interview by Anthony Georgieff

Prof Dr Kosta Kostov, MD

Prof Dr Kosta Kostov, MD

Professor Kosta Kostov is one of Bulgaria's leading pulmonologists. He has specialised in Germany, Switzerland and the UK, and has taught for many years at the Medical Faculty of St Kliment of Ohrid University in Sofia. Earlier in 2020 he was the chairman of the Expert Medical Council under the Bulgarian Council of Ministers, a short-lived agency designed to provide the government with professional advice how to tackle the Covid-19 crisis. Dr Kostov has been in all Best Doctors lists in Bulgaria. In addition to being a medical professional, Dr Kostov is an essayist and the editor of a medical journal, Inspiro.

Dr Kostov's assessment, on the 1-10 scale (where 1 is bad and 10 is excellent), of the Covid-19 situation in Bulgaria as seen against the background of the other EU countries and the rest of the world is not very positive.

Certainly at the bottom. This is not my personal opinion because it can be seen in all the statistical analyses of the pandemic. Let me say Bulgaria is No. 2. The situation in this country is so bad that we cannot even get the first place among the worst countries.

I this not at sharp variance with the government's claims it does fairly well? How come?

The main reason is the lack of unity as well as the complete deficiency of trust between citizens and government, which also explains the tepid adherence to the anti-pandemic measures. The government should not have followed a slimmed-down version of the DDD, or Distance, Discipline and Disinfection, protocol. Instead, it should have gone for the more comprehensive MDDT, or Masks, Distance, Disinfection and Testing, procedure. It is a small wonder that half-hearted anti-pandemic measures produce lukewarm results. At the beginning of the pandemic there were arguments against widespread testing. Those were based on the relative unreliability of the available tests at the time as well as the shortage of facilities and qualified personnel to conduct them. Subsequently, as things changed in the rest of the world the opinions of the Bulgarian policymakers remained the same. Some local experts failed to understand the value of such a comprehensive approach even as they observed the best performing countries that did adhere to it. These include, but are not limited to, South Korea, Singapore, China and Taiwan. A number of European countries such as Germany, Austria and Slovenia followed suit as well. Bulgaria is also at the bottom in terms of the number of people tested. Unfortunately, we tend to live at the bottom of many things. The Bulgarian society has been deeply split between sceptics, who do not believe in the hazards of the pandemic, and rationalists, who follow the voice of reasons; between pro- and anti-Swedes.

Three things the government did well since March 2020?

The government introduced relatively fast and on time relatively strict anti-pandemic measures. It created an administrative setup with the National Operational Staff and the Expert Medical Council. It did make an attempt, though futile, to punch above its weight against the background of a crippled health care system that sustains itself mainly on the feelings of professional responsibility and self-sacrifice of those who work in it.

Three things that it botched?

It fulfilled the anti-pandemic measures only partially because it stuck to the DDD rather than the MDDT. It failed to understand that the National Operative Staff and the Expert Medical Council should work in cooperation. The former should have focused on the implementation of the measures while the latter provided the diagnostic and scientific basis. In fact, the two were designed not to function properly as indicated by the varied clinical and academic competence of the individuals appointed at the two agencies. It failed to win over the hearts and minds of the general public to ensure full compliance with the anti-pandemic measures. It swayed between barracks-style drills and science, between military authority and calm, balanced scholarly approach. The situation continues to this day, though in a less drastic manner.

What are the reasons?

To put it succinctly, the general public chaotic attitude to the pandemic was met by the inconsistent and half-hearted implementation of the anti-pandemic measures. The diagnostic and therapeutic recommendations by the Expert Medical Council were played down in spite of the fact that they were based on research and science. Consequently, the recommendations of the Expert Medical Council were "hung" on the Internet site of the Bulgarian Association of Medical Doctors and stashed away in some cupboard inside the Public Health Ministry. Some inquisitive doctors can access them. But what happens in real life, throughout the country, is a flurry of creative therapeutic practices designed by healers and bone-spinners who spread out magical treatment protocols as if composed by army chaplain Otto Katz, one of my favourite characters in The Good Solider Švejk by Jaroslav Hašek.

What is your forecast of the crisis in the shorter term, by the end of the winter, and the long term – by the end of 2021?

We will struggle on like a fisherman in a dinghy until spring arrives – or until the number of those vaccinated and those already recuperated from Covid-19 reaches 50 percent of the total population. If we do it by the end of the summer we will probably be in for a calmer autumn and winter 2021-2022. Then we will get some new hope.

What are the political dimensions of the Covid-19 crisis?

The pandemic coincided with the increasing mistrust in the government prompted by its failure to sustain liberal democracy. Both the severity of the pandemic and the fears Bulgarians have for the future increased as a result. The politicians did whatever they could to strangle science into submission and use it for their own purposes. Some even started to act as if they were experts of diagnostics and therapeutics.

A state may be a democracy in the sense the majority rules. But it is not necessarily a liberal democracy where the individual enjoys certain freedoms. In this sense Bulgaria is not a very good example. As the pandemic raged, it transpired that a significant number of Bulgarians, many of them young and educated, failed to convince the political establishment that changes were in order. Whether Bulgarians became wiser during the pandemic is too early to say. I am sceptical because social apathy in this country outperforms the enthusiasm needed to change the status quo and thwart inertia. As one of my favourite poets puts it, a large population, a small nation, a shortage of characters.


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