– Patients who do not come today will report “tomorrow” with more advanced diseases. The “sick freezer” is one of the things I fear – says hematologist prof. Wiesław Jędrzejczak, with whom we talk about what awaits us after the pandemic.
- Prof. Wiesław Jędrzejczak admits that after the first information about the epidemic in China, we underestimated the threat
- When asked how the situation in Poland will develop, he says: – Of course, various scenarios are possible: we will either go towards Spain or Italy or not. It is difficult to say why the rate of increase in the number of infected people in Poland is slower. Maybe some isolation measures were taken, or maybe other factors, such as weather conditions, played a role
- The professor draws attention to an important problem – currently patients with other diseases are as if in a “freezer” and will start reporting to specialists when the threat is over. This can make the health system overload, and it can’t take it
Zuzanna Opolska, Medonet: Professor, let’s go back in time: January 2020, the American Center for Disease Control and Prevention reassures us that the risk of coronavirus compared to flu is small. Today in the USA, patients with COVID-19 die on average every two minutes. Do you remember the first thought you heard about the Wuhan virus?
Prof. Wiesław Jędrzejczak: I must admit that I also underestimated the severity of the threat. I didn’t think the coronavirus would prove to be more dangerous than previous mutant flu viruses. However, the rapid course of the epidemic in Wuhan made all of us aware of what we can face. On the other hand, it is a matter of access to information – I am a private person and I do not know what the rulers who have information services know or should know. I cannot explain the Americans’ short-sightedness, especially since the first case of coronavirus infection was diagnosed there in January.
Even today there are voices that we are exaggerating the threat …
We don’t really know what it is. I recently received a desperate email from my friend, a prominent hematologist in Bergamo, the city hardest hit by the virus outbreak. He wrote that the losses are staggering – the organizationally destroyed hospital, the devastated organization of the health service. And we are talking about Lombardy, famous for its high level of medicine and a professor at the top of the world who regularly publishes in the prestigious New England Journal of Medicine.
How is Poland doing compared to other countries?
Relatively good – the number of infected people, and especially those with a severe disease, has not yet exceeded the capacity of the health service. Of course, different scenarios are possible: we will either go to Spain or Italy or not. It is difficult to say why the rate of increase in the number of infected people in Poland is slower. Maybe some isolation measures were taken, or maybe other factors, such as weather conditions, played a role. After all, we know that dry and sunny weather is not conducive to the spread of the coronavirus. Or maybe just underreporting.
- Also read: The epidemic will end in July, but that’s the most optimistic scenario. Interesting conclusions of the Krakow scientist
A month has passed since the diagnosis of “patient zero” in Zielona Góra – we have closed hospitals and dozens of doctors in quarantine. What went wrong?
There are many mistakes. Undoubtedly, a disgrace to the system is the elementary shortage of protective clothing.
The situation in which doctors of the Banach Hematology Clinic look for protective masks on the Internet, and even more – they are deceived by a false advertisement, is a square cabaret.
We are going back to the times of the First Republic, where the fight is to be fought not by a regular army, but by a mass mobilization. I myself am a retired military doctor and in my day there was such a thing as ZN (inviolable stocks). The depot in Celestynów had reserves of medicinal products and medical equipment in case of a sudden increase in demand. What happened to all of this? I do not know…
Examples such as Grójec, Olsztyn or Bielsko-Biała show that a person is at fault outside the system …
First of all, the current management team, unlike mine and the previous generation, has never faced a similar problem. We are talking about people who are, for example, 40 years old and have not seen a world other than the National Health Fund and are guided by the functioning of the hospital as an economic entity that must balance revenues and expenses. Today, however, we have returned to the situation from before 1999, when the main task of each medical facility was to protect a specific population of patients in a specific respect. It also means changing the revenue structure. We do not know yet what financial consequences we will face … It is only the first month and too early for the balance sheet.
What would be the worst-case scenario for the coming weeks?
If the number of patients requiring hospitalization increases drastically, homonymous infectious diseases hospitals will cease to be efficient, and patients with COVID-19 will appear in all hospitals. This means that we will be forced to separate sub-units for positive, doubtful and negative patients in individual clinics, and to assign separate medical and nursing teams to them. Due to a staff shortage, medical personnel positively tested, but asymptomatic, will not be able to quarantine. Every fit doctor will return to work.
- Also read: What does a doctor feel when he goes to the hospital during an epidemic?
Every day the media inform us about new infected, which patients do we forget about in all this?
This is an unrecognized situation. From the point of view of our clinic, the pressure of the sick who should press on is much smaller. It might seem that patients would try to reach specialists through private channels, but this is not the case. I did not stop my private practice myself and if I consulted 10-15 people before, now I consult 2-3. Everyone seems to have collected themselves and is sitting at home. And yet we suffer from leukemia and lymphoma in a way that is independent of the epidemic. These are random events that occur with a certain frequency in each population. Therefore, patients who do not report now will report “tomorrow” with more advanced diseases. The sick stuck in the “freezer” are one of the problems I fear.
Let’s assume that home quarantine will be prolonged – can the influx of “postponed” patients exceed the logistical, human and financial capabilities of the institutions?
It is possible. It is difficult to say to what extent the pandemic will affect the health care system itself – 69 doctors have died due to coronavirus infection in Italy. We do not have it yet, but the number of infected medics is growing. Although in Singapore, where basic PPE was widely used: masks and gloves, infection was almost non-existent among staff.
A prolonged home quarantine is associated with another threat – a damaged psyche.
Yes, it’s no secret that loneliness and isolation can negatively affect mental health. In our clinic for patients after bone marrow transplantation, we did not eliminate double rooms, among others because sharing the room with another person solved a large part of psychological problems. Anyway, 35 years ago, when I made my first attempts at bone marrow transplantation, we hospitalized the patient with a caregiver due to the lack of nurses. It was the first time in Poland when a parent was hospitalized with a child. With very good psychological effect. In my student days, the little patient was confined to the hospital, and the parent had the right to visit twice a week for two hours. Consequently, all children had an orphan disease.
However, I have the impression that due to the change in lifestyle and family functioning model, we endure isolation better than a dozen or so years ago. Besides, we are quarantined differently if our four walls are a house with a garden, and different if it is only a room with a kitchen. Now the question: what families are there more in Poland? Some people will not stand it – alcoholism, depression and aggression, increased suicide attempts. Even in prison, there is such a thing as a yard yard.
We know that the elderly and chronically ill are the most vulnerable to coronavirus infection. Does COVID-19 follow a different course in hematology patients?
It is not fully known (there are no such publications), although you may be concerned – according to my information, haematological patients were positively tested in only two centers: in the Specialist City Hospital in Toruń and in the Banach Clinic. Three of our four patients were transferred to infectious diseases hospitals, while in Toruń one person died. Familiar hematologists with whom I contacted did not inform me about another particular course of COVID-19 in hematological patients, but we are talking about immunocompromised patients. A few years ago, we had a similar incident – a wave of violent pneumonia caused by the flu virus, which has actually been published. The course of inflammation was electrifying and the patient died within a day.
What should patients with blood cancers remember during a pandemic?
That they must not neglect their underlying disease, which can often be fatal, and that they must remind decision makers of their existence and their needs.
We are dazzled by the numbers of people who died due to coronavirus infection, and we forget that over 250 people die from cancer every day in Poland. Daily! Annually it is 100.
That they should follow the insulation recommendations. We call it reverse isolation: it is not they who are the threat to others, but other possible carriers of the coronavirus for them. So, masks and gloves in confined spaces other than your own home and in contacts with other people. And vaccinations: if someone has not got vaccinated, then maybe against flu, and all against pneumococci and Haemophilus influenzae. In the event of symptoms of infection, a recent flu vaccination will help doctors in the differential diagnosis, and the remaining vaccinations will reduce the risk of so-called superinfections, i.e. additional bacterial infections.
physician, specialist in internal diseases, hematologist, clinical oncologist, transplantologist, professor and associate professor of medicine. He was the first in Poland to perform an allogeneic bone marrow transplant in 1984 and an autologous transplant in 1985.