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– We are inhibiting the transmission of the coronavirus at all costs, but it does not help. Our actions do not prevent it from spreading, says the drug. Paweł Basiukiewicz. Meanwhile, the costs of such an approach are enormous. We have been living in the reality of a constant state of emergency for over a year. What’s more, it turns out that this time has brought over 90 thousand. excess deaths are one of the worst results in Europe. Why did this happen and how can the situation be improved? The doctor wrote about it in the report «Not a single tear. Healthcare in a pandemic ».
- Last year brought over 90 thousand. excess deaths in Poland. These are partly covid deaths, but also cases caused by healthcare failure in the COVID-19 pandemic
- The collapse of the health care system includes, among others, its under-financing, shortage of staff, but also the adoption of erroneous assumptions in the fight against coronavirus – says the doctor
- Paweł Basiukiewicz presented his recommendations, thanks to which the situation in the health sector could improve. Some of the proposals are controversial
- Do you want to live longer? Make a simple test and find out how!
- You can find more such stories on the TvoiLokony home page
Over 90 excess deaths in Poland
– We are approaching the limits of the health service capacity, we are one step away from crossing the border beyond which we will not be able to properly treat patients, heal our citizens – Prime Minister Mateusz Morawiecki said during the Thursday conference announcing the tightening of the lockdown. However, the ineffectiveness of the Polish health care system has been talked about for a long time, before we even heard about SARS-CoV-2.
Today, however, after more than 12 months of living with the COVID-19 epidemic, Poland has over 90 the so-called redundant deaths (partly caused by the coronavirus). This is one of the highest rates in Europe.
– There were not so many of them in Sweden, which has a similar profile of deaths from COVID-19 per million inhabitants, in Germany virtually excess deaths have not been recorded – the drug points out. Paweł Basiukiewicz, Head of the Observation and Infectious Department of the Western Hospital in Grodzisk Mazowiecki and the author of a report on the situation of Polish health care during the pandemic entitled «Not a single tear. Healthcare in a pandemic »(as he points out, it is a subjective view).
Sebastian Stodolak from the Warsaw Enterprise Institute (WEI, a foundation focusing on key areas for the business environment and improving Poland’s prosperity) points out that excess deaths are partly covid deaths, but also deaths caused by the health care situation. In the report, Paweł Basiukiewicz speaks directly about the collapse of the efficiency of the Polish health care system, which we will struggle with for years.
What problems does our healthcare service face, what does it lead to and what can be done about it? Paweł Basiukiewicz included these issues in his report.
Polish health protection against the COVID-19 pandemic. The problems
We have been hearing about the crisis in Polish health care for years. However, as Paweł Basiukiewicz points out, before the pandemic, it did not stand out from other countries “in any extraordinary way – apart from the ongoing chronic under-financing”. As the doctor notes, our expenditures are two or three times lower than in other EU countries.
There is also some positive information. The data for 2018 shows that in terms of the number of hospital beds, we were at the forefront of Europe, clearly exceeding the European average (473 beds per 100 inhabitants). If you add beds in sanatoriums, inpatient rehabilitation wards and neonatology wards, «in Poland at the end of 2018 there were 248. beds (approx. 652 beds per 100 inhabitants) »- the report reads. The percentage of occupied places in hospitals in Poland was 67%, which, compared to other EU countries, constituted an above-average «buffer». So it seems that “Poland was relatively well prepared to hospitalize a large number of patients in a short period of time” (although it should be mentioned that the number of places in intensive care is low).
More, as Paweł Basiukiewicz points out in his document, “What made the Polish health care system unprofitable in the long run (the need to maintain a large number of hospital places and not using these places), paradoxically turned out to be an advantage in the event of an epidemic threat related to the need to hospitalize a large number of people”.
It may come as a surprise that even in October 2020, when there were a lot of cases of patients with SARS-CoV-2 infection requiring hospitalization, there were often no vacancies in hospitals, and ambulances stood for hours on the ramps or circulated between hospitals, the number of hospitalizations was a year dropped by 35 percent in a year! So why were patients not getting help?
As the author of the report emphasizes, in order to adequately respond to a pandemic, it is not enough just to have an appropriate accommodation and equipment base, but also to have a properly trained staff of specialists (doctors, nurses). Meanwhile, we have been struggling with a huge deficit of medical personnel for years. – We have twice as few doctors per 100. inhabitants than Germany, much less nurses – says Basiukiewicz.
Fighting COVID-19 in Poland. “One mistake gave birth to another”
In the opinion of the author of the report, the problem was also the adoption of erroneous assumptions in the fight against the coronavirus, and then persistence with them. “One mistake gave rise to another, and institutional indolence was deepening”, the doctor notes in the report.
The specialist speaks of “a reaction to the appearance of a virus”. As he explains in the report, “the main method of combating the pandemic in Poland is an attempt to postpone the problem by extending the presence of the coronavirus, i.e. curve flattening using drastic and increasingly controversial non-pharmaceutical methods. The extraordinary isolation and disinfection procedures used in health care, protecting against the possibility of infection, lead to neglect in the field of diagnosis and treatment of patients suffering from “COVID” and “nonCOVID” ».
One of the examples given in the report is the isolation and quarantine of people who have come into contact with an infected or suspected person. “The costs and damage caused by the massive isolation and quarantine of citizens suspected of being infected have never been counted.” – the doctor points out, reminding that such a person cannot leave the house, go shopping or see the doctor (except in exceptional circumstances).
Meanwhile, as the report reads: «The risk of transmission of an infection by a person in quarantine is very low (healthy people stay in quarantine after contact). The risk of transmission by an asymptomatic person staying in isolation due to a positive test result is very low, as it has been proven that asymptomatic persons do not infect or their infectivity is minimal, and presymptomatic persons (asymptomatic persons 1-3 days before the onset of symptoms) constitute approx. 25 percent basically asymptomatic people »(…)« Considering that we do not recognize all infections (we probably recognize about 10% of all infections) and taking into account the damage and harm done to citizens who are sentenced to extrajudicial house arrest for at least 10 days that the epidemic benefits outweigh the costs is at least questionable. Moreover, such a calculation was not carried out »- emphasizes the specialist, noting that “The isolation and quarantine of contacts must be abolished as an intervention that violates the individual’s civil rights and liberties”.
Among the problems indicated in the document by the doctor, there were also “mass quarantine and isolation of staff – often without symptoms or with flimsy symptoms, recommendations of scientific societies ordering the maximum reduction of time allocated to the patient, special restraint in planning and performing diagnostic and therapeutic procedures, mass performance of the PCR test, which, as mentioned, does not accurately identify the sick and infecting person, mass quarantine of families preventing normal functioning or obtaining help (and even hindering self-help) ». The specialist also mentions the prevailing social chaos, the state of “pseudo-war”. It all adds up to the aforementioned shortage of staff.
- The third wave of COVID-19. What is happening in health care? Doctor: we’ll crash into people
– At any cost, we inhibit the transmission of the coronavirus – admits the doctor. – As we can see, it doesn’t do anything. Our actions do not prevent the virus from spreading.
Meanwhile, the effect of the observed over-reaction to the appearance of the virus is an increasing health debt, i.e., as Basiukiewicz explains, a delay in the provision of services in all areas of medicine. “These excess deaths should be viewed as a very high interest rate on this debt”, admits Paweł Basiukiewicz in the report.
COVID-19 in Poland. How to improve the functioning of health care today?
How can healthcare be improved today in a pandemic? In the report, the doctor included specific recommendations, emphasizing that “Methods of fighting the virus in health care should be based on the principle of risk acceptance”that is, acknowledging and accepting the fact that it is not possible to completely stop transmission of the virus, even by the most drastic methods. What actions does Paweł Basiukiewicz recommend?
1. Discontinue the use of tests in asymptomatic individuals and use them only in patients (symptomatic).
2. Do not isolate the personnel (after the completion of the vaccination campaign for medical personnel, this problem will generally cease to exist).
3. Do not isolate asymptomatic people who also require hospitalization for other reasons in a hospital setting, because the risk of transmission is low.
4. Isolate symptomatic people with indications for hospitalization no longer than 9-10 days from the onset of symptoms (the American CDC recommendations, in force to some extent, meet this requirement)
5. The cost is to accept a certain number of infections that will occur in the hospital environment, in exchange for a significant increase in diagnostic and therapeutic possibilities
6. In the case of outpatient health care, the admissibility of teleporting should exist only in strictly defined cases, e.g. the need to extend the prescription for chronic drugs in a person in a stable condition
7. With regard to outpatients, the order of isolation of persons with a positive test and quarantine of contacts should be abolished – excerpts concerning SARS-CoV-2 from the “Regulation of the Minister of Health on infectious diseases causing obligatory hospitalization, isolation (…)”. People with clinical symptoms of respiratory tract infections should be encouraged to self-isolate voluntarily and they would certainly submit to such self-isolation, especially in the face of the current social pressure.
The doctor emphasizes that there is a possibility that SARS-CoV-2 will not be completely removed, “but it cannot mean a continuous state of emergency – communities, families, states must start functioning normally”.
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