LVIV, Ukraine — The last thing on anybody’s mind these days in Ukraine seems to be Covid.
With millions of people on the move fleeing the Russian invasion, health systems disrupted, and testing and vaccination programs suspended in many places, health officials fear that conditions could spread disease. But the pandemic, they said, was no longer a top priority.
“People are not frightened about Covid anymore,” said Dr. Marta Saiko, head of the therapy department at the Clinical Municipal Emergency Hospital in Lviv, in western Ukraine. “People are frightened of the war.”
The chaos of war has made it impossible to gauge how the pandemic is progressing. Coronavirus testing has largely been suspended since the war began on Feb. 24, and physicians have been told to make an observation of clinical symptoms without bothering with a laboratory test, Dr. Oleksandr Matskov, deputy director of the General Public Health Center of Ukraine, said in a written response to questions.
As a result, new recorded cases have declined sharply in the last two weeks, but “the decrease also may be natural,” he added, noting that the Omicron variant surge was already waning before Russian troops and tanks crossed the border.
The invasion has brought attacks on some of the largest cities, including the capital, Kyiv, and the second-largest city, Kharkiv, causing an exodus of people and a breakdown in services. Half the population of Kyiv, a city of about three million, has left, the city mayor said this week. Other cities are under siege with little or no access to medical services, Dr. Matskov wrote.
Ukraine has a relatively low Covid vaccination rate, barely one-third of the population, and millions of people fleeing their homes have crowded into evacuation trains, resettlement centers, temporary housing and underground shelters — conditions ripe for a new surge of infections. The areas of Ukraine that remain relatively safe from the war for now face new problems as the medical networks in those regions are overloaded by the influx of displaced people, Dr. Matskov added.
For the average Ukrainian these days, Covid ranks low on the list of worries.
“It faded into the background,” said Oleksandr, 46, a seaman who was returning from his job in Norway to join his family in Odessa in southern Ukraine. He declined to give his surname for security in wartime conditions. “Our enemy is much more frightening.”
His company in Norway had insisted on very strict rules during the pandemic, he said, but in Ukraine no one was bothering. He was resting inside a tent at the railway station in Lviv, waiting for the night train to Odessa. The half-dozen people inside were not wearing masks.
“I am vaccinated and at home they all got sick with Covid already,” he said with a shrug. He was going home to defend his city and his brother had already enlisted, he said.
Recently, Ukraine has also been grappling with a rare outbreak of polio, which spreads through the kind of unsanitary conditions and water contamination that are common in a refugee crisis. Compounding the threat, vaccination for polio and other diseases has slowed worldwide during the coronavirus pandemic.
Europe had been certified as polio-free, but in October, 20 people in Ukraine tested positive for the virus, which can cause fever and paralysis, and then it spread to a second region in the country. The outbreak seems to have been contained, but two patients were affected by paralysis, Dr. Matskov said.
The outbreak was identified by genetic sequencing to match a variant in Tajikistan, indicating that the virus was brought by someone traveling from Tajikistan. It is hard to tell when the threat has abated, because most people infected with poliovirus show no symptoms, but can still spread it for weeks or months.
“The risk of the spread of polio has increased significantly since the beginning of the war, as there are crowds of people in shelters, places of temporary residence of refugees at the borders, which cannot provide adequate sanitation and hygiene,” Mr. Matskov wrote. “Due to the damage to the infrastructure and the humanitarian crisis, there are interruptions in the supply of drinking water and food.”
Like much of Europe, Ukraine experienced a coronavirus surge earlier this year, averaging more than 35,000 cases per day in early February, and more than 200 daily deaths by the middle of the month, according to figures compiled by Johns Hopkins Coronavirus Resource Center. The official figures declined rapidly from those highs — and then fell to zero in the days immediately after the Russian invasion, indicating a rupture in reporting.
Dr. Matskov said cases were once again being registered as before in the regions not directly affected by fighting. “For 9 March there were 6,112 cases and 115 deaths,” he said.
Russia-Ukraine War: Key Things to Know
On the ground. Russian forces, battered by the local resistance, have stepped up their bombardment across Ukraine, targeting locations far from the front lines. Satellite imagery of a convoy north of Kyiv suggests that Russia is repositioning its forces for a renewed assault there.
A punishing measure. In a move to escalate the economic pain on Russia, President Biden called on Congress to suspend normal trade with the country, in a coordinated move with the Group of 7 and the E.U. The change that would raise tariffs for many Russian products.
Iran nuclear deal. A European Union official said that talks on reviving the 2015 deal had paused following the invasion. Russia, a signatory to the accord, has tried to use final approval of the deal as leverage to soften sanctions imposed because of the war.
Disinformation push. Russia falsely claimed that the Pentagon was financing biological weapons labs in Ukraine — a lie repeated by Chinese diplomats. The Biden administration called out both countries, saying the United States might provide cover for a potential biological or chemical weapons attack on Ukrainians by Russia.
Ukrainians had been relatively disciplined about wearing masks inside shops and restaurants and on public transport before the war, but most people seem to have abandoned any protocol. As refugees have crammed on to trains and into station waiting halls, social distancing became impossible and there is barely a mask to be seen amid the crowds.
Dr. Saiko, at the hospital in Lviv, said she had 32 patients with Covid in her ward, four of them in intensive care at mid-week, she said. Only one patient had died this week, she said.
The caseload was much less than that of previous months, she said. “Now it’s usually four or five patients a day and it used to be 20 to 25 a day.”
She said cases could increase because of the influx of people into Lviv from other parts of the country, but the hospital has the largest Covid ward and can manage 730 patients at a time. Supplies, she added, were “good enough.”