirements in the local community. In Romania, the behavioral responses in the population to the physical distancing measures varied, reflecting to some extent the urban and rural divide. For example, one of the exceptions from the nation-wide lockdown is for agricultural activities. This is reflective of the high proportion of rural population (over 45%) and of subsistence farming. The authorities’ enforcement of these measures changed with the increased number of infections and deaths. Of note is the call on the military to support police and Gendarmerie personnel in enforcing the travel restrictions (24 March), as well as the increase of fines for non-compliance (fines for individuals rose 20 times).

Suceava was placed under quarantine when it became the biggest COVID-19 hotspot in the country, holding over a quarter of all infected cases and about two thirds of all infected medical personnel.

Country wide, the rate of medical professionals’ infection is high (between 10 and 15% of patients). This vulnerability has the potential to impact both COVID-19 patients and other types of emergencies that the hospitals need to address during the crisis period with a high risk of increasing morbidity and mortality rates.

In hindsight, a more stringent triage and more testing would have slowed the pandemic. The testing strategy has been debated and some disagreement between government and the health authorities emerged, leading to the resignation of the Minister of Health on 26 March. The number of tests per day increased from 400 (early March) to 3,200 (end of March), but testing capacity is unlikely to increase further.

The coming Orthodox Easter Holidays (19 April) are the next challenge due to the risk of concentrated transmission during mass gathering events. Of interest here is the reaction from the Romanian Orthodox Church. Early on in the crises (28 February), the Church suggested that followers use their own spoons (for communion rituals) and avoid the traditional kissing of icons in church; however, its reaction during the next period remains to be seen.

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