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Public Health

Anda Ķīvīte-Urtāne (pictured), leading researcher at the Rīga Stradiņš University (RSU) Institute of Public Health, is leading a national research programme project approved by the Latvian Council of Science: Impact of COVID-19 on the Health Care System and Public Health in Latvia; Strengthening the Preparedness of the Health Sector for Future Epidemics.


We invited the project leader to a conversation to learn more about the progress of the project, the impact it will have on society and RSU’s involvement in combating the effects of the coronavirus.

How did the idea arise, and how did you manage to prepare the application for an extensive project like this in such a short period of time?

You could say that this project was built backwards. We did not have a common theme that would require the development of sub-projects or sections, but rather there were several ideas for large-scale public health studies floating around that lacked funding. Several international partners had approached our colleagues Professor Gunta Lazdāne, Professor Elmārs Rancāns, and leading researcher Ieva Reine, calling for research related to COVID-19. The national research programme was exactly the thing we needed and it came at the right moment. It helped our colleagues make positive decisions and respond to calls from international partners as well as provided the opportunity to expand and apply the planned studies, and specifically to study the situation in Latvia.   

A study on the effects of the virus on sexual and reproductive health is being carried out under the guidance of Prof. Lazdāne. Prof. Rancāns is leading, as we say, a work package to investigate the impact of COVID-19 on mental health, while leading researcher Ieva Reine is analysing the impact of the epidemic on the Latvian population in the 50+ age group. We added two more areas of research: one of them, led by Prof. Dace Gardovska, examines the effects of the virus on children’s health and quality of life, while the second one assesses the overall impact of COVID-19 on health care and is led by Prof. Anita Villeruša. Thus, we have achieved our goal for the project to cover all age groups.

How would you describe the project’s scientific and practical benefits?

The project is being implemented from 1 July to 31 December and will conclude with publications and final research reports. The Ministry of Health, which is co-responsible for the implementation of the national research programme, has assigned us additional targets: we need to develop recommendations and guidelines according to the research topics and based on the results that we achieve. For example, we already know that discounting the crisis, there is insufficient state supported psychological aid in Latvia. Oncology patients started receiving psychological aid recently, as well as patients in palliative care. There are, however, situations in every person’s life at one time or another that would require this type of support, which might not entail getting such a serious disease. Not everyone can afford to pay for psychotherapists, and in a crisis situation this need increases significantly. In addition, research shows that mental health disorders are, for example, what accounts for the longest inability to work. Sick leave might only last a month for someone who breaks their leg, but with clinical depression, for example, sick leave might last six months, or even longer. Mental health, therefore, has a huge impact on the national economy and health care in general.

When the pandemic was at its height, almost no on-site medical services were available, only emergency care. Are you studying how this affected society?

Of course. It is important to understand how this has affected patients, particularly patients suffering from chronic illnesses – whether there was a significant increase in the number of acute cases and hospitalisations, or an increase in the volume of emergency calls. Many health care facilities and health care professionals began offering remote counselling on an individual basis. One should not forget that the elderly are more likely to be chronic patients who might not have access to the Internet or know how to use it. Online consultations are therefore not always possible. What should people with chronic illnesses for whom remote services are not available do? Moreover, not all health care services can be carried out remotely. In another sub-project, we are researching whether abortions and family planning methods, for example contraceptives, were available during the crisis.

Logically, merely publishing our conclusions will not be enough for society, there also needs to be expert recommendations on what to do. We will submit recommendations to the Ministry of Health so that the Ministry can make decisions based on scientific research in order to withstand the second wave of COVID-19, and other future emergencies.

What research methods are you using?

Collecting both quantitative and qualitative primary data is carried out in the form of online surveys of citizens and health care workers, as well as through in-depth interviews and focus group discussions with representatives of different population groups (seniors, women who gave birth during the emergency, parents of children suffering from COVID-19, etc.), and experts in the field (managers and employees of health care institutions, representatives of responsible public bodies).

We also select and process secondary data that we get from the National Health Service and the State Emergency Medical Service registers. They provide data on the number of calls or hospitalisations, for example.

Another method is to analyse regulatory enactments. The Ministry of Health has ordered an evaluation of the emergency medical system. How successfully did the system respond to the crisis situation? The basis of patients’ rights is also evaluated. Did the restrictions that we experienced during the emergency situation, and which we still have in place, violate any human rights?

We are, of course, also collecting international scientific literature and comparing the Latvian experience with conclusions drawn by international colleagues about the situation caused by COVID-19 in their countries.

Tell us more about the team. What have you managed to accomplish?

We are a team of over 70 people from three universities. Along with RSU, which is the leading implementing partner of this project, the University of Latvia and the BA School of Business and Finance are also participating in the project. The project involves both professors as well as researchers without a scientific degree, and students from various study programmes. Involving students in the research was one of the conditions of the national research programme and our project employs more than 20 students. I admit that it wasn’t easy to organise and coordinate a large team like this in such a short amount of time, but my colleagues were one of the main motivating factors for why I decided to lead this project. Our staff are all outstanding experts in their field, whose enthusiasm, work capacity and personal characteristics I truly admire. I would trust these people with my life, as the saying goes.

The project started on 1 July, and I would say that an extraordinary amount of work has been done in over a month: the design, selection, and tools have been developed for all the studies, research protocols have been prepared, all the necessary agreements have been reached with participating institutions and organisations, all studies have received feedback from the Ethics Committee, and procedures for procuring necessary resources have been initiated. People have cancelled their holidays, and all the work packages have already started fieldwork – data collection in online surveys is actively taking place, in-depth interviews are being conducted and transcribed. A significant amount of scientific literature has been collected.

A larger internal meeting will take place in the second half of September, when the leaders of all the work packages and researchers will assess the progress. This is likely to be the first stage where we report our initial findings.

The pandemic is not over. What if a second wave of COVID-19 comes? Will the study help?

I think that it will help. Our project is dedicated to this. However, our research is not just about COVID-19, but about crisis situations in general. There will be a ready algorithm to use next time. In nature, microorganisms have mutations, they cross species boundaries; living organisms have the ability to change, so we need to be able to be vigilant and adapt. We need to be prepared for both a possible second wave of COVID-19 and other possible epidemics or pandemics in the future.