Dr. Lorky Libaridian

Dr. Lorky Libaridian Speaks on Covid at CYSCA’s Annual Meeting

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CAMBRIDGE, Mass. — Dr. Lorky Libaridian spoke on “Cambridge and Yerevan through Covid-19” via Zoom at the annual Cambridge Yerevan Sister City Association (CYSCA) membership meeting on June 10.

This was the second annual meeting of the organization conducted virtually due to Covid-19, making the topic more than fitting.

CYSCA president Roxanne Etmekjian

Libaridian was introduced by Roxanne Etmekjian, CYSCA president. Libaridian graduated Yale School of Medicine, and completed a combined residency in internal medicine and pediatrics at the University of Rochester (NY). She works at the Cambridge Health Alliance and is medical director for Performance Improvement in Primary Care. Her work and research include improving chronic disease management and pediatric well care and vaccination. She is an instructor in medicine at Harvard Medical School and has been involved with Armenia for several decades. There, her focus is on education and training of family medicine residents and primary care physicians but this past year, it shifted to health care worker training related to Covid-19 and public health and mental health initiatives related to the events of the past year.

Libaridian began by noting that she grew up and still lives in Cambridge, while she considers Yerevan home as well, and declared that as part of her comparison of the two cities, she would be “highlighting the shared humanity that this pandemic has brought out and the reality of being human in this pandemic.” Her talk was accompanied by illustrations and charts.

She provided basic statistical information, such as that Yerevan, with a 98 percent Armenian population of about one million and 26 percent living below the poverty line as defined there, has almost ten times the population of Cambridge, with a multicultural population almost 13 percent below the local poverty line. She compared the surges in Covid infections and concluded that with a total of 123 deaths in Cambridge and 4,463 in Armenia from Covid in total, there were significantly more deaths per capita in Armenia than in Cambridge.

Reactions to Covid in Cambridge and Armenia

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Both Cambridge and Armenia were able to identify superspreader events, Libaridian pointed out, such as the Biogen conference at the end of February 2020 in the former, and a woman returning from Italy to an engagement party in Echmiadzin or a factory outbreak in Yerevan for the latter.

Libaridian gave a general narrative about what happened in the Covid period in both places, which to a degree experienced similar realities, such as early states of emergency. However, in Armenia, unlike the US, four main strategies were initially used: everybody with Covid was hospitalized even if not symptomatic; any people with contacts who had Covid were isolated and monitored much more rigorously than in the US; testing was a main strategy; and hospitals were ramped up.

Schools and businesses were shut down, and opened up again only temporarily because the numbers of sick went up once more. The borders with Iran and Georgia were closed and there were a lot of difficult political and economic discussions about what flights from which countries to stop, she said. While people in Cambridge eventually experienced fatigue in conforming to health restrictions, an important difference was that masking, social distancing, and handwashing were much more difficult in Armenia due to social and cultural reasons. The limitations on gatherings, especially funerals, became impossible to impose, especially in November 2020 during the Artsakh war.

In Cambridge, Libaridian related, it was possible to repurpose health workers and building infrastructure for Covid-related use, and despite initial shortages of equipment and personal protective equipment (PPE), it was possible to keep on top of the situation.

In Yerevan it was a very different story. Hospital beds ran out so that patients in hospitals had to sleep on mattresses on the floor. Primary care in villages tried to send patients to Yerevan hospitals but there was not enough room, so patients with low oxygen saturation at home were told to open the window and stand by it to breathe, Libaridian said. Health care providers often would have to wait for one patient to die before giving the bed to another. Oxygen ran out, so that if you turned up one patient’s oxygen on a ventilator, the other one’s fell. The shortage of PPE supplies was an issue, especially in remote areas. Crowding took place in clinics, which led to further spreading, while testing rates were extremely low and testing capacity never increased to the extent it did in the US.

At some point, it cost 15 or 20,000 dram to get a test in Armenia, which is about $30-$40, depending on where you did it.

Armenia was influenced in approaches to treatment by various countries throughout the world such as the US, France, China, Georgia, WHO, etc., so the variety of guidelines was overwhelming, while the Armenian Ministry of Health’s resources were taxed. Many staff there too were falling sick.

Even today, Libaridian said, patients in Armenia get a laundry list of treatments, with too many antibiotics and steroids, and some might even be harmful. There is a lot of misinformation and it is difficult to communicate with providers who are overwhelmed and on the verge of collapsing. This was one similarity with the US, where health care workers also became overwhelmed emotionally and burnt out.

Effect of the Artsakh War in Armenia

As if the pandemic were not enough, Armenia was involved with a war with Azerbaijan in Artsakh. Libaridian gave a concise background for the non-Armenian listeners. She remarked that Covid numbers began to go up during the war, and though surrounding countries also had similar peaks at that time, she felt the war no doubt had an effect.

The most important one was noted by Dr. Armen Hagopjanian, a podiatrist who went from Los Angeles as a surgeon during the war. He pointed out that with patients with life or death threatening injuries, nobody cared about Covid when they came in. This, Libaridian stressed, was  a main difference of what was experienced in Armenia vs. Cambridge.

Dr. Hagopjanian, like many other doctors and nurses, got Covid while there, but continued to practice because there were no other providers, so Covid spread like wildfire. Libaridian said that she was in Armenia when the war ended and there was significant political upheaval. Very few in the large mobs and protests wore masks, as Covid seemed not to matter at that point, Libaridian said.

Volunteers who went to Artsakh from Armenia and abroad to fight took the virus with them, as did healthcare personnel. Families sheltered for days and weeks in bunkers without ventilation and then were placed on buses to Armenia, bringing back Covid.

The losses of thousands of lives of soldiers had a massive psychological effect on the Armenians as a nation. No masks were generally worn in funerals, and there are at least two documented cases of funerals turning into superspreader events, but no one cared any more. Libaridian exclaimed that the psychological effects were and still are astounding. They changed how people thought about Covid.

Another difference between Cambridge and Armenia is that Armenia has a diaspora which mobilized on two fronts, the Artsakh war and the war on Covid.

The Future

Hopefully Covid-19 vaccination will be the light at the end of the tunnel. Libaridian said that questions of trust, misinformation, disinformation, and equity along socioeconomic and racial lines continue during vaccination in Cambridge, but now there is an excess of vaccines and we need to understand as a society and city why people still are hesitant toward vaccination.

Armenia, she said, has the same misinformation and disinformation, and with the upcoming June 20 parliamentary elections [editor’s note: the meeting happened 10 days before the elections], vaccines are used as tools of criticism. Equity issues concern province vs. city in Armenia as opposed to multiethnic and multicultural roots in Cambridge. There are mobile units in Armenia as in the US to help increase vaccine uptake but it still remains very low in Armenia.

In Cambridge over 60 percent have gotten one or more doses of vaccine, though there are wide variations in populations ethnically and pockets not vaccinated. In Armenia, it is much lower, as the war had such a large impact on perceptions, Libaridian explained.

She pointed to a survey by the Republican Research Institute (IRI) about 1 ½ months ago, which asked households what their most important problems were. Healthcare was only the fifth most important. When asked what is the most important problem facing Armenia, healthcare and covid did not even make the list.

In sum, though there are similarities because of the human condition, as Libaridian termed it, the situation in Yerevan is very unique and very different because of the types of concerns Armenians have, especially as a result of the Artsakh war. All eyes were, during the time of the lecture, on the forthcoming election.

After the formal presentation, questions were taken from the audience. CYSCA’s president expressed a wish to continue a dialogue with Libaridian to see what CYSCA could do to help the Covid situation in Armenia.

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