|PERSPECTIVE/VIEWPOINT - COUNTRY/REGIONAL
|Year : 2020 | Volume
| Issue : 2 | Page : 124-125
Romanian Perspective of COVID-19 Outbreak from a Social Psychiatric Lens
Doina Cozman1, Roxana Stoean2, Andrei Buciuta3, Claudia Dima4
1 Department of Clinical Psychology, University of Medicine and Pharmacy Iuliu Hatieganu; Romanian Association of Psychiatry and Psychotherapy, Cluj-Napoca, Romania
2 Romanian Association of Psychiatry and Psychotherapy, Cluj-Napoca; Department of Psychiatry, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
3 Romanian Association of Psychiatry and Psychotherapy; Cluj County Emergency Hospital, Cluj-Napoca, Romania
4 Public Health Expert, National Institute of Public Health Associate, Bucharest, Romania
|Date of Submission||17-May-2020|
|Date of Decision||29-May-2020|
|Date of Acceptance||02-Jun-2020|
|Date of Web Publication||14-Aug-2020|
Prof. Doina Cozman
Department of Clinical Psychology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca
Source of Support: None, Conflict of Interest: None
The COVID-19 pandemic brought multiple changes in everyday life and healthcare assistance, including psychiatric healthcare. With the purpose of preventing infections, on March, 16, 2020, the Romanian government established the state of emergency and issued several restrictions regarding the free movement of persons and regulations for the health-care system, thus increasing the difficulty of healthcare access, both in the public health-care system and the outpatient services. One of the measures was the suspension of nonurgent hospitalizations and consultations in outpatient setting, which, associated with the increase in referrals for anxiety and depressive symptoms generated an abrupt increase in presentations in the emergency rooms. The resulting new needs were addressed by issuing the legislation for telemedicine consultation in the outpatient network and removing some requirements in the drug prescribing procedure. Despite the lack of dedicated resources, the resilience of the health-care system was outstanding.
Keywords: COVID-19 pandemic, health-care system, psychiatry, Romania, state of emergency
|How to cite this article:|
Cozman D, Stoean R, Buciuta A, Dima C. Romanian Perspective of COVID-19 Outbreak from a Social Psychiatric Lens. World Soc Psychiatry 2020;2:124-5
The COVID-19 pandemic had revealed through the entire world, not only pre-existing problems in the health-care systems, but also difficulties in adapting some technologies to the urgent needs of the population in the context of a specific health problem.
The pandemic generated new needs concerning mental health, which, on a long term, can overload the available mental healthcare resources, both in infrastructure and psychiatric personnel.
The legislative acts that regulate the healthcare assistance from the moment of the first recorded COVID-19 case (26.02.2020) until today were numerous, assuring the legal frame for the rapid changes produced in the functioning of the Romanian healthcare system, including psychiatry.
By the Decree of The President of Romania (March 16, 2020) regarding the establishment of the state of emergency and then by the Military Enactment no. 3 of March 24, 2020, regarding the prevention of spread of COVID-19, special measures of social distancing were taken, targeting the entire population (e.g., prohibiting the movement of persons outside the home with the exception of ensuring the basic needs of people and pets, permission of the movement of persons over 65 years of age only between 11 am and 1 pm). Furthermore, the suspension of the hospitalizations that do not represent medical-surgical emergencies was imposed. Furthermore, the nonurgent consultations in hospital outpatient clinics (public or private) were suspended.
The Military Enactment no. 4 of March 29, 2020 modified the previous enactment, permitting the movement of people over 65 years of age to leave their homes for medical reasons outside the previously mentioned interval. A more important act was the Government Decision no. 252 of March 30, 2020 which allowed the outpatient medical consult through telemedicine, for everyone, regardless of their insurance state. Therefore, the consultations and the transmission of medical documentation online were permitted (medical letters to the general practitioner, prescriptions, and referral tickets for tests).
The plan of measures for the adaptation of hospitals for the COVID-19 pandemic was established by the Order of the Minister of Health no. 555/07.04.2020 and imposed the epidemiological triage at each hospitalization or consultation at the level of the Emergency Room of each hospital, regardless of specialty. It was also decided to transform the structure of all hospitals by setting up new facilities: triage department at the hospital entrance, isolation department for suspected patients, and a treatment department for COVID-19-positive patients with mild respiratory presentation but with severe psychiatric symptoms. In addition, support hospitals have been set up for patients tested positive or suspected of having the SARS-CoV-2 virus.
On April 14, 2020, the President of Romania decided to extend the state of emergency, but all telemedicine regulations were maintained.
Since the declaration of the COVID-19 pandemic, in the EU (March 2020) and implicitly in Romania, there has been an increase in referrals for anxiety and depressive symptoms, both in patients diagnosed before the pandemic and in those who have contacted psychiatric services for the first time. However, at that time, in Romania, the activity in the outpatient services was suspended. Therefore, the activity in the emergency rooms of the psychiatric hospitals experienced an abrupt increase of presentations, most of them not being psychiatric emergencies.
At the express request of the Romanian Association of Psychiatry and Psychotherapy, the government responded quite promptly by issuing the legislation for telemedicine consultations (implicitly also those of telepsychiatry) in the outpatient network. At the moment, psychotropics can be prescribed online, except for psychoactive substances and benzodiazepine derivatives.
Romania has had to face since the beginning of the pandemic the return of many Romanian citizens who worked seasonally outside the country. The entry into the country of hundreds of thousands of people from EU countries with higher cases of COVID-19 was an important source of import cases infected with the new coronavirus.
For example, between February 26, 2020, and March 18, 2020, out of a total of 261 confirmed cases, 127 were registered with people who returned to Romania from abroad, the most common country of origin being Italy (with a share of 66% of import cases), followed by France, Germany and Spain (approximately 5% of cases), and the United Kingdom and Austria (4% of cases).
| The Dynamics of the Pandemic Evolution in Romania (2020)|| |
The first infection on the Romanian territory was registered on 26.02.2020. The number of cases followed an upward curve, correlated with the increase in testing capacity [Table 1]. The first cured case was reported on 05.03, and the first death occurred approximately 3 weeks after the first recorded case.
|Table 1: The evolution of the pandemic with Covid-19 in Romania during the state of emergency|
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The distribution on the geographical areas of Romania was uneven, the North-east region being the most affected by the COVID-19 pandemic. Thus, the diseases in that area (119.89/100000 people) far exceeded the average number of diseases in the country (78.55/100000 people).
| Conclusion|| |
The mental health of the Romanian population during the COVID-19 pandemic was influenced by specific disease-related consequences, but also by more difficult access to mental health care. The difficulty was due to the restriction of free movement of persons, to the unequal geographical distribution of psychiatric infrastructure and human resources. It is remarkable that in the despite the lack of dedicated resources, the resilience of the health-care system was outstanding, regarding rapid adoption and the practice for the first time of telemedicine in the Romanian health system.
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Conflicts of interest
There are no conflicts of interest.
| References|| |