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Bulgaria’s Tale of COVID-19, Medicine, and Vaccination
Pandemic National Case Studies
“The mind reigns, the mind is enslaved, the mind grazes ducks.” -Bulgarian proverb
Sitting between Turkey and Romania along the Western coast of the Black Sea, bordering Greece to its South, and east of Northern Macedonia and Serbia, Bulgaria has seen the many chaotic transitions of European history: Mongolian invasions, the Ottoman Empire, and more recently Bulgaria sat at the edge of the Communist Bloc extending from Moscow through Eastern Europe.
Bulgaria’s Hunt for Medicine During the Early Pandemic
On March 8, 2020, Bulgaria confirmed its first two known SARS-CoV-2 infections, though there were likely others since neither case involved travelers to areas of known infection. Bulgarian physicians quickly began using chloroquine (CQ) and hydroxychloroquine (HCQ) to treat patients, reportedly sourcing supplies of HCQ from China, perhaps because the drugs were in disuse for some time in Bulgaria.
Bulgaria soon began production of its own supply (April 7, 2020) of the medications at the state-run Bul Bio laboratory. On May 7, 2020, Bulgaria began distribution of its own internally-produced supply of CQ.
While most nations in Europe suffered high case fatality rates (CFR) through June 1, 2020, Bulgaria’s was far lower, meaning that a smaller proportion of COVID-19 sufferers died in Bulgaria than in Europe (and also the world). However, Bulgaria’s CFR stood 2 to 20 times that of most other nations using HCQ, which might relate either to lack of supply or conditions unfavorable to immunity. Still, while France was banning HCQ, Bulgaria was opening back up its economy already. A study on prophylaxis and treatment of COVID-19 in healthcare workers (HCWs) (Simova et al, 2020) found zero hospitalizations or deaths among the HCWs using HCQ along with zinc. The prophylaxis (PrEP) result was consistent with numerous trials performed in India.
Through June 1, 2020, Bulgaria suffered less than a tenth of the per capita COVID-19 mortality seen in Europe. Through October 1, 2020, Bulgaria suffered less than half of the per capita COVID-19 mortality of Europe, ranking 60th in the world in COVID-19 deaths per million residents.
Until October, 2020, Bulgaria experienced no excess mortality during 2020 at all.
But something changed in mid-October around Europe, and it impacted Bulgaria harder.
Bulgaria suffers a harder Winter influenza and respiratory illness season than most European nations, as do most countries at the Western end of the Black Sea. Bulgaria lost control of the pandemic, and the substantial mortality differential relative to Europe evaporated.
Bulgaria’s Mass Injection Campaign
On January 18, 2021, Bulgaria began a vaccination program that has seen use of both mRNA vaccines (Moderna and Pfizer), the AstraZeneca vaccine, and the Johnson & Johnson’s vaccine. Startlingly, another COVID-19 wave broke out immediately that claimed more lives than Bulgaria lost to COVID-19 during all of 2020.
As the most recent wave began in Bulgaria, ivermectin came into use, though it is not at all clear to what degree, or how long it took to reach the proportion of the population that it reached. However, it does appear that in the chart above, the climb in cases gets disrupted in an unusual way.
Recently, Bulgaria’s 2021 Winter wave is subsiding. It has been worse than the previous two, which is unusual for a fast-spreading virus. Bulgaria went from having one of the lower COVID-19 mortality rates in Europe to the highest. As of December 1, 2021, Bulgaria ranks second in the world in per capita COVID-19 death toll. On a per day basis, since the start of Bulgaria’s vaccination program,
COVID-19 cases have approximately doubled.
COVID-19 deaths have more than doubled.
The COVID-19 case fatality rate (proportion of cases resulting in death) has increased.