The basic problem of patients during the initial stage of the coronavirus epidemic was difficult or, in some cases, closed, access to services. Patients requiring immediate intervention, not directly related to COVID-19, remained invisible to the health care system. The Ombudsman for Patients’ Rights received many complaints and requests from people undergoing oncological therapy, after heart attacks or strokes, with diabetes and other chronic diseases.
- It is good that we took the coronavirus seriously from the beginning, that we did not follow the example of Sweden or Great Britain, disregarding the problem and reducing it to the level of ordinary flu. It would result in total paralysis, because many departments would not be able to cope with the rapidly increasing number of patients – claims prof. Samolinian
- Prof. Samoliński complains that while the procedures for dealing with those infected with COVID-19 were quite clear, the doctors did not know how to deal with other patients: with diabetes, hypertension, heart failure
- Many clinics were closed in the pandemic, and telemedicine did not always work. Oncology and cardiology patients were left to themselves. Allergy sufferers received conflicting recommendations – explains the doctor
- – It is not true that the epidemic is ending – says prof. Samolinian. When asked about the second wave of cases, he says: – I bet on October. In the coming months, however, single epidemic outbreaks will appear and here I would point to the coast
We talk to Professor Bolesław Samoliński – a public health specialist and head of the Department of Public and Environmental Health at the Medical University of Warsaw, who also serves as the chairman of the Council of Experts, the Patient’s Rights Ombudsman, about the way our health care system functions in the era of combating the coronavirus.
Monika Zieleniewska / Medonet: The epidemic situation in Poland now looks stable, we are defrosting the economy, opening borders, and going on vacation. How would you summarize the functioning of our healthcare system so far?
I have the impression that Minister Szumowski realized from the very beginning that the quality of the health care system and the level of its financing were so imperfect that we would not withstand the outbreak of the epidemic. This would result in total paralysis, because, for example, pulmonary departments or HEDs would not be able to cope with the rapidly increasing number of patients.
It’s good that from the very beginning care was taken not to risk. We did not follow the example of Sweden or the United Kingdom, disregarding the problem and reducing it to the level of the ordinary flu. Today we already know that in Sweden the death rate from the coronavirus remains at the level of 12%. and is the highest in the world.
The overall rate of deaths from COVID-19 is 5%, while from the flu 0,1%. So far, SARS-CoV-2 has infected 10,5 million people and 500 have died. Let’s ask ourselves, shouldn’t we protect society as a whole?
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I’ve heard voices saying that the economy is more important.
– Such a philosophy is unacceptable. Health is a public good and therefore should be protected by the state. Let us forget about economic liberalism and concentrate on the health security of our citizens, because disease is a great misfortune for people and their loved ones. And in the case of the state, it is the source of the crisis. Never in the history of mankind have we obtained such hard proof of the influence of health on the economic development and economic security of a country.
In fact, the pandemic immediately generated problems in the labor market. The government has launched a target, but the complaints continue.
– The shield has drawbacks, but the discussion of whether or not it should be implemented is futile. The state works because you have to show people that adherence to restrictive rules that threaten bankruptcy must be compensated.
I hear voices that the freezing of the economy has done more harm than good, but these are the opinions of unimaginative people. I am convinced that an epidemic would be much worse than the current economic situation. People would fall ill, they would not go to work, and the budget would be burdened with enormous expenses for health problems.
It is also said that 80 percent. infected pass the disease mildly, 44 percent. no symptoms so bother. Meanwhile, studies show that in young people, in whom the course of the disease was asymptomatic, changes in the lungs appear. So we cannot claim that COVID-19 is harmless.
- “The idea that COVID-19 saves young people is simply untrue”
In a word, the general direction of state authorities’ actions was correct, but chaos prevailed at the level of healthcare facilities. Those are the opinions of patients, don’t you agree?
– We had instructions on how to deal with a patient infected with the coronavirus, and we did not have instructions on how to deal with the others. And yet there were many more of them; it is tens if not hundreds of thousands of people with multiple diseases, chronic diseases, e.g. diabetes, hypertension, and circulatory failure.
No new system of patient circulation (admission, diagnosis and therapy) in healthcare facilities has been established. The most surprising thing is that they stopped taking them altogether. In some POZ clinics, telemedicine broke down, and specialist outpatient clinics were closed. The healthcare system cannot respond to epidemic situations by cutting itself off from the patient.
There is also no procedure describing how to behave towards a patient suspected of COVID-19 who, for an emergency reason, must land, for example, in cardiology or surgery. Without a test result, his path through the system was virtually closed, and if admitted to the ward, everyone in his entourage was sent to quarantine. Security facilities should reorganize in such a way that the patient is admitted, but safe for himself and for healthcare professionals.
- Every month, I urgently referred a dozen patients to the hospital. Where are they now? Are they dying at home? [LETTER TO MEDTvoiLokony]
And patients undergoing long-term therapy, e.g. cancer therapy, were left to themselves.
– It was a common phenomenon, cardiologists and oncologists say about it … In allergology, contradictory, unjustified recommendations were issued, recommending abandoning the therapy. The information policy also failed, we heard once not to wear masks, and later that we were to wear them. Yet the public health professionals knew exactly how to proceed! During an epidemic, contact with the environment that may be infectious should be avoided. This is done through the use of personal protective equipment, i.e. masks that provide as much as 60% protection.
Who to blame for this situation?
– All in turn, even the WHO. For example, a recommendation was issued that only COVID-19 patients should wear masks, and we know that they also infect people who do not have ailments and do not know that they are ill. Besides, the sick should not stay in public space at all. They are to be quarantined or hospitalized. Such actions do not stand up to criticism and prove the weakness of expert preparation of the public message. Representatives of the medical community said one thing, and the decision-making bodies said something else through the mouths of the minister and his spokesman. The information chaos had an impact on the healthcare system, and we had conflicting recommendations on the same subject.
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How does this affect the fate of a particular patient?
– Case, i.e. the case study, is always the best for showing errors in the system. Take someone with the typical symptoms of a respiratory infection or exacerbation of bronchial asthma or COPD (chronic obstructive pulmonary disease) – conditions that are identical to coronavirus infection. The system cannot do anything with it until it is recognized. Or an infectious team is sent to him, which will take him, where exactly, according to the guidelines? To the infectious diseases ward, to the unnamed hospital? Patients with a positive test result go there. There is no such thing, so he is thrown into the emergency room, HED or GP doctor. And what’s next? Outpost paralysis.
If an ordinary ambulance arrives, the entire ambulance team goes to quarantine and waits 7 days for the situation to be resolved. In one health department, after a week, there will be automatic information that the result is negative and you can work, and in another there is none. The crew has to find out by themselves, look for who knows where. I know a rescuer who received an answer that he could return to work, and after a while, the police called him asking why he interrupted the quarantine. The system was lame, generating problems, and consequently fewer emergency teams were available.
So there is still no recommendation on how to proceed with other patients?
– The Minister of Health should appoint a team of real experts as soon as possible. I do not have many criticisms of him, but I would look at a group of authorities who support him. There is, of course, a national epidemiology consultant, but the rest are mostly mathematicians. This is disturbing. We need mathematical predictions, but as an add-on. The key element is communication with experts in the field of epidemiology and virology, working out problems, and then presenting and implementing solutions, because after the holidays the virus will attack again.
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Where do these assumptions come from?
– When the autumn rainfall begins, the number of cases of infectious diseases is always increasing. Then COVID-19 will also come back, as the immunization of the population remains at a few percent. Research conducted in Krakow shows that only 2 percent. gained immunity without being ill. Thus, over 90 percent. society has not acquired it. When we close the windows and start accumulating in confined spaces, the virus will activate, because it is among us.
When exactly?
– I bet on October. In the coming months, however, single epidemic outbreaks will appear and here I would point to the coast. I conclude this from the analyzes of factors that have nothing to do directly with the coronavirus, such as the incidence of rhinitis or smog in Poland.
And it was only recently that Prime Minister Morawiecki calmed us down on TV.
– This is a manifestation of political epidemiology. The prime minister is not an expert, so I ask which expert says the virus no longer infects? I’d like to discuss with him. We do not have a problem with the epidemic at the moment, thanks to previous recommendations for collective and individual isolation – closing borders, stopping transport, detaining people at home, imposing the obligation to wear personal protective equipment.
But now it’s all gone?
– There is no turning back from prophylaxis. If we fail to meet the standards, we will experience an outbreak of disease in the fall. Let’s be smart, let’s maintain the regime in common spaces – shops, restaurants, offices. Again, we need to protect our entire face. In an environment where there is an aerosol with a virus, a mask is not enough. The aerosol settles on the face, and by touching it, we transmit the virus, and it can also enter the body through the conjunctiva.
Therefore, apart from the masks, we should wear glasses, and in addition to washing our hands, we should wash our face. Fast, which is worn by e.g. restaurant staff, do not protect against anything. They don’t stop the aerosol that forms when we sneeze or cough, and they don’t protect the airways. There must be a nose and mouth mask for the visor.
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How to convince people to do so again?
– We need a clear instruction because we are now taking a step back. We had well-developed protection rules, thanks to which the number of common infections, e.g. flu, decreased. It means that the security works, you just have to maintain the rigors.
In confined spaces there must be a constant exchange of air, keep a 2-meter distance, personal protective equipment. There is no return to locking citizens at home, because outside the risk of contamination is almost zero due to air currents and the degree of aerosol dilution. It is known that windows need to be opened and ventilated.
Set up an electric fan so that it blows air out of the room. The ventilation should operate at the highest speed, but we give up all air vents, so e.g. we turn off the dryers.
Anything to make human-to-human transmission difficult.
– Where did the term plague air come from? Because there is a high concentration of the infectious agent in the patient’s environment. That is why most people become infected in the health care system. The percentage is as high as 30 percent. which means routines are failing. Here again we can recall the case of a patient with a negative test result who is lying in the same room with a positive patient. This means that the facility manager was completely unprepared to manage it during the epidemic. Therefore, you need to provide him with instructions, send him a crisis management specialist who will review the procedures and suggest how to change them.
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And how should chronic disease patients behave in the event of a second wave of the epidemic?
– They need to learn a new way to communicate with healthcare professionals. Limit unnecessary visits, but don’t skip what should be. Teleporada works only in the case of a stable patient in good condition or a healthy person. For people who are starting to feel unwell, teleporting may worsen their health.
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