– There are too many extremes in the decisions of the authorities. First, we were practically locked in our houses, we were not allowed to leave, then we were ordered to wear masks everywhere. And then, when the bans began to be lifted, practically all of them were lifted at once. For people, it meant the message “soul kick, hell is gone”: the restaurants were immediately full, all the seats on the buses were occupied, people returned to the churches, says the drug. Lidia Stopyra, head of the Department of Infectious Diseases and Paediatrics at Szpital Specjalistyczny im. Stefan Żeromski in Krakow, when I ask why the epidemic in Poland has been going on for 100 days and cannot end.
- – Certainly, if we extended the isolation and regimes, the recent increases in the number of new cases would not be there – says the drug. Lidia Stopyra. – But looking at it realistically: it is difficult to live in absolute isolation for years – he adds
- – The mood in society is very extreme. A large proportion of Poles approach the matter reasonably and follow medical recommendations. But at the same time, a very large group believes that someone invented this virus to get rich on vaccines – explains the doctor
- – We had a father with two daughters in the ward, both girls were sick and infected. They spent three weeks in solitary confinement, ate together, played together, and their daughters cuddled up to their father. My father did not catch it, although we have examined him many times. Beyond theory, you have to learn hundreds of human stories to learn about this epidemic, she recalls
- The doctor also explains that most viruses do not peak in summer, but from fall to spring, this will probably also be the case with coronavirus. – A tough autumn is ahead of us – he adds
100 days have just passed since the first confirmed case of COVID-19 in Poland. This date provokes various reflections. The first patient came to us relatively late. The epidemic developed slowly, in March and April we were glad that we managed to avoid the dramatic situations that took place in Italy or Spain. But today Italy and Spain are far behind the peak of the epidemic, and Poland is at the forefront of European countries when it comes to the number of new infections. What went wrong? What have we done wrong that the epidemic does not want to end in Poland?
It’s hard to say that something went wrong. It is true that the situation is difficult, because we have about 600 cases a day in the last three days, but Italians and Spaniards had several thousand in the worst period. Much worse is the fact that there is an upward trend in Poland all the time.
The first patients – as you mentioned – appeared quite late. The first patient in Poland was confirmed on March 4, in Krakow – on March 9. The first Polish illness was brought from Germany, the patient from Lesser Poland came from Italy. However, we did not have any infections from Chinese patients in Poland, which is why the epidemic in our country began much later.
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Initially, it was developing slowly, because we introduced relatively high sanitary requirements relatively early. The borders were closed a few days after the first confirmed cases.
All of this happened because we saw what was happening in Italy. There, the epidemic spread quickly, because it hit tourist and ski areas, and we all know what a ski bus full of skiers looks like at 17 pm – it is crowded, which favors the spread of the virus. Tourists then returned to different parts of the world, so the pandemic quickly spread across Europe. Poland, on the other hand, quickly closed its borders, which certainly translated into the initial control of the epidemic.
In the last few weeks, however, the restrictions have been loosened, and consequently – new outbreaks of the disease.
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However, it is worth knowing that regardless of the number of infections, we are in a much better situation. Polish patients suffer more mildly than Italian, American or Chinese patients. The percentage of patients requiring intensive care is lower, mortality is lower, and doctors and hospitals are much better prepared. Italians at some stage had to decide who to connect a ventilator to. There was a shortage of places in hospitals and intensive care units, which also increased the mortality rate. Not all respirators were used here, we had a lot of supplies.
So the scenario in which we have several hundred infections a day for many, and there is no end in sight, could not be avoided?
Well, for sure, if we extended the isolation and regimes, such an increase would not take place.
But looking at it realistically: it is difficult to live in absolute isolation for years. There were also different opinions. As a doctor, I am of the opinion that everything must be done to protect patients from infection, and if it fails – to treat them effectively. But you also have to remember that COVID-19 is not the only disease. There were also opinions that the coronavirus is much more dangerous than for our health, it is for the economy. It seems that the economic aspect at one point turned out to be decisive.
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As a practitioner, how do you evaluate the restrictions that have been introduced in Poland? Were they applied at the right moment? Taken off in the appropriate? Were the measures chosen by the government sufficient?
The mood in society is very extreme. Many Poles approach the matter wisely. But at the same time, I was surprised by the number of people who are able to believe in various conspiracy theories of history. I have read many opinions that the coronavirus is one big plot, that it was created by someone who participates in vaccines, that someone planted the virus in order to implant us some microchips or nanochips. The fact that people can believe such things is astonishing to me. This greatly weakens confidence in the authorities and the rules of the regime being introduced.
There are too many extremes in the decisions of the authorities. First, we were practically locked in our houses, we were not allowed to leave, then we were ordered to wear masks everywhere. Perhaps someone wise has calculated that at the beginning there will not be enough masks for everyone, and then there will be enough masks, perhaps he had the data to make such decisions. However, later, when the bans began to be lifted, practically all of them were lifted immediately. For the people, it meant the message “soul kick, there is no hell”: the restaurants were immediately full, the buses were full, people returned to the churches.
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Overnight, we went from harsh regime to full freedom, and the virus does not change and is spreading the same way all the time. Safety still gives us social distance and wearing masks.
It is true that we cannot stay locked in our homes for years, it is true that 90 percent of the coronavirus is it is asymptomatic or mildly symptomatic. But certain rules had to be kept for the safety of all of us.
In March and April, when Poles really wanted to wear masks, the Minister of Health did not recommend them and laughed at their effectiveness. Now that the number of infected has increased and the masks could protect us, but we are also tired of them, the minister relaxes the order to wear them. Do you understand any of this?
The coronavirus spread in March and April as much as it does now, so the rules should be the same all the time, a compromise between safety and nuisance. And logical.
In February and March we saw mostly dramatic pictures from Italy – murdered doctors, overcrowded hospitals, dying in the corridors of unaccompanied patients, lack of respirators. And then everyone in Poland got scared that this is how the epidemic looks like.
Then, when the first patient appeared in our country on March 4, and then another one, it turned out that the epidemic was much milder. We did not have such situations where we had to choose who to connect to the ventilator. There was a message in the media that the most seriously sick and dying were the elderly and people with burdens, so people felt safer in this situation. They stopped being afraid, I even heard voices that some would like to get COVID-19 and have peace.
Some are still afraid of infection, others are fed up with isolation, or have lost a lot due to the fact that they have not worked and see that the epidemic in Poland is relatively mild, they want to show the world that the restrictions do not necessarily have to be that serious.
I am curious where it will lead us. There are still many new infections, though so far it is not hard in terms of hospital space or access to ventilators.
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It is difficult not to combine the increase in new cases with the fact that there have been much fewer bans for a week or two. We left our homes and that immediately translated into statistics.
Two weeks ago, when society rejoiced at loosening the restrictions, I said: let’s be careful, such a sudden loosening of the regime will not be without consequences, the number of the infected will surely increase. The fact that this is so is a natural consequence of politicians’ decisions.
Now more depends on ourselves. Everyone knows very well what to do in order not to get infected: keep your distance, wash your hands often, wear a mask, even a disposable one, it protects you against infection in contact with the carrier of the virus. So maybe it is worth thinking that the mask can be a rescue, that it is not such a great inconvenience. Maybe it is worth having it on your face, not because we are afraid of a financial penalty, but for our own health. Thinking for yourself, instead of repeating the theories you read somewhere that bacteria and fungi live in the masks and we can suffocate from them. We now use masks all the time, my fellow surgeons spend half their lives wearing masks, and I can assure you that you can breathe in them.
How do you evaluate the behavior of Poles during these 100 days of the pandemic? We are disciplined and punished, we do what the authorities tell us? Or rather, as Poles do, do we try to get around these bans, repeat conspiracy theories?
The circle of my acquaintances, friends and many of my patients are people who represent a high level of knowledge and awareness. They ask the right questions and follow the recommendations of specialists.
I see it a bit differently when I look at Poles as a whole. We have something in our blood to stand up to power and be proud of it. I observe many conspiracy theories of history that are downright irrational.
A theory has emerged that, along with the coronavirus vaccine, we will be implanted with nanochips to track our behavior and monitor where we are. I will skip the fact that specialists have already said that it is not technically possible. And besides, it is enough to use social networking sites to release a whole lot of information about yourself to the Internet. You just need a mobile phone to be tracked. Various types of institutions already see a lot about us, we do not need nanochips.
There are many statements in the media by people who are not competent in medical matters, but who are very willing to comment on them. Not everyone can identify this information well.
On MedTvoiLokony, we try to explain and educate, but sensational and conspiracy theories will always find the widest audience.
For example, there was information in the media about the surfaces on which the virus is transmitted, and on which it lives the longest. The results of laboratory tests are given, which say that the virus was discovered at a large part of Krakow’s stops.
The reality, however, is a little more complicated. So far, around 40 children with COVID have been hospitalized in the ward I am in charge of. However, we generally have over 100 children in care, and these are always children with their entire families. And we can see exactly how the virus is spreading. Sometimes it is easy to get infected where there should, in theory, not be so many. Theoretical information is needed, but beyond theory, it takes hundreds of human stories to learn about this epidemic.
But there are also opposite situations: we had a father with two daughters in the ward. One was seven years old, the other was already a teenager. The girls were sick, symptomatic, they lived with their father in one solitary confinement. They sneezed and coughed, then the infectivity is higher. For three weeks the family stayed in solitary confinement, they ate together, played together, their daughters cuddled up to their father. My father did not catch it, although we have examined him many times.
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It’s very interesting. How accurately are you able to determine the place and time of infection?
First of all, we focus on diagnosing and treating someone. But the epidemiological inquiry is important.
If a new outbreak occurs, we follow the spread of the virus fairly closely for very practical reasons; we want to know more or less how many patients to expect. There is a bonfire in the monastery. It turned out that at the end of May, when the strict wearing of masks was no longer obligatory, masses were held in the monastery for up to 150 people who did not keep their distance. The probability that they will get sick is high.
Since we serve Małopolska, but also part of Silesia, I am observing the situation among miners with interest. We know that they go underground in small elevators, they are close to each other, they work together in long shifts, it is obvious that they infect one another.
In recent days, the number of daily cases has increased quite significantly, but the number of tests has been around 20 for many weeks. daily. We don’t do more tests, but we have more patients. Why?
If an outbreak occurs and the sanitary regime is lifted, the outbreak immediately spreads.
If someone is very sick and does not leave the house – it will not infect anyone. If he is infected but asymptomatic and he comes out but wears a mask – probably not. Even if other people live with it, but cover their nose and mouth, they don’t have to infect anyone either. On the other hand, if someone who rides the small elevator with other people every day becomes infected, the chances of spreading the virus are huge. This is what is happening now among miners.
As for the tests – apart from the quantity, a lot depends on who we are testing.
If we test a group of IT specialists who have been working remotely from home for three months, the number of those infected will be small. If we test the miners at the outbreak – we will detect many infected. And the number of tests will be the same.
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What about the peak of the epidemic? Everyone is waiting so much for him. When will it finally come, when will it be finally over?
It is difficult to pinpoint the peak of the epidemic, because a lot depends on the decisions of the authorities. If the regime returns to full regime in a week’s time, the number of new infections will surely drop. And if not – it may continue to grow.
Besides, this virus cannot be completely eliminated. We have to learn to live with it, develop methods of minimizing the risk and act in a way that it is not too burdensome.
However, it is worth remembering that most viruses do not peak in summer, but fall to spring. These are viruses that cause infections of the upper respiratory tract, influenza, parainfluenza, rhinoviruses, astraviruses and all kinds of coronaviruses. However, in summer there is always less disease, it is warmer, we spend more time outdoors, we open windows more often, many places where viruses spread, such as schools, are closed.
If the course of the coronavirus epidemic were natural, without any regimes, we would expect declines in the summer. Conversely, if the regime was in the spring time, the incidence of upper respiratory tract infections and flu has dropped sharply, now that the regime has been relaxed, we see an increase again.
So for sure in autumn there will be even greater growth, because we always observe an increase in upper respiratory tract infections in autumn, not only with coronaviruses but also with other viruses. We must prepare for such a situation that every patient with an infection, regardless of whether it is influenza, coronavirus or any other disease, will be suspected of having SARS-CoV-2. It will be isolated, the staff will work with personal protective equipment, this will reorganize the operation of hospitals. How many of these fall infections will be SARS-CoV-2 and how many flu? It all depends on how many people get the flu shot.
We will also have one more big problem that has already appeared: because everyone is afraid of the coronavirus, people with heart attacks and strokes later reach the right departments.
In terms of organization, we are in for a tough autumn.
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This does not sound optimistic.
It is optimistic that the FDA has approved remdesivir and we have a serum of convalescents available, and there will be more and more of these convalescents. In the serum of convalescents, i.e. people who have recovered, there are antibodies to the coronavirus, we can take these antibodies and give them to a sick person. They neutralize the virus and thus support the healing process.
This is how it naturally recovers from an infection. If a microorganism enters our body, we produce antibodies that neutralize the virus and we recover naturally. If we lose this fight, we fail to produce antibodies, we get seriously ill, and may even die. However, if we can collect these antibodies from the donor and give them to the sick, we gain a weapon in the fight. This is a great asset that neither the Italians nor the Chinese had.
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Every now and then the media informs about new drugs that are the hope of fighting the coronavirus, but there is some controversy around each of them, information about side effects and ineffectiveness. What does the topic of drugs and vaccines look like from your perspective?
For us to feel safe, we need either a vaccine or an antiviral drug, or both. Therefore, enormous efforts are being made both to produce the vaccine and the drug.
When it comes to the vaccine, let me say right away that it’s not that everyone wants to be the first and only because they want to do big business.
No pharmaceutical company will have such processing capacity that there will be enough vaccines for everyone at once. In Poland, we are constantly struggling with the problem of the lack of vaccines, e.g. now there is no vaccine against HPV, which causes cervical cancer. It is enough for a few large countries to buy this vaccine for population vaccination, that is, for several million teenagers, and it consumes the entire production of companies that sell these vaccines.
Even if dozens of companies produce a vaccine for Covid, it will not be available to everyone, so speculation that there will be compulsory vaccination is pointless. Rather, it will be a problem at first to get the vaccine when it comes out.
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However, when it comes to drugs, there are two paths: try to use those that are already on the market and at the same time look for new ones that directly destroy the coronavirus.
Of course, in some patients with a mild course, we will not have to use it, the immune system will cope with the destruction of the coronavirus on its own.
There are currently two groups of antiviral drugs that are being tried to be used to fight the coronavirus. The first is anti-HIV drugs. They have been proven for many years, there are a lot of HIV infections in the world, so we know very well what these drugs have side effects, how they work, in what doses to use them, it does not require special tests. Hopefully, since there are some parallels between HIV and the coronavirus, a drug that works against one virus will also work for another. So far, reports on the effectiveness of the treatment vary.
We also have a second group of drugs, such as chloroquine – it is a drug originally used in malaria, i.e. an antiparasitic drug. They do not affect the virus directly, but the inflammatory response that the virus causes. And this inflammatory reaction damages tissues enough that you can die from it. So the idea is to weaken that inflammatory response. Hence the use of chloroquine. There has been a lot of talk lately about the side effects of this drug. This report does not surprise us, it is well known to us, because many patients are taking this drug. it is also used in rheumatic diseases. Let’s be reasonable.
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