– Nobody is hiding that it is hard. The medical staff is exhausted and there are places where there are shortages, so we removed the rigid criteria for the number of staff in individual departments, so that the management of the hospital itself decides where to move people. There is a good situation with equipment – says the Minister of Health, Dr. Adam Niedzielski, economist and expert in public management, in an interview with the editor-in-chief of Medonet, Dr. Anna Zimny-Zając. We invite you to the next installment of the #Gość MedTvoiLokony series.
- In the interview with MedTvoiLokony, the Minister of Health analyzes the current epidemiological situation in Poland and reveals the plan for the time after the pandemic. He talks about three elements that will be introduced to take care of Poles’ health – incl. research for people aged 40+
- Adam Niedzielski explains why the spike in coronavirus infections was a surprise for the Ministry of Health: it turned out that the models used do not have the ability to forecast the turning point
- Are we at risk of a national quarantine? No, if we follow the restrictions and the number of new infections will remain at the current level
- You can find more interviews on the TvoiLokony home page
Anna Zimny-Zając: It will be three months since you became the Minister of Health. How do you evaluate this time?
Adam Niedzielski, Minister of Health: Apart from the fact that during this time I have aged ten years, that I sleep little and still sit at work, and the number of e-mails and text messages that come to me exceeds 200 a day, that’s generally okay.
But taking your position in the midst of a pandemic, you probably didn’t expect it to be easy?
I certainly did not expect to have an easy and pleasant office.
Anyway, during the talks with Prime Minister Morawiecki, who made me a proposal to take the post of Minister of Health, we spoke in our spirit: “blood, sweat and tears”, and not profits. You could say that I accepted this offer with all the benefit of my inventory.
I knew immediately what I was signing up for. However, I did not expect that so soon, i.e. only two months after taking office, I would have to deal, firstly, only with COVID-19, and secondly, that the escalation of the coronavirus pandemic would be so large.
What did you expect?
A continuation of an uptrend rather than a sudden jump that occurred in October. Until recently, the limit of 10 thousand. new coronavirus cases per day seemed abstractly high, and from today’s perspective, we consider it to be a “safe” level.
Of course, objectively speaking, 10 thousand. new cases translate into the occupancy of the hospital system with a thousand COVID-19 patients per day, which is absolutely not optimistic, because we all know what the healthcare workload looks like. But looking from the perspective of almost 30 thousand. daily infections we had at the beginning of November, 10 thousand. is much better news.
Unfortunately, despite the fact that I have four external analytical teams at my disposal, which means four models for the development of a pandemic, none of them predicted such a jump in infections as took place in Poland in recent weeks. These models turned out to be unable to predict the turning point. They are good for short-term forecasts and simulations, but have not worked well for picking up the acceleration point.
See also: Coronavirus in Poland – current data [MAP AND CHARTS]
Already at the end of September, when out of several hundred we reached over a thousand new cases of infections a day, hospitals appealed that the beds were running out and the medical staff was short of time. At present, despite the increase in the number of beds and respirators, the situation looks bad.
Nobody hides that it is hard. The medical staff is exhausted and there are places where there are shortages, so we removed the rigid criteria for the number of staff in individual departments, so that the management of the hospital itself decides where to move people. The situation is good with equipment, because there is such equipment and we can increase the amount of it in hospitals at any time. We are transforming more hospitals and departments into COVID. We make difficult decisions every day, difficult decisions are made every day in hospitals.
Fortunately, in Poland we have more hospital beds per citizen than in many other countries, which paradoxically saved us a bit in this pandemic situation, because at least we do not have to worry so much about the fact that there will be no wards, no beds, no infrastructure. Of course, the infrastructure itself does not heal and the lack of staff as it was, is a huge problem now.
At the end of October, we exceeded the number of 20. new infections daily. Where, in your opinion, came this huge leap, which – as you mentioned earlier, was not expected by the Ministry of Health a month earlier?
Despite the surprise, the answer is actually very simple. First, we went from remote mode to normal life. The children went to school, many of us went back to work in offices and workplaces. On the other hand, the surveillance regime has clearly weakened after the summer, we have got used to the coronavirus.
During the holidays, nobody wore masks and there was such a conviction that basically nothing was happening – “because we do not follow these rules, so guarded in the spring, and we do not see that the epidemic is accelerating”. But we went back to work and school in September, and this failure to comply with the regime led to this surge of new infections. It’s not that there were bonfires in schools, because there were really few of them, it’s about the number of social interactions, which increased significantly in September.
Fortunately, after great increases, exceeding 100 percent. week to week in October, now the situation is stabilizing.
What about changing your testing strategy? In September, the focus was on testing symptomatic patients and those at risk. And this, as many experts emphasized, meant that we omitted asymptomatic people who, as we know perfectly well, can also be infectious.
In line with our strategy, which is based on discussions with experts such as national consultants, we focus on testing symptomatic individuals, capturing them and isolating them. We have delegated the authorization to refer to the test to the doctors who have the best knowledge in this field. But at the same time, all patients admitted to elective procedures, for example in oncology, have been and are tested regardless of their symptoms.
Sanepid still collects people at risk of infection. The questionnaire, which is used for scoring when referring to the study, obviously takes into account the elements of risk, not just symptomatic issues.
But is it possible to announce that the situation is stabilizing if we do not catch asymptomatic people who may be contagious? In addition, for a week we have seen that the number of tests performed has dropped significantly.
Our testing system is set up so that fewer tests already reflect fewer symptomatic patients. Since GPs refer fewer people to the examination, it means that the number of people suspected of being infected with the coronavirus is decreasing.
By performing over 80 one day of research, which had already taken place, we reached the limit of our efficiency. Of course, we can move them further, the only question is whether it will be fully rational.
We concentrate our forces where the risk and threat are greatest. Certainly never any country, even with enormous increases in testing, will be able to catch all asymptomatic infected. It is physically impossible, because most of these people will not come to the tests because they will not find an indication for it.
We are now introducing antigen tests, which allow us to slightly expand the scope of testing. One million of the latest generation antigen tests have already arrived, and the target number will be two million. They will also allow for quick testing of medical personnel.
However, WHO estimates that in order for us to be able to talk about the fact that the epidemic in a given country is under control, the rate of positive tests should not exceed 5%. Poland, on the other hand, is a leader in Europe, with the percentage of positive tests over 40 percent.
This is not an indicator of whether we are controlling the epidemic or not. This indicator is whether we have a buffer of beds and ventilators for admitting patients. And we now have over 14 bed reserves and over 800 buffer of respirators. And these are not fictitious beds, but precisely verified our states.
However, when it comes to this high percentage of positive tests, it is like that, because this is our testing policy. In health care centers, we focus on testing symptomatic people, hence this percentage of positive tests is higher. Doctors refer to tests with increasing accuracy.
See also: 40 percent COVID-19 tests return positive. The worst result in Europe
But I will come back to these anaerobic people again. Those that are often unconsciously infectious. Shouldn’t we aim to test as many people as possible? In Europe, Poland ranks 40 in terms of testing per million inhabitants. Only Hungary, Macedonia, Bulgaria, Bosnia and Herzegovina, Moldova, Ukraine and Albania are behind us. Do you think our testing system is really good?
I do not like these international comparisons for one reason – each country has different conditions, different efficiency of the health care system. One cannot draw conclusions about how a pandemic is developing in both countries, i.e. the number of surveys carried out in the population.
Moreover, the PCR test is extremely sensitive. So what if we will test instead of 80 thousand. for example, 150 thousand people when we do not know which asymptomatic people can infect and which do not – because there are no tests that would be able to distinguish it. The antigen test, on the other hand, is hypersensitive.
I believe that the number of tests we do in the system of testing symptomatic patients – I am talking about politics at the level of primary health care, as well as tests ordered by the health care department and hospitals, this is a mix of rational approach in various areas. We test so that we have high efficiency. And some will say that this is a symptom of a large-scale pandemic developing, and I can say that it means that we have a good testing policy, that we are targeting our resources where it should be aimed.
I am impressed that everyone in Poland knows each other not only about football, but also about covid. I bet that if we were to make a policy according to the premises you are talking about, there would be voices about wasting funds in a moment, because one PCR test is currently valued at PLN 280. There would probably be an argument that the low accuracy of the tests means that we are trying to dilute this epidemic.
See also: Coronavirus infection can be asymptomatic. How to recognize it? [WE EXPLAIN]
I am afraid that when we mention the waste of money by the government, we are entering a shaky ground …
I admit that since I took office, I have the impression that everything that the Minister of Health does is interpreted in bad faith. And this is a phenomenon that I honestly admit I have never encountered before in my professional work.
And yet without building this social capital, that is, full trust and such a sense of shared responsibility, it is really hard to change anything.
Social capital is extremely important. However, did the actions of the previous health minister and the government, which raised many doubts, cause this trust to melt all the time?
Even assuming there are grounds for having limited confidence, what? Does this mean that I should leave the office? That the Ministry of Health is to stop working? After all, it is known that this is not the case. We just have to break it.
If anyone has a need for inquiry, let them do so. Only the time is right for that too. At present, however, we must concentrate all efforts to get rid of this filth as soon as possible, ugly – in the sense of a virus. And an extremely important element of this fight is the social capital that I mentioned. When the pandemic ends, it will be time to hold us accountable for our work. I am open to it. Now there is no opportunity for normal debate.
Currently, the most terrifying thing for all patients is the fact that when their health and life are in danger and they call an ambulance, they may not be admitted to the hospital. We hear about such situations often recently, and with them the statistics about empty beds or free respirators seem like creative accounting. Especially in the largest cities.
Unfortunately, I know that such situations were the case, and that is why we have built a mechanism for monitoring the current bed occupancy, introduced a coordination mechanism in crisis management teams and conducted direct consultations with hospital directors. I am not saying that these situations will disappear, because they appeared even when the epidemic did not exist, but in a management sense we reacted in such a way that there is no escalation of this phenomenon. There will always be some misunderstandings or mistakes, but I hope there will be fewer of them each day.
Unfortunately, the opening of the temporary National Hospital does not seem to improve the situation significantly.
The hospital was opened last week and it is obvious that during the first days the staff is organized and trained, all procedures that were previously only on paper are implemented. Meanwhile, it is immediately settled that he does not admit the most seriously ill patients from the very first day.
Minister, only we have heard many times that temporary hospitals were planned already during the summer holidays. We are currently in mid-November, which means that we have the right to doubt whether everything that should have been done in the summer has been done.
Of course. It is me who will say something not from the perspective of the minister of health, but of the president of the National Health Fund, which I was still in the summer. In fact, from the beginning of the summer holidays, I had a clearly defined priority at work to defrost the healthcare system as quickly as possible. Because in addition to the fact that we have patients with COVID-19, we also have quite large health negligence regarding other diseases, we have a health deficit – because that’s how we define it – related to, among others, oncological and cardiological diseases.
In my opinion, we used the time of summer quite well to restore the functionality of the health care system to the greatest possible extent, which was largely successful. And this, of course, was not a preparation for the second wave, but was making up for a certain health deficit.
The second thing is that we have reorganized the entire supply system with equipment needed for hospitals, such as personal protective equipment or respirators. There is no shortage of respirators in Poland, and there are also temporary hospitals, where beds, cardiac monitors or other, often very technical, small-scale devices are also placed. So we used the summer to make big purchases. Now we are incomparably better protected with various types of equipment compared to what was in the spring.
You mentioned your trust in the Ministry of Health. Certainly, access to data would help in building it. Unfortunately, despite the fact that you provide daily statistics, nowhere on the website of the ministry can we check what the situation looks like over the course of weeks or months, while most countries provide all such data to their citizens. Poles must use data collected, for example, by Medonet, scientists from data collected by enthusiasts …
When I became the Minister of Health, it obviously caught my attention. Therefore, for some time we have been working on a platform that will provide all data on the development of the pandemic in Poland. It is possible that it will be available next week.
The number of new infections reported in recent days indicates that the vision of a national quarantine is fading away for now. You are talking about stabilization. But is this not premature joy?
Everything is in our hands. The data now shows a stabilization. If this is the case, then there is no risk of introducing new restrictions. If we are already more than a week after the introduction of large restrictions, we should rather expect a decrease in the number of infections, as the number of interactions decreases, significantly reducing the chances of transmission of the virus.
What’s my prediction? It’s a bit like the financiers say – stabilization with an indication of potential improvement.
The pandemic will pass someday. Unfortunately, the health problems of Poles will not go away with it. The tragic situation of Polish psychiatry, chronically ill patients whose treatment is currently neglected in many cases, or people with cancerous lesions who will be diagnosed late are just a few of the burning topics. Does the Ministry of Health have a post-covid plan?
We have a recovery plan prepared, waiting in the drawer. It consists of three elements. The first is screening for people 40+, because this age group is the most vulnerable to health neglect and chronic diseases and we will start this program as soon as the situation stabilizes.
The second element is the introduction of complete delimitation in the specialist, comprehensively everywhere. This will also apply to outpatient psychiatry.
The third element is to strengthen certain coordination mechanisms. We will extend the National Oncology Network to the entire country, because we can see that the cooperation between POZ and reference centers is working well. The person who coordinates each patient who conducts the treatment process plays a particularly important role here.
We will do the same in the field of cardiology and this is where the National Cardiology Network will be created. We will also continue the reform of psychiatry. First of all, we will return to what the pandemic has kept us from, i.e. environmental care competitions, because we want to fundamentally change this model from a hospital to community care. I think we are actually catching up with some backwardness both on the level of adolescent psychiatry and adult psychiatry.
So there is a plan. Finally, I would like to ask: how does the minister of health care for his health?
After the age of 40, I started to run regularly, but unfortunately I have to admit that since I took the office of the Minister of Health, I do not have much time for it, because my work takes me 15-16 hours a day. I leave the house around seven in the morning, I come back only after 21, 22. And I must admit that I go to sleep almost immediately. I need to get enough sleep to work efficiently, so make sure I have at least six hours of uninterrupted sleep.
On my free days, which are rare in my case, I try to set aside an hour for a walk, because being in the fresh air has a building effect on health and I recommend this activity to everyone.
So far, fortunately, I have not been infected with the coronavirus, although I have had contact with a very large number of people, including sick people. Overall, I think the risk of contamination in my office is high. Therefore, as in the case of each of us, it is extremely important for me to follow the basic safety rules – keeping distance, wearing a mask and disinfecting.
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