Gen. Gielerak: Too often COVID-19 patients cannot get help and try to heal at home

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Vaccinations, building immunity, early identification of people who need to be taken care of by the system are a necessity to effectively fight the COVID-19 epidemic, the head of the Military Institute of Medicine, General Grzegorz Gielerak, told PAP. He added that in Poland, similar mistakes are made in each successive wave, including in terms of inadequate pre-hospital care for patients.

Polish Press Agency: Let’s start with pre-hospital care for COVID-19 patients. You recommended on Twitter the December position on this matter, the national consultant in the field of family medicine, Prof. Agnieszka Mastalerz-Migas. Are the recommendations contained in this document implemented in Poland? Is this care for patients in the early stages of the disease at the level that we are ready for in terms of staff and organization?

Grzegorz Gielerak (Military Medical Institute in Warsaw): What is the tragedy and failure of our fight against the SARS-CoV-2 coronavirus pandemic over the course of successive waves of infections? This is a question of very high unacceptable mortality. We are one of the world leaders in the excess death rate. This is a very disgraceful and incriminating statistic. Why is this happening? This is where reflection is needed. From my perspective, but also from every practitioner observing the situation in health care, from the very beginning, from the first wave, a very dangerous situation occurred. The outpatient treatment system – I do not want to say that it has shut down, but to a large extent – not quite as it should have been, has become involved in patient care. The effect of this was that the patients could not get the necessary help, which led them to attempt self-treatment at home. This resulted in the fact that in the 2-3 weeks the infections were often hospitalized. In very bad condition. If they did not choose home treatment, they tried to get to hospitals at all costs, which generally affected the efficiency of these facilities. It was a very bad practice, the original sin that was repeated in successive waves. Proper conclusions were not drawn from this.

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PAP: And here we come to the document, your consultant …

GG: Remember, however, that this is a document from the second half of December 2021. It is hard to say today that this document is not used because it is almost new. The discussion that I initiated, pointing to the high value of this document, I hope will find an answer from the community. We expected exactly such a document, such an approach to the issue of dealing with COVID-19 patients. In medicine, it is simply the case that good treatment is based on proper diagnosis, on good access to diagnostic methods, therapies, but also on the application in practice of procedures according to which such treatment will be carried out. We missed that. We cannot allow a situation where even medics from different parts of the country, driven by good will and their own experience, use radically different therapeutic methods. Medicine is a field strongly based on facts and evidence and recommendations based on research findings.

PAP: You do not have the impression, General, that the discussion began, among others thanks to the statements of prof. Piotr Kuna from Łódź, who in the fall drew attention to the renewal of this error, but the patient, the average Kowalski, still feels left to himself in the first phase of this disease. How can this be changed?

GG: Like prof. Since April 2020, Kuna has been paying attention to what patients are referred from other facilities to the Military Medical Institute. There was simply a gap between the way patients were treated in hospital X and hospital Y. Even then, it gave rise to a legitimate concern, from which we did not quite draw the right conclusions. In one of the articles, I pointed out that we had successive waves in which we were re-creating separate, different strategies each time. At the same time, the element – the most important in my opinion, namely the patient’s path through the various stages of health care, has not been refined in any way. After all, we currently have modern, very effective drugs against coronavirus, but they show their effectiveness only if we use them early enough, i.e. between 1 and 5 days after the onset of infection symptoms. Early diagnosis and the efficient path of the patient in the health care system are the decisive factors in reducing complications and mortality.

PAP: Can these errors be fixed somehow?

GG: At the level of primary health care in particular, you have to use the experiences we have from, for example, emergency departments. Already at the very beginning of the epidemic, we made triages in hospitals. Each patient admitted to the hospital is triaged initially, we assess his risk of infection, so as not to mix infected and uninfected patients. Nursing triage in POZ would be an equivalent of this. The second issue is, for example, assigning these patients specific admission hours.

PAP: For example, in the second half of the day.

GG: Exactly. If you come with a fever, cough or infection, you come at certain times. After this time, we perform decontamination and fumigation. In addition, there should be dedicated personnel with appropriate protection measures to handle these patients. It’s simple three steps. They are perfect for SOR. This would greatly enhance the functionality of primary health care, so that patients – I agree with your diagnosis – do not bounce off the door. So that they do not feel that they are in the system, but actually outside it.

PAP: In the face of the next wave of infections, shouldn’t we simply accept the fact that this virus will affect all of us, or almost all of us, and focus on targeted measures? After two years of the epidemic, we know what the risk groups are in this disease. Protecting the entire society by locking people into their homes – probably every common-sense person already knows this – is unrealistic, too costly, ineffective. Maybe in the face of this wave we should focus mainly on the strongest possible promotion of vaccinations and vaccine-like doses in people aged 50+?

GG: Absolutely. You hit the nail on the head. The goal of our Polish fight against the epidemic must be to reduce the mortality rate. It is not necessary, it is a necessity. It is necessary to increase the percentage of people vaccinated, especially in risk groups. In one article I referred to the statement of the spokesman for the Ministry of Health, who used the phrase that “today the most important task is to vaccinate children and adolescents”. It is not children and adolescents, 300-700 people who die every day in Polish hospitals. 50, 60 and 70-year-olds die in 80-90 percent of those who are not vaccinated. It is to them that you need to reach, the risk groups. We need to convince these people of the most effective and safest weapons we have in this epidemic.

Another very important element is the improvement of the health care system to make it efficient. That he would be able – as the consultant writes about – to take care of the patient at an early stage after infection. The physician should supervise such a course of action – make decisions adequate to the patient’s clinical situation. We have new, very good drugs that are over 90 percent effective – regardless of the variant of the coronavirus. I’m talking about Molnupiravir, Paxlovid, monoclonal antibodies. We have these drugs in Poland. We can use them in people who are at the highest risk of a severe course of infection, in people with reduced immunity. We should use all these advantages. There is only one condition for this – an infected patient must be quickly identified by the system. The whole procedure must therefore be conducted not so much on the basis of the conviction and good will of the physician, but rather on specific procedures.

PAP: Perhaps there is still a belief that we are able to tame the virus and fight its spread. This is possible in the world quite moderately – to put it mildly. Maybe we should switch our thinking to effective treatment of people, and not to fight windmills, i.e. the numbers of infections? Subsequent variants – like the Omikron – are more infectious and less virulent. There is little we can do about a larger number of infections, but maybe we can effectively help those who may die from this infection?

GG: Surely the evolution we see with the Omikron, which is the expected and expected path towards less virulence and greater infectivity, was predictable. It’s a natural process. However, let’s be aware, because this applies to any other viral disease, including seasonal flu, that there are people who will always be prone to its severe course, a high risk of death. These people will always – today, in a year, in five years – we will have a duty to protect. How? Through vaccinations, early medication, post-exposure prophylaxis. Let’s also not forget about building immunity.

PAP: We forgot about it at all, right?

GG: We must remember that it is our immunity that determines the course of the infection. We have well-documented data that patients taking the appropriate dose of vitamin D – reaching its concentration at the level of at least 50 nanograms per milliliter, are in the so-called the “zero mortality” group. You take a large dose of vitamin D and are protected against death. Is it so hard? Let’s do it massively. It is part of prevention, as is vitamin C intake, regular exercise and a proper diet. This is an asset that we should use at all costs. Vaccinations, building immunity and early identification of people who need to be looked after by the system. This is the basis. (PAP)

Tomasz Więcławski interviewed

Do you want to test your COVID-19 immunity after vaccination? Have you been infected and want to check your antibody levels? See the COVID-19 immunity test package, which you will perform at Diagnostics network points.

Gen. Gielerak: Too often COVID-19 patients cannot get help and try to heal at home

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