A Retrospective of the First 3 Weeks of Infection with SARS-CoV-2 in Romania

1 Department of Plastic Surgery, „Bagdasar Arseni” Emergency Hospital, Bucharest, Romania 2 Graphic Designer, LVDT, Bucharest, Romania 3 Department of Cardiology, „Prof. Dr. CC Iliescu” Emergency Institute of Cardiovascular Diseases, Bucharest, Romania 4 Department of Pediatric Psychiatry, „Al. Obregia” Hospital, Bucharest, Romania 5 Department of Internal Medicine, Colentina Hospital, Bucharest, Romania Corresponding author: Andrei MARIN, Department of Plastic Surgery, „Bagdasar Arseni” Emergency Hospital, Bucharest, Romania. E-mail: marin_dpt@yahoo.com Abstract


INTRODUCTION
Th e novel Coronavirus (SARS-CoV-2) was fi rst detected in China in December, 2019 1 . Since then, there have been many cases reported worldwide. Information about treatment and the management of critically ill patients is still scarce. Th erefore the evolution of the virus dissemination correlated with the political policies need to be reviewed via a retrospective observational study for the Romanian population in order to see how an entire hospital in Bucharest was placed in quarantine 3 . Another similar case was that of woman in Hunedoara County, who also falsely declared not travelling in a country extensively aff ected by COVID-19 and then having contact with 42 people 4 .
Th ese false declarations postponed the epidemiologic investigation, thus increasing the risk of infecting more people.
As shown in the image below, the patients who did not respect self-isolation (either by lying about travelling abroad or by leaving the isolation) managed to infect a great deal of people who they have been in contact with.

Local government and international measures
In Romania, all meetings with more than 1000 people were forbidden starting 8 th of March; on the same day, the practical courses for medical students which took place in hospitals were suspended; the patients' relatives were no longer allowed to enter the hospitals' perimeter for visiting hours. A restriction for gatherings/social activities with no more than 100 people went into eff ect on the 12 th of March and this number got reduced to 50 on the 14 th 6,7 . Romania closed all schools on the 10 th of March and 2 days later the World Health Organization declared pandemia 8,9 . Th e Romanian president declared state of emergency starting 16 th of March, requesting citizens to stay indoors and to exit only for food and medicine.
for COVID-19. Th ese were patients with acute respiratory infection (experiencing one of these symptoms: cough, fever, sore throat, shortness of breath) and either contact with a patient infected with COVID-19 in the past 14 days or history of travelling in the past 14 days in one of the countries extensively aff ected by COVID-19.
We present the epidemiologic investigation for the spreading of the virus and we try to correlate these numbers to a series of factors: the restrictive measures recommended by the medical personnel or imposed by the government, number of contacts for each infected patient, degree of quarantine adherence, border restriction/permissions.

Epidemiologic chain
Italy, one of the most aff ected countries, declared its fi rst cases on the 31 st of January. Th e fi rst diagnosed case of COVID-19 in Romania occurred on 26 th of February in Gorj County in a rural area. Patient 0 was an Italian citizen who stayed in Romania for 5 days. In his case, the transmission was self-limited.
One key link in disseminating this virus was case number 17 -that of a man who falsely declared not having travelled abroad. In reality he returned from Israel on 26 th February. After being admitted on the 5 th of March into the hospital for another disease, he was found infected with coronavirus on the 9 th of March. Since his return into the country, the patient contacted over 150 people; over 15 people confi rmed infected and On the other hand, lack of proper protective equipment as well as specifi c circuit inside hospitals could cause intra hospital contamination, increasing the number of cases. Asymptomatic patients can be difficult to detect due to the testing possibilities and they can also become a cause of community transmission.

CONCLUSIONS
Social distancing and strong authority measures implemented early represented the key to reducing the incidence SARS-CoV-2. No community transmission was reported until the 3 rd week, as the epidemiologic investigation could trace all the infected patients.
A small number of new patients allowed the medical system to cope with the permanent fl ux of patients needing health care.

RESULTS
Th e chart on the evolution of this virus shows that there was an exponential growth in the number of new cases. Although precaution measures were taken by the government, the number of new cases rose.
On 19 th of March, there were no deaths reported in Romania. Th e new cases were either from abroad or patients who were in contact with the infected coming from abroad.

DISCUSSIONS
Th e number of new cases was probably the result of the patients who had already been infected, but weren't diagnosed. Th is is due to the fact that the number of diagnosed cases and the number of real cases was not the same, since not all patients with the specifi c symptoms were tested 10 .
On one hand, the restrictive measures restrictive measures taken showed their eff ect after a few weeks -they did not end the epidemics, but limited the exponential rise. Th e null fatality at the end of the 3 rd week was related to the fact that only a small number of patients (about 10%) were over 60 years old 11,12 .