We must do everything so that a patient with COVID-19 is not intubated too early and not connected to a ventilator, Prof. dr hab. Piotr Kuna, head of the XNUMXnd Department of Internal Medicine, Medical University in Łódź. He stated that many patients could be saved and that pulmonologists should be responsible for coordinating treatment.
- I am a medical practitioner and I see that today COVID-19 is often treated by doctors who are administratively obliged to do so. There are also dermatologists, ophthalmologists, a lot of interns and residents without specialization. This leads to the fact that patients are looked after by doctors with no experience in treating patients with respiratory failure – says Prof. Marten
- As he explains, the treatment of patients with COVID-19 should be performed by pulmonologists with experience in the care of patients with respiratory failure.
- Prof. Marten: Now that a COVID-19 patient is getting worse, there is an immediate alarm that an ICU is needed and anesthesiologists are being sought to put on a ventilator. It is shifting the responsibility for leading a seriously ill person onto others
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PAP: You expressed the opinion that in the fight against the COVID-19 epidemic, rational and irrational actions have already been mixed up, and wise actions with stupid ones. Is it that everyone wants to do something, show commitment, and not everyone just has the appropriate substantive preparation to treat COVID-19 patients?
Prof. Piotr Kuna: This coronavirus is a new mutation of a group of well-known viruses that cause colds. It causes complications in the form of severe viral pneumonia in a greater percentage of patients. It differs from other viruses in that it affects the vessels and increases the risk of blood clots, unlike other common cold viruses. This is why not only causes pneumonia, a well-known disease, but also inflammation of the vascular endothelium, leading to thromboembolic complications. The main cause of death of patients, however, is severe respiratory failure due to pneumonia.
What is part of infectious disease is the transmission and transmission of the virus. On the other hand, pneumonia has always been treated by internists, specialists in family medicine and pulmonologists. Infectious disease doctors did not want to cure pneumonia, they were not prepared for it. They treated hepatitis, HIV infection, and some other infectious diseases of your choosing. It was their domain and it should remain so. Forcing infectious diseases departments to treat COVID, the treatment of patients was limited, e.g. with hepatitis.
I am a medical practitioner and I see that today COVID-19 is often treated by doctors who are administratively obliged to do so. There are also dermatologists, ophthalmologists, a lot of interns and residents without specialization. This leads to the fact that patients are looked after by doctors with no experience in treating patients with respiratory failure.
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PAP: How do pulmonologists treat pneumonia?
PK: In pulmonology, there has always been a golden rule for patients with respiratory failure: do not intubate at all costs and do not connect to a ventilator. This often leads to bacterial nosocomial pneumonia, sepsis and death. Unfortunately, this is exactly what we see in COVID. All possible methods of treatment were used, e.g. non-invasive mechanical ventilationbecause we knew that if such a patient goes to the ICU and under a ventilator, he will die. And now that a COVID-19 patient is getting worse, there is an immediate alarm that an ICU is needed and anesthesiologists are being sought to put on a ventilator. It is shifting the responsibility for leading a seriously ill person onto others. It is believed that if a patient dies in the ICU, it will not be a problem, and if he dies with us, there may be charges.
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PAP: Are you saying that we have a sufficient number of specialists in the treatment of lung diseases, so it was not necessary to turn the medical care system upside down?
PK: The number of pulmonologists in Poland is over two thousand. people. One or two specialists per ward are enough to supervise and guide other colleagues, e.g. internists, who know what to do and how to guide a patient with respiratory failure. So as not to put him in the ICU. I believe that deaths would be several times smaller then. We have evidence of this from other countries – Israel, Ireland, Sweden, Norway, Denmark. Where systems have been overturned, which is unfortunately in most countries of the world, the effects are many times worse.
This should be organized in such a way that covid patients should be isolated in hospitals dealing only with covid and not being warded in the center of hospitals.
The rooms where covid patients are placed should be no more than two people. This virus works in such a way that the more we inhale it, the greater the risk that it will kill us. If there are six people in the room, the windows are closed, and we put a padlock on the door, the bioaerosol produced with each breath will kill anyone. In fact, the hospital is the worst option. People who are infected should be isolated at home. Patients who cannot be helped otherwise should really go to the hospital.
PAP: SARS-CoV-2 has been with us in Poland for 1,5 years. If today the minister of health asked you what to do, how to proceed and what of what we have been doing is to be left behind, because it worked, what would you say?
PK: First of all, hospitals treating COVID-19 patients should be surrounded by greenery, preferably forests. As in the past, tuberculosis was treated. Good examples are the hospital in Otwock or in Łagiewniki in Łódź. These are hospitals placed in pavilions – they were built in such a way as not to transmit infections from patient to patient.
The second thing is to delegate the supervision of the care of patients with SARS-CoV-2 pneumonia to the supervision of pulmonologists. We have the right algorithms, data, experience, and we know how to lead such a patient so that he survives.
We don’t have one hundred percent effective medicine. According to WHO, Remdesivir is a drug useless for this disease, but it is recommended, although it does not prevent or treat respiratory failure and does not reduce the risk of death. This disease is treated by our immune system. And this builds up before we get the virus. You need an adequate amount of sleep, a diet rich in vegetables and fruits, daily walks, and avoiding stress. And what more? Treatment of underlying diseases. There are 1500 drugs – even more – that are used in diseases such as diabetes, heart failure, COPD, and asthma to prevent the development of coronavirus when infected.
There are inhalation steroids that are very cheap. It has become commonplace in Poland that they do not work with this disease. They work. However, they must be turned on very quickly. Immediately after the virus is detected.
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PAP: Did you admit patients throughout the entire epidemic?
PK: There was a time in the hospital when I could not see the sick for administrative reasons. At Lux Medza, I was seeing patients all the time. Let me tell you more – of the patients I treated for pneumonia caused by SARS-CoV-2 coronavirus infection, not a single person died.
PAP: The immunity you are talking about also depends on the psyche. Does the emotionality of pandemic messages undercut this natural protective barrier?
PK: Our psyche is extremely important. In healthcare institutions, in old people’s homes, many people die as a result of loneliness, which destroys our immunity – just like anxiety. Not only that – fear of death often leads to denial of this disease. In addition, people are afraid of something that can be minimally risky and is highly effective, such as vaccinations.
This is not about the rising number of infections because we have less influence on it than some people believe, but about organizing the healthcare system so that people don’t die from COVID. We must acknowledge that we will be infected with the coronavirus, if someone does not get infected today, it will happen in six months, next year. Let’s stop fiddling with it, waste a lot of energy and resources, because the effects of this fight to reduce transmission are and will be poor. Instead, let’s restore normality to the entire health service and hospitals.
PAP: What about vaccinations? Can we do something to get more people vaccinated?
PK: Of course. I ask every patient who comes to me if he or she is vaccinated. There are those who say no, because no. And they probably won’t be convinced. Many people, however, are concerned about vaccination, so you need to spend time, a lot of time talking to them. For several months, we admitted patients who had other diseases that contraindicated them to the ward and vaccinated them in excellent medical protection. There were many of them and nobody was hurt. Now, however, the National Health Fund does not give us such an opportunity. The barrier of reluctance and fear of many people can be overcome, although not all of them will decide to get vaccinated in a pharmacy or in a tent.
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PAP: Some doctors say that COVID-19 patients should be treated with the active participation of rehabilitation specialists. What are your experiences in this area?
PK: I confirm it. These patients should not be still lying down, but should receive physiotherapy adapted to their respiratory fitness from the very beginning. This was on a program that I presented to the Health Technology Assessment Agency (HTA) in the COVID panel. However, there are fears that hardly anyone in Poland knows how to do it. I say that we know how to do it very well, only a little organizational effort is needed
PAP: Professor, what of what has so far been used in the fight against the epidemic is worth leaving?
PK: It works best distance of two meters, wash your hands regularly with soap and water. But let’s not go overboard with disinfectants: they damage the epithelium of the respiratory tract and pave the way for viruses. Anyone with a respiratory infection, regardless of etiology, should isolate himself from others. And resistance. We have to take care of her. The fact that we now lock children in the Lublin or Podlasie regions will not change the situation or help us in anything. Locking children in their homes, lack of exercise, and lack of peer contacts causes another pandemic of obesity, anxiety and depression. The peak of the wave will take place anyway, and the declines will start around December. There will be two relatively quiet months and there will be increases again from February. This is how it is with these viruses.
Tomasz Więcławski interviewed
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