August 11, 2020 — The COVID-19 infection rates are surprisingly low in Croatia, considering that the country has allowed hundreds of thousands of tourists from all over the world to enter without restrictions.
The Croatia COVID-19 Task Force confirmed 91 new cases and two deaths today. Yesterday, there were 45 new cases and one death. There are currently 618 active cases in Croatia, 115 patients are hospitalized, and 8 are on ventilators.
The situation is significantly worse in neighboring countries, especially in Serbia and Bosnia and Herzegovina, where new cases are consistently in the three-digits, and deaths in the double-digits.
According to the eVisitor system, there are currently more than 830,000 tourists in our country. More than 660,000 of those are foreigners. Most of them are coming from Germany, Slovenia, Austria, and the Czech Republic. Tourists from third countries like the USA, where the pandemic in full swing, can enter Croatia with a PCR test not older than 48 hours or face a 7 to 14 day quarantine.
Croatia Records 4.2 Million Foreign Arrivals Since January
According to the Croatian National Tourist Board: from January 1 to August 9, there were 5.2 million arrivals and 33.6 million overnight stays in Croatia. Foreign guests accounted for 4.2 million arrivals and 27 million overnight stays. During the past weekend alone, foreign tourists accounted for more than 1.8 million overnight stays.
While these results indicate a positive trend, Index reports that some are questioning the credibility of our epidemiological data.
How can we determine the accuracy of our data? We can interpret the results in several different ways. For example, because the Croatian health care system tests fewer people, the infection rate is also lower.
Therefore, many experts believe that the number of infected is not the best measure of an epidemiological situation in a country or region. Nor should it be the only number which we take into account. For a complete understanding, we ought to consider three key factors: the number of infected, the rate of positive cases related to the total number of tests, and the number of deaths.
However, different countries have different ways of calculating deaths. For example, some countries attribute deaths from underlying diseases to COVID-19.
Finally, it is also important to follow the general trends – whether the number of sick and dead is increasing or stagnant and decreasing. It is also necessary consider the number of new patients, hospitalizations, and deaths in relation to the total population.
Critics: Croatia COVID-19 Numbers Low Because Few Tested
One of the frequent explanations for the surprisingly positive Croatian epidemiological data might be that Croatia is testing relatively few people.
Serbian President Aleksandar Vucic has repeatedly claimes that Serbia would have significantly fewer infected people if they tested for COVID-19 as little as Croatia.
In late July, Vucic virtually accused Croatian authorities of manipulating infection numbers, and claimed that Serbia had taken a different approach on testing. Unlike Croatia and Bulgaria, he claimed that Serbia prioritizes people’s health and lives; not “political statistics.”
Croatia only tested 1,319 people on Monday, which may support his claim. Out of those, 91 (6.8%) tests were positive. A total of 130,688 people have been tested in Croatia since the beginning of the pandemic, and 5,740 (4.4%) of those tests were positive (see interactive map below).
This is a relatively high percentage, and well above the European average. Only Bulgaria (4.9%), Romania (6.5%), Spain (7.4%), and Ukraine (8.7%) have higher percentages than Croatia. Even Sweden, which had higher percentage of positives in July (7.9%), has improved its numbers. At 3.3%, Serbia currently has a slightly lower percentage of positives. However, the number of active cases, hospitalized, and deaths in Serbia are significantly higher.
Medical Experts: Croatia Epidemiological Situation Favorable Across Board
Ozren Polasek, Head of the Department of Public Health and Head of the Center for Global Health at the Medical Faculty of the University of Split, believes that Croatia has very good epidemiological situation and that everything is under control. He disputes Vucic’s accusations.
“Serbian authorities reacted poorly to the COVID-19 epidemic, and they are now trying to find an excuse,” Polasek claims.
He explains that the percentage of positive tests can vary significantly.
“I used to think that Alemka Markotic was wrong for implementing restrictive testing. But ultimately, we should be looking at mortality rates. As long as mortality rates are not high, we have our situation under control in spite of less testing. We are currently in an ideal situation to compare the number of tests to uncontrolled disease outcomes.”
Epidemiologist Branko Kolaric, from the University of Rijeka, believes that it would be impossible to conceal a bad COVID-19 epidemiological situation in any democratic country.
“The numbers of hospitalized, people on respirators, and deaths would increase very quickly. It would be impossible to hide.”
Epidemiologist Claims Impossible to Hide Bad COVID-19 Situation
Croatia is also doing well regarding number of hospitalized people and number of deaths. So far, a total of 160 patients have died. With a 39 reported deaths per 1 million inhabitants, Croatia is one of the most successful in Europe regarding the fight against COVID-19. Even neighboring Slovenia has more deaths per million inhabitants (62). With 63 and 75 deaths per million respectively, Hungary and Serbia are significantly worse than Croatia.
Furthermore, Montenegro and BiH (108 and 136 deaths per million) are even worse (see interactive map below). Finally, Belgium, Great Britain, Spain, Italy, and Sweden have the worst numbers in Europe.
It is also worth noting that there is no standardized rule on counting COVID-19 deaths. Polasek explains that countries’ policies differ widely.
“Belgians count anyone who dies while being COVID-19 positive as though they died from COVID-19. Germany will not count a fatality from COVID-19 unless it is clear that complications of COVID-19 caused their death. Croatia sits somewhere in the middle. It is not helpful that there is no standardized process to distinguish who died from COVID-19 from those who had COVID-19,” Polasek points out.
Process for Determining COVID-19 Deaths Varies by Country
Kolaric agrees with that assessment.
“Croatia counts everyone who has COVID-19, and dies from something that may result from that infection, as having died from COVID-19. Our country counts any death, which might be related to COVID-19, as a death from COVID-19. More precisely, we determine the cause of death by a sequence of pathophysiological changes caused by the disease, which in this case is COVID-19 “, explains Kolaric.
Therefore, Croatia is doing well according to these criteria too. However, are there other possible explanations for the favorable situation in Croatia despite so many tourists?
One possible explanation might be that COVID-19 is infecting more young people — especially in clubs and various hangouts. Since young people generally have milder symptoms, they often don’t get tested.
More Young People Getting Infected With Less Severe Symptoms
Regarding infected tourists, it is no surprise that they would be reluctant to get tested while on holiday in a foreign country. If those foreign tourists are also young, it is likely that they would not get tested in Croatia or upon their return home. That is, unless they have to, as is the case in Germany. Many will recover from COVID-19 without medical help, just like they would recover from the cold or flu. Therefore, getting tested in a foreign country would only complicate matters unless they have severe symptoms.
Recently, 10 German high school students and two Italian high school students tested positive after returning home from a vacation on Pag. German media reported that a travel agency, which specializes in party travel, organized the graduates’ trip. They felt the first flu-like symptoms after returning from vacation, but that does not necessarily mean that they got infected in Croatia. Since the incubation time for COVID-19 is between 2 and 14 days, and sometimes up to 27 days, it is possible that some of them were already COVID-19 positive. Then, they spread the virus during their trip. Of course, they could have caught the virus in a club in Croatia.
Must Consider Infections of Locals in Tourist Towns
Kolaric says that it is very likely that we have more infected people than the numbers currently show. He also believes that we should consider the number of locals in tourist towns who may have been infected. Then we could determine how tourism affects the spread of COVID-19.
“We could determine if we have a problem with tourism if we monitor whether we have a significant increase in the number of infected among the local population in tourist towns,” Kolaric explains.
We could claim that opening the borders for tourism was not as dangerous as we anticipated. Mostly young people are catching COVID-19, and the number of active cases is low. However, the number of hospitalized and deaths are also quite low.
Polasek predicts that young people will become the main carriers of the virus.
“In the spring, the epidemic spread primarily through semi-closed systems, and among the elderly. It is currently spreading primarily among younger people who are more mobile and not afraid of the virus. This is good in a way because they are less likely to experience severe symptoms or die from the virus,” Polasek points out.
Young People Tired of COVID-19, Ignoring Measures and Risks
“Many young people are even openly denying the existence of COVID-19. They are tired of fearing it, and wish they could just turn it off and say it’s over. Older people are more careful because they understand the risks. So far, we have had about ten different viruses that young people have recovered from as easily as they would from a harmless cold. For young people, COVID-19 is also a relatively harmless disease, at least in terms of symptoms,” explains Polasek.
However, young people who become infected during the summer holidays will return to their families and infect those at risk. Furthermore, research has shown that COVID-19 can cause problems which will affect young people in the long run.
Both scientists agree that the biggest hotspots are nightclubs at the moment. Unfortunately, this problem is not easy to solve. If we close night clubs, young people might rebel. Also, politicians generally want to maintain a good relationship with club owners.
Polasek says that we are now in the phase of finding out what is dangerous and what isn’t.
Epidemiologists Still Pinpointing High Risk Situations
“Some gatherings and settings, which we did not consider dangerous, like weddings, have become a problem. On the other hand, we were concerned about tourism, but that was not as dangerous as we anticipated. Clubs are definitely a problem. Every country is different, and we are now trying to determine what situations are dangerous for Croatia,” Polasek adds.
Kolaric mostly agrees.
“Nightclubs are a serious problem because they can infect many young people who will then not experience more serious symptoms. I was not in favor of opening clubs in June. It is very difficult to keep a distance in clubs. People get drunk, shout in each other’s faces, and hug and kiss. The risk is high there and even higher than at weddings,” says Kolaric.
Follow our dedicated COVID-19 page to stay up-to-date on the epidemic in Croatia.