Prof. Bulk: unvaccinated people should not use public places where people gather

The fourth wave of COVID-19 is accelerating. What should we do to minimize the impact? Introduce restrictions in specific regions of Poland? Limit access to public places to unvaccinated people? These questions are answered by prof. Jarosław Drobnik, head epidemiologist at the University Teaching Hospital in Wrocław.

1. The number of people hospitalized due to the coronavirus has increased since the beginning of August. The number of occupied respirators also increases.
2. It happened, what epidemiologists have been talking about for a long time – the fourth wave of COVID-19 appeared in Poland
3. The Ministry of Health is considering introducing nationwide restrictions if the daily number of new coronavirus cases exceeds a thousand. Additional restrictions may arise in areas where vaccination levels are low
4. In turn, Jarosław Kaczyński mentioned possible restrictions on unvaccinated people
5. This discussion should take place earlier. The idea is to introduce the principle that unvaccinated people should not use public places where people gather – cinemas, restaurants, fitness salons – says Prof. dr hab. Jarosław Drobnik, MD, internist, family doctor, public health specialist and epidemiologist
6. You can find more such stories on the Onet homepage

The grafting level should be higher

Adrian Dąbek. MedTvoiLokony: The fourth wave has already come to us. What should we do to minimize its effects?

Prof. Jarosław Drobnik: There is nothing revealing here. We need to make the level of vaccination against COVID-19 much higher and more effective. And the second thing is that society has to be slowly accustomed to the fact that certain restrictions will be restored. For starters, it’s a matter of distancing yourself or wearing masks. These are the basic things.

Should these restrictions be nationwide or apply only to regions with the least vaccinated people?

Restrictions such as washing hands, wearing masks, keeping a distance should be a national element. These are basically the basic tools for fighting an epidemic or trying to stop a virus. On the other hand, regionally, it will be necessary to introduce more stringent tools to combat the epidemic. Perhaps limiting the number of guests in restaurants, assembly venues. But I believe vaccinated people should be privileged because they are less likely to transmit the virus and are less likely to be infected.

The relationship between the low vaccination level and the increase in infections in individual provinces is clearly visible.

This has been going on for at least a few weeks. However, in absolute numbers, it does not appeal to the imagination yet, because if there is an increase of several percent week to week with the current average, there are several cases or 30 cases a day. But it shows that this snowball mechanism is starting to accelerate. Where the population is more sensitive, the number of infections after the end of summer holidays, after children return to school, and adults to work, where the filling will be greater, will increase. In those regions where the vaccination level is low, we will see a greater increase in the incidence, which will translate into the national average. So that is where the first actions should be directed.

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However, I do not know to what extent the regional restrictions will affect the transmission of the virus throughout the country. They can slow down, but in my opinion this will not solve the problem.

Compliance with the rules of the sanitary regime is a primer

So we go back to the basics of observing the rules of the sanitary regime again.

I’m on my way back from vacation. I was at the lake, in a tourist town. And there, in stores, no one adheres to these rules. I was also in Masuria and it was the same there. Only a few people, entering a store or a public place, will sometimes wear a mask. In the open air, even if they are sitting together, it doesn’t work anymore. We have to start bringing it back. Because it is ABC, elementary principles without which there is no chance to flatten or slow down another wave. This is the first and most important thing.

Another element is a significant increase in the vaccination coverage level. I believe that this discussion should take place earlier and I postulated in May that it should take place then, but it is still ahead of us. The idea is to introduce a rule that unvaccinated people should not use public places where people gather – cinemas, restaurants, fitness salons. These people are an important factor in the transmission of the virus, and thus infection and in many cases of severe course. We have to find a way to get people to get vaccinated because I think we already have a lost month. If the tide now comes and people get vaccinated with Johnson & Johnson, the immunity will come in three or four weeks, and with a two-dose immunization, we’ll need at least a month.

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The children will be back soon, the broadcast will be back and we will have to make difficult decisions again. The number of infections will increase slowly, and I think that by mid-September it could become disturbing.

Should we do anything before the kids go back to school?

It certainly doesn’t make sense to test all babies, so it’s more a matter of observation. In the first weeks, organize as many outdoor activities as possible, and slowly introduce the rules for masks among older children. Perhaps at the beginning, the lessons should be shortened so that these children do not stay together for so long. And observe and check what is happening in this environment, what is the transmission of the virus to, for example, parents and teachers who have not been vaccinated. Fortunately, it is not a large group. But let’s remember that the school is not only teachers, but also other staff that should be vaccinated.

Parents should watch their children if they show even the slightest symptoms of a respiratory tract infection, have an elevated temperature, and should not go to school, at least in this initial period..

Mask order, restrictions for the unvaccinated

I will come back to compliance with the mask obligation. I was on vacation in Italy and there is a completely different approach than with us.

I was one of those epidemiologists who argued that we should not put up with the requirement to wear masks in the air. Not because it makes any special sense during this period, because it does not matter in the epidemiological dimension, but it was a symbol of complicity in the process of inhibiting the transmission of the virus. When it ends, people don’t have masks in stores because they just don’t take them with them when they go outside. They forget or decide that it is not necessary anymore. And this is a straightforward path to a painful collision with the fourth wave, and that will sometimes end in disaster, heavy mileage, or death just because we’ve lost our basic habits. These habits have been fading for a long time. Taking into account the social atmosphere, I was against the abolition of this injunction.

Now we see what is starting to happen. From September it should be an obligatory and strictly enforced element. You cannot be offended by the fact that in a shop, theater, market, cinema, we must wear a mask. It should be an alphabet.

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The fourth wave is the fourth wave, but the question is what lies ahead. I believe that this is the last moment when the government should make a decision. Either find a miraculous way to encourage people to vaccinate, because what is happening at the moment is not very effective, or tell people that, for example, from September 1 or October 1, every unvaccinated person will not be able to benefit from specific vaccines. places or goods. End, period. And this gibberish about civil liberties should stop. It cannot be that, in the name of this freedom, another person has the right to expose me to loss of health or life, has the right to expose other people to the fact that they cannot function in the social or economic dimension. We should understand that there is no other way to combat epidemics than vaccination.

A third dose may be necessary for people with weaker immune systems

The recent statement by the health minister about doubts about the third dose hardly helped in this situation.

The statement by the minister in the context of the third dose that perhaps it is a matter of pharmaceutical companies, that is something below the belt. I understand that it may not match the third dose because there is no such hard evidence. Some, following a little more caution, which has a scientific justification, they believe that there are groups for which the third dose is worth giving. Not all do it. But there are indications that it is worth considering.

I would understand if the minister said no, because the priority is to vaccinate everyone with one dose or the other. That would be ok. But when the minister says pharmaceutical companies do something at the third dose, it’s a drama. How is this different from the first or second dose?

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The worst thing is that the minister talks about added value for public health. It just so happens that I am not only an epidemiology specialist and clinician, I am also a public health specialist. And of course, this value is very important. But she can’t be counted in a week or a month. These procedures and systems need to be practiced on a representative group, then we can talk about an added value. And if someone talks about added value in terms of vaccination, it is as if they do not understand what is happening at all. Because everyone knows that the vaccine is the only way to inhibit the transmission of not only this virus, but also many, many others. And every doctor knows, or at least should know, with elementary medical education, that the elderly will have poorer immunity, will respond less to vaccinations, and that the issue of potential vaccination is always being considered.

Taking into account the experience of the three waves, if the minister says anything of added value, it means that he does not understand anything. Nothing. He only sees the bars and the balance sheet. There is added value when we introduce new procedures or modify certain procedures. And here we go along the already known road. Has anyone ever talked about the added value of how it was necessary to have a repeat vaccination against hepatitis B? You have to use the experience. Or was to make a meaningful test. Have a representative group, measure the level of antibodies in specific groups and then evaluate it. And if you don’t do these things, then you have to rely on experience.

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