COVID-19: How did State Sector Cope?

Katalin Cseh, Momentum MEP. Photo by Momentum.hu

The prime minister continued with lavish praise for Miklós Kásler, who, as Minister of Human Capacities is responsible for healthcare. Indeed, the reason why Hungary avoided mass infection was “mainly due to the timely work performed by the healthcare team led by Miklós Kásler, and the hospital directors, doctors and nurses working under them”, he added.

The facts, in terms of confirmed infections and deaths during the first three months of the COVID-19 pandemic, certainly show that Hungary averted mass infection. On June 15, coronavirus fatalities in the country had climbed to 563, with a cumulative total of 4,076 infections.

These numbers mean Hungary suffered a mortality rate of 5.72 per 100,000 inhabitants, according to the Johns Hopkins University website. This result puts Hungary in good standing compared to Romania (7.16) and Austria (7.65), but outperformed by the Czech Republic (3.09) and especially Slovakia, which logged an astonishingly low 0.51 deaths per 100,000 inhabitants.

But as far as fatalities per infection was concerned, a measure of how well the health service performed in treating infected patients, in early June Hungary stood at 13.8%, double that of Romania and close to four times the ratio in the Czech Republic.

Deep Knowledge

In view of these metrics, which indicate a median performance by the healthcare sector, it is perhaps surprising that Hungary ranked as high as 18th worldwide in the COVID-19 risk assessment tables compiled by the Deep Knowledge Group, a Swiss-based analytics company.

Yet while this placing surely pleased the government, many in the general public, health sector itself and political opposition remain critical of how the public health service was managed in the pandemic, with arguments raging over every subject from preparedness of the sector and reliability of statistics to the Easter evacuation of hospital beds (see separate box).

Gabriella Lantos, a former director of a private Budapest hospital, says that while the data on the deceased is accurate, “the case numbers are not reliable at all”, because the healthcare service was unable to carry out enough tests, especially in the first month of the pandemic.

“State financing [for public healthcare] has been very, very low by [successive] Orbán governments – the lowest in the EU countries. That’s why there was, at the beginning, just one micro-biological lab in Hungary that could carry out the reliable PCR test,” she said.

Although the number of accredited laboratories was raised to eight in total, this was still insufficient for the needs. Austria, for a smaller population, has 40 accredited testing laboratories, she said.

Level of Infection

Subsequent research, led by the Semmelweis Medical University appears to support this claim. News website Index, in a surprisingly low-key manner, reported on May 19 that first results of testing indicated that between 0.6 – 0.7% of the population over 14 had been infected with the COVID-19 virus.

While this figure appears almost insignificant, when multiplied by the 8.2 million individuals at risk, it translates to some 52,000 people – a figure 13 times greater than the official number.

Katalin Cseh, a member of the European Parliament (for opposition party Momentum) and qualified doctor who volunteered for hospital work during the crisis, said: “The transparency around the data is very… well, I’d rather not say, but it’s in a very bad shape.”

Cseh’s principal complaint centered on the government’s unwillingness to engage with the Hungarian Medical Chamber, and subsequent allegation that it was providing political propaganda for the opposition.

“I think it’s really unfounded and unprecedented to accuse the highest body of Hungarian doctors with claims [of political motivation]. They were not consulted and their demands were very much in line with international standards and guidelines,” she emphasized.

Hospital Evacuations Provoke Rage and Confusion

Soon after Easter, several independent media reported that hospital directors had received instructions the previous week from the Ministry of Human Capacities to evacuate 60% of their patients’ beds by April 15. The plan was to free up some 36,000 beds in preparation for a feared mass of COVID-19 infection cases that were predicted for early May.

But the evacuations meant many patients undergoing treatment or recovering from operations being turfed out of hospital beds and sent home at short notice.

Two hospital directors who voiced opposition to the move were fired by the ministry.

Many of their receiving families were reportedly clueless as to how to look after their relatives, although in the confusion, and lack of transparency from official sources, stories of dubious authenticity gained credence.

“Official numbers [of evacuated patients] haven’t been released, but health experts calculate from the data of National Health Insurance Management that about 25,000 patients were sent home,” Gabriella Lantos, a former director of a private Budapest hospital, told the Budapest Business Journal.

Miklós Kásler, the minister responsible, added fuel to the fire when, on May 25, he declared that the original April instructions included the order to continue treating all patients whose condition necessitated it. Anyone disregarding these orders had “violated the Hippocratic Oath”, he said.

Health professionals were outraged. In a sharply worded retort, the Hungarian Medical Chamber responded: “On behalf of the entire medical community, we reject Kásler’s statement that doctors were responsible for the professional and ethical consequences of his order to vacate hospital beds while simultaneously accusing them of violating their Hippocratic Oath.”

Bertalan Tóth, Socialist party president, demanded an enquiry into the affair from both Kásler and Interior Minister Sándor Pintér. He received a reply denying any claims that the evacuation put the lives of patients at risk.

Gabriella Lantos denounced the entire affair as “a real scandal”, adding the need for 36,000 beds was wildly excessive.

“The lack of laboratory capacity [to test for COVID-19] in the first place is the main reason why they didn’t know how to calculate accurately [the spread of infections]. They then prepared for the worst case. But this didn’t happen in Hungary. We don’t even have enough doctors [to attend] so many patients” she said.

Miklós Kásler, Minister of Human Capacities. Photo by Kormany.hu