COVID-19 pandemic in Bulgaria

On 8 March 2020 Bulgaria confirmed its first two cases, a 27-year-old man from Pleven and a 75-year-old woman from Gabrovo. Neither of the two reported having traveled to areas with known coronavirus cases. The man tested positive for the virus after being hospitalized for a respiratory infection, and authorities announced plans to test several people who were in contact with the two individuals.[2] Two other samples in Pleven and Gabrovo were found positive on 8 March.[3] Patient zero remains unknown.[4]

On the same day, the hospital in Gabrovo requested additional personnel from other hospitals in the country, as it only had three communicable diseases specialists. All of its internal medicine specialists have been quarantined after one of the four initial cases was confirmed to be a nurse at the hospital.[12] The government issued a nationwide ban on closed-door public events.[13] The origin of the outbreak remains unknown, and the Ministry of Interior is tracking down all individuals who have been in contact with the patients.[14] As of 8 March, 254 suspected cases were under quarantine across the country.[15]

Two additional cases were confirmed in Sofia on 10 March 2020: a 74-year-old man and his 66-year-old wife. Both have arrived from Lom two weeks prior to admission.[16][17] The woman died on the next day, becoming the first COVID-19 victim in the country.[18]

A suspected case of a 33-year-old man was reported by the Saint George Hospital in Plovdiv on 11 March.[19] The same day, a 40-year-old woman in Varna showed COVID-19 symptoms on CT scan, although regional health authorities have not yet confirmed the case.[20]

By 12 March, the number of cases had increased to 23, most of them in Sofia. Many of these had been in contact with the elderly couple admitted to the Pirogov Hospital on 10 March.[21]

On 13 March, after 16 reported cases in one day, Bulgaria declared a state of emergency for one month until 13 April. Schools, shopping centres, cinemas, restaurants, and other places of business were closed. All sports events were suspended. Only supermarkets, food markets, pharmacies, banks and gas stations remain open.[22] Additionally, all arrivals from Italy, Spain, Iran, South Korea and China were placed under a mandatory 14-day quarantine.[23] There were 13 breaches of quarantine; patients involved were returned to treatment facilities and warned of repercussions, including fines and prison sentences.[24]

On 14 March, a second death and a third case in Pleven were reported. The second victim of the virus was the 74-year old husband of the first victim.[25][26] Late in the evening on 31 March a Member of Parliament was tested positive for the virus. All MPs were urgently tested on the following day. If some of them are also tested positive, the Parliament will be adjourned. Options for the MPs to continue their legislative work (including voting) online from home under isolation are being explored.[27]

The number of confirmed cases in Bulgaria rose to 51 on 15 March. A total of 83 tests were done at the Military Medical Academy, of which six were positive, and 51 were processed at the National Reference Laboratory, of which two were positive. In Varna, one test out of 12 samples proved positive.[28]

The Ministry of Health announced that citizens from a number of countries would be prohibited from entering Bulgaria starting 00:00 on 18 March. These are China, Iran, Bangladesh, India, the Maldives, Nepal, Sri Lanka, Spain, Italy, South Korea, France, Germany, the Netherlands, Switzerland and the United Kingdom. Additionally, sanitary control units will be established on some border crossings with Serbia, North Macedonia, Greece and Romania.[29] The number of total cases rose to 62, including two British citizens vacationing in Bansko.

81 cases were reported, several linked to an outbreak in Bansko. None of the patients were in critical condition.[30]

The total number of cases increased to 94 by 18 March, with new cases appearing in Smolyan, Veliko Tarnovo and Pernik among recent arrivals from outside the country. The previous day, Bansko became the first town in the country to be put under quarantine.[31][32]

On 19 March the cases rose to 105 and an 80-year-old woman, who recently had a stroke, died from COVID-19 on the same day, making her the third victim from the disease in Bulgaria. Elsewhere, a 78-year-old Bulgarian citizen died from COVID-19 while visiting family in Pittsburgh, Pennsylvania. The woman, a choir conductor in Sofia, was uninsured and refused to seek medical attention.[33]

The total number of cases increased to 127 and the first recovery occurred.[34]

The number of cases increased to 142 by noon, and three patients had recovered. Two cities, Dobrich and Shumen, confirmed their first cases, the latter related to the Bansko cluster. There are 84 male and 58 female patients, the youngest being 4 years old, and the oldest 81 years old. More than 5,000 tests had been carried out, and an additional 10,000 tests would be made available at short notice.[35]

The cases increased to 218 and the first case in Stara Zagora province was confirmed. A man from the town of Kazanlak was admitted in the Infectious unit in the hospital in Stara Zagora. He is believed to be 60 years old and returned from France on the 14th of March.[36]

The number of cases increased to 242 by the end of the day, with the city of Sliven reporting its first confirmed case. 16 new cases with no relation between them were registered in Sofia, with some being medical staff from a local hospital. Two new cases were confirmed in Blagoevgrad, two in Plovdiv and one in Pleven. Two of the patients who were in critical condition were stabilized but remain "in stable but severe condition". One recovered completely, bringing the number of total recoveries to 5.

A total of 22 new cases were reported, bringing the overall number to 264. The coronavirus was registered for the first time in Kardzhali and Haskovo. 15 of the newly confirmed cases were in Sofia, 2 in Smolyan, one in Pleven, one in Veliko Tarnovo and one in Varna. Two people were admitted to hospital in critical condition, while three new patients recovered, bringing the number of recovered to 8. Three soldiers were confirmed to be infected – two were stationed in Kosovo and were immediately brought back to Sofia, and the other contracted the virus in Romania, where he was hospitalized.[37]

29 new cases were registered, with the total number reaching 293. From these, 17 were in Sofia, 5 in Plovdiv, 3 in Burgas, and one each in Varna, Kyustendil, Sliven and Pazardzhik. At least 93 people remained hospitalized, with 53 in Sofia alone.[38]

The total number of cases reached 331, an increase of 38 from the previous day. The new cases included 19 in Sofia, 5 in Blagoevgrad, 4 in Burgas, 3 in Varna, 2 each in Kardzhali, Plovdiv and Shumen, and 1 in Smolyan. Four new deaths were also reported, with two occurring in Blagoevgrad and one each in Kyustendil and Sofia.[39] The cases in Blagoevgrad, a mother and her daughter, were initially refused admission to the local hospital despite visible symptoms and had to request testing at a private lab; by the time the results came out as positive, the patients' condition had deteriorated significantly. They were eventually admitted and sent to intensive care, but both died shortly after.[40]

A total of 15 new cases were reported, with 8 in Sofia, 3 in Plovdiv, and one each in Kardzhali, Sliven, Smolyan and Varna. Three new recoveries were also announced, while the number of deaths rose to 8 after a 51-year-old woman died in the Blagoevgrad hospital, one day after her mother had succumbed to the virus. The Ministry of Health announced that 125 out of 324 active cases remain hospitalized, with 13 of those in serious condition. The total number of tests performed exceeded 7,000, with 276 done on 29 March alone.[41]

Thirteen new cases were reported, with seven in Sofia and one each in Blagoevgrad, Kardzhali, Montana, Pleven, Plovdiv and Sliven, for a total of 359 cases. 113 patients remained hospitalized, with 13 in serious condition. Around 56% of all those infected so far were male versus 44% female, with a median age of 45. The total number of recoveries rose to 17.[42]

The total number of confirmed infections increased by 40 to 399, and the first two cases were reported from the province of Silistra. 20 of the new cases were registered in Sofia, four each in Burgas and Kyustendil, three each in Plovdiv and Varna, two in Silistra, and one each in Kardzhali, Pernik, Shumen and Stara Zagora. The number of hospitalized patients increased to 146, with 14 in serious condition, while 20 medical workers were announced to have contracted the disease so far. No new deaths or recoveries were announced. From the total of 399 confirmed cases, just under 57% (227) were male, versus 43% (172) who were female.[43]

The province of Ruse reported its first case as part of 23 new infections across the country, bringing the total to 422. In addition to Ruse, 10 new cases were reported in Sofia, two each in Blagoevgrad, Burgas, Dobrich and Plovdiv, and one each in Haskovo, Kardzhali, Sliven and Stara Zagora. Two deaths were registered - a 57-year-old man in Kyustendil and a 40-year-old man in Sofia.[44] Hassan Ademov from the Movement for Rights and Freedoms became the first Bulgarian member of parliament to contract the virus, forcing the announcement of a mass test on 2 April that would cover government staff and all 240 MPs.[45]

The total number of infections increased by 35 to 457, with the first case being reported from the province of Vidin. The new cases included 20 in Sofia, four in Smolyan, three in Varna, two in Dobrich, and one each in Blagoevgrad, Montana, Pazardzhik, Plovdiv, Veliko Tarnovo and Vidin. No new deaths were reported, while the number of recoveries reached 25. 179 patients were currently hospitalized, with 18 in intensive care.[46] A further two MPs were among the new cases, both from the ruling GERB party, including their parliamentary group speaker Daniela Daritkova.[47]

The National Assembly approved the government's proposal to extend the state of emergency by one month until 13 May.[48] The confirmed case count reached 487, after 28 new infections were registered - 18 in Sofia, two each in Plovdiv and Smolyan, and one each in Blagoevgrad, Burgas, Kardzhali, Kyustendil, Veliko Tarnovo and Vidin. Four deaths were also announced, with one occurring late on the previous evening in Stara Zagora.[49] Male patients continued to account for just under 57% of all cases (versus 43% female), with a median age of 47.[50]

The Ministry of Health announced that the total number of COVID-19 tests had reached 15,899, with 8 laboratories performing the procedure across the country.[51]

The village of Panicherovo in Stara Zagora Province was placed under quarantine, after a COVID–19 positive man escaped from a hospital where he was being treated and returned to the village.[52]

The Ministry of Interior established checkpoints limiting movement in and out of the predominantly Roma-populated Sofia neighborhoods of Filipovtsi and Fakulteta.[53] The neighborhoods were categorized as COVID-19 clusters by the National Crisis Management center.[54]

In a late night emergency joint press conference of the Minister of Interior, the Minister of Health, and the Chairman of the National Crisis Management center, it was announced that entering and exiting Sofia would be severely limited until further notice following increased traffic out of the city before the Easter holidays.[55] Following numerous imported cases from Britain (e.g. a 78-years old Briton whose sister was known to have been infected by the coronavirus[56][57] and a Bulgarian repatriate from Varna[58]) the Civil Aviation Authority put a ban on all flights between Britain and Bulgaria[59]. The decree refers to the sharp increase in COVID-19 cases in that country for the last weeks surpassing the level in other concerned countries. Three days before the measure was implemented the Governor of Varna Oblast had expressed his apprehension regarding the flights between Varna and London.[60]

The ministry of Health announced the renewal of planned surgeries and hospitalizations, immunizations, child and prenatal care. These will be conducted under strict schedule on Tuesday and Thursday of each week. [61]

The hour limitations on entering and exiting Sofia were lifted. [62]

The prohibition of the passenger air traffic between Bulgaria and Britain was revoked after 11 days[63].

Compulsory mask-wearing in open public spaces was rescinded with a new decree by the Minister of Health.[64] National parks outside municipal boundaries, closed to the public on 20 March, were reopened, with local authorities commissioned to provide the organization for visitors.[65][66]

The first case in the province of Razgrad was confirmed, meaning that now 27 out of 28 provinces have proven cases of COVID-19. On this day also, was recorded the first death of a medic. A 43-years-old female doctor from Sliven died after contracting the disease. She worked in the Infectious Diseases Department in the city of Sliven.[67]

Dr Andrea Ammon, Director of ECDC, listed Bulgaria as the only country monitored by the Centre still seeing an increase in newly registered cases.[68]

Checkpoints outside provincial centres were removed and restrictions limiting inter-city travel lifted.[69]

Targovishte, the last Bulgarian province without any registered cases yet, had its first COVID-19 case confirmed.[70]

As of 14 May at 00:00, the national emergency was lifted, and in its place was declared a state of an emergency epidemic situation. Organ transplantations are allowed again after a 2-month ban. Parks are open for the use of all. Most of the anti-epidemic measures are still valid. The 14-day quarantine for everyone who enters the country remains. Schools and daycares remain closed, as well as shopping centers and indoor restaurants.[71]

Growth factor is defined as today's new cases / new cases on the previous day. It is indicative of the epidemic's evolution.

0 = No data

0 = No data

Data Source [109]

As of 24 March, there are 5 laboratories testing for COVID-19 in the country with a capacity of 300 tests per day. The total number of tests done by March 26 was 6,454, with 264 confirmed cases and a rate of infection around 4.1%.[134]

On 27 March, the Ministry of Health announced that the country now has the capacity to process between 1,000 and 1,200 tests per day, at an estimated cost of BGN 930,000 (EUR 475,000) per month. Two additional methods of testing would be introduced at later stages of the pandemic - fluorescence immunochromatographic tests (up to 20,000 per day) and the so-called 'quick' tests (up to 40,000 per day). Major General Ventsislav Mutafchiyski called all three types "equally important", as the PCR ones provided reliable data, while the fluorescence tests could speed up the process before quick ones are applied to establish how many people have acquired immunity.[135] However, Mutafchiyski later added that rapid tests are considered "unreliable" and therefore mass screening would be "meaningless".[136]

Conversely, Prof. Radka Argirova, chairman of the National Expert Board in Virology at the Bulgarian Doctors' Union, urged increased rapid testing in order to discover asymptomatic cases, avoiding the chance of a future second peak and terminating the epidemic progression.[137] "Aggressive, complete screening" of the population was also advocated by Dr. Rumen Hichev, a Bulgarian medical profession based in the United States and part of a medical advisor team to the White House. According to Hichev, the Bulgarian government had reacted quickly, but without mass screening to establish asymptomatic spreaders, any effort would be behind the course of events.[138][139]

On 5 April, the Ministry of Health announced a total of 15,599 tests had been performed to date in eight laboratories across the country.[51] The government announced that by 18th of April, 26 417 test have been performed.[140]

After testing positive for COVID-19, business magnate Kiril Domuschiev announced that his company will procure chloroquine from foreign sources and donate it to the national coronavirus task force. Chloroquine, a quinine drug, has shown positive effects on COVID-19 patients in China and France. The Bulgarian government is looking into import opportunities from China and domestic production by local pharmaceutical companies.[141] Exports of all quinine-based drugs were prohibited until further notice, and 35,000 doses of quinine-based Analgin for export have been diverted for domestic consumption. Another 250,000 doses of the drug can reportedly be produced on a short notice by local pharmaceutical companies.[142] On 3 April, the government negotiated the delivery of 171,429 packs of hydroxychloroquine sulfate and 30,000 packs of azithromycin from the China National Pharmaceutical Group.[143] The shipment was delivered using a NATO Boeing C-17 Globemaster piloted by a Bulgarian Air Force captain; the cargo also included more than 1,600,000 masks and 50 ventilators.[144]

Bulgarian biotechnology company Micar21 has been developing a general coronavirus vaccine in the past four years, and announced that it will begin clinical trials of a SARS-CoV-2 vaccine based on this research in mid-2020.[145] The company announced that with government support in funding and shorter clinical trial protocols, the drug could be synthesised in two months.[146]

According to a research conducted by the Institute for Health Metrics and Evaluation at the University of Washington, the pandemic was expected to reach its peak in Bulgaria in the end of April. The projections are assuming full social distancing through May 2020. The research lists 856 ICU beds in the country and projects no shortage of medical resources.[147]

Georgi Todorov, a Bulgarian doctor with experience in viral breakouts in Ghana, criticised the handling of the COVID-19 threat. In particular, Todorov stated that Bulgaria's health administration is so rife with nepotism that it cannot come up with any coherent response; as a result, infectious disease specialists were not taken into account when formulating response policies, and no specific locations were designated for potential COVID-19 cases. Todorov further assumed that infected individuals may have not been identified because of improper application of testing procedures.[148]

The Bulgarian government has enacted a series of measures aimed at reducing the economic impact of the COVID-19 pandemic to businesses and individuals.[149]

The so-called "60/40 measure" is a short-term instrument to help businesses retain their employees during the COVID-19 crisis. The state will cover 60% of employees' insurable earnings, as well as the social insurance contributions owed by the employer. The measure is in effect for the duration of the State of Emergency announced on March 13, 2020, but for no longer than 3 months.

The program provides state-backed, interest-free, zero-fee loans to individuals, deprived of the opportunity to work as an effect of the COVID-19 pandemic. The program is implemented by the Bulgarian Development Bank in partnership with a number of banks from the private sector.

Self-employed individuals and individuals under an employment contract are eligible for an interest-free loan of up to 4,500 BGN (2,300 EUR), with a grace period between six and twenty-four months, paid out in three monthly installments of 1,500 BGN.

The program, financed by the Bulgarian Development Bank, provides working capital loans of up to 300,000 BGN, aiming to provide liquidity to SMEs affected by the COVID-19 pandemic.

Small and micro-enterprises are eligible for state grants between 3,000 and 10,000 BGN, provided they have reported at least 20% drop in monthly revenue compared to the same month in 2019.

The board of directors of the Bulgarian National Bank established a private moratorium on loans repayments, as presented by The Association of Banks in Bulgaria, which allows for payments deferral of up to six months.