Łukasz Szumowski: the first wave is behind us, but the virus is not disappearing

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Health Minister Łukasz Szumowski resigned. We remind you of the last interview he gave to Medonet.

– You have to be humble and prepare for the worst, counting on the best – says Medonet, Minister of Health Prof. Łukasz Szumowski, cardiologist and electrophysiologist. The country’s chief physician answers questions about the second wave of the coronavirus epidemic, the president who has not been vaccinated against the flu, the salaries of doctors and the sanitary regime that has become a fiction in Poland in an interview with the editor-in-chief of Medonet, Dr. Anna Zimny-Zając. We invite you to read the first interview in the #GośćMedTvoiLokony series.

1. Minister of Health Łukasz Szumowski on August 18.08.2020, XNUMX announced that he is leaving the Ministry of Health
2. The minister of health is anxiously waiting for autumn. There is a huge problem with the mixing of potential COVID-19 sufferers and people who have the flu, he tells Medonet
3. Most new coronavirus infections come from workplaces, factories, meat plants, nursing homes, health facilities, and to a lesser extent from weddings and family celebrations
4. In Poland, we cannot talk about broadcasting on the streets
5. The minister promised to talk to the president and encourage him to get the flu vaccine
6. The so-called Act 6% GDP is not at risk. Healthcare expenditure will be increased as planned
7. – Shopping in times of a pandemic is an extremely difficult topic for all countries in the world – answers the question about irregularities in the purchase of masks, respirators and coronavirus tests

Anna Zimny-Zając: Do you still feel fear?

Łukasz Szumowski, Minister of Health: Of course it is. Let us remember that preparations for the fall have already started. It is a huge logistical, medical and organizational challenge. Because if we look at upper respiratory tract infections during the seasonal flu, it is several hundred thousand people a week. So there is a huge problem with the mixing of potential COVID-19 sufferers and those who have the flu. It will undoubtedly be a challenge.

You must have been surprised to hear the Prime Minister’s words that the situation is “stabilizing in the most positive sense” and that COVID-19 “is already a disease, you can say, like others, we are only waiting for a vaccine”?

The situation is stabilizing in a positive sense, because when we do not have new outbreaks, the daily number of positive cases fluctuates around 300. In many provinces, the epidemic is residual. We have several cases in them.

But of course, cases of daily increases at fairly large fires, such as in mines, will surely continue to emerge. We cannot avoid this. We are definitely waiting for a vaccine. It is already tested on humans, so we hope that we will be able to offer it to Polish patients soon.

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But with 500 or 600 cases, the government said not to panic, because these are single outbreaks, not an increase in the epidemic …

Exactly.

Are more workplaces being tested now, or are the new cases mostly people who self-reported for tests or were referred by a doctor?

No, it’s not a horizontal transmission, they’re still foci. From workplaces, factories, meat factories, nursing homes, health facilities, and to a lesser extent from weddings and family celebrations.

If we look at the number of positive cases in screening tests that do not include outbreaks, the rate of infection is very low. The National Health Fund has already tested over 30 thousand. people going to the sanatorium. And there were only about 40 sick people there. This shows that there are not hundreds of thousands of these infections in the general population, as some say. The scale is within 0,1 percent.

And the campfires are not horizontal transmission?

We separate the horizontal transmission, which occurs on the streets, from the transmission at bonfires, in quite limited spaces – most often workplaces. In Poland, we cannot talk about broadcasting on the streets.

When compared to the rest of Europe, the situation in Poland does not seem so optimistic. We are in the 8th and 9th place – depending on the day – in terms of the greatest number of new daily cases.

I would like to point out that we have never achieved such a wave of increases in the disease as other European countries. We in Poland have never reached even 1. illnesses daily. We managed to flatten the epidemic, which means that we are coming down from this flattening for quite a long time.

As for the results of 500 infections a day, we record them on the days when we conduct a very wide screening of asymptomatic people. No European country has conducted such a screening.

See also: The latest data on the coronavirus. See the map, charts and the latest statistics

It is me who will come back to the data from Europe. Because here we are on the 31st place in terms of the number of tests …

The number of tests does not depend on the number of inhabitants but on the number of patients. If the number of patients increases drastically, so does the number of tests. We did not have to deal with a drastic increase in the number of patients, so we did not have a large group of contacts to be examined. With the number of patients we have in Poland, our daily testing is one of the highest in Europe.

Nevertheless, the conversion rate per million inhabitants shows the scale of testing, and Poles are concerned about their distant position in Europe. However, I understand that in your opinion we have no cause for concern.

Every day we send about a thousand text messages to people from the quarantine so that they can drive up and do a test. About 1/3 of those eligible use this option. We have laboratory capacity to perform up to 40. daily tests, and see how much is actually done.

In many places, tests are not ordered, because if we have one patient per province, who are we actually testing. However, I still emphasize that if we look at how many patients we have and how many tests we have, Poland is in a very good place.

Remember that according to the recommendations of the World Health Organization, the tests should be performed on symptomatic people and contacts, i.e. the number of patients determines the number of tests.

However, there are reports of people who have been waiting for weeks in quarantine for a test, or those where only one person from the entire family is tested. Do you know the scale of this type of irregularity?

Of course there are such stories and then we react immediately. However, remember that at one point in quarantine we had well over 100. people. At the moment, each such situation needs to be identified and of course corrected.

However, let’s see that Sanepid was underinvested for years. Everyone thought that it was only used for gastronomic checks or inspections of scout camps. And suddenly it has become a key service in the fight against a really dangerous epidemic. It turned out that over the years there had been gaps in the equipment or computerization of the Sanepid.

Everyone is getting ready for fall and waiting for the second wave of the epidemic. Can it be much worse in autumn than it is today?

Yes, and unfortunately everyone agrees. The first wave is behind us, but the virus is not going away. This will only happen when we have the vaccine and the drugs. And now we are looking at the daily increases and decreases in the number of cases.

What’s next? We are afraid of one thing – the coincidence of influenza, paragrip and COVID-19, because all of these diseases have very similar symptoms. The biggest challenge will be to separate people with the SARS-CoV-2 coronavirus from those with the flu and to manage the entire system in such a way that patients do not infect each other.

And won’t people who are weakened by the flu be more susceptible to the coronavirus that causes COVID-19?

We do not know how these two diseases will behave, as we have not had such cases so far. Let’s remember that COVID-19 is still a new disease that we have only known about for six months. I hope another viral infection will not predispose you to COVID-19. It is not common for a patient to suffer from two infectious diseases at the same time, but of course, here you have to be humble and prepare for the worst, counting on the best.

The best way to protect yourself from the flu is to get vaccinated. Meanwhile, the flu vaccination coverage in Poland is less than 4 percent. For comparison, in other European countries it reaches even 60-70 percent.

It worries me too, because I know the benefits of the flu vaccine. There are many of them, and it’s not just about protecting yourself against the flu. Vaccination can reduce the risk of a heart attack, for example. Unfortunately, in Poland, the willingness to use this vaccine is not so great.

I vaccinate myself and so does my family. I believe that we need it very much. However, it is a matter of education and the operation of the entire medical community so that it speaks with one voice. It is also about making the patient aware.

I often hear that someone is vaccinated and still seems to be sick. So I would like to remind you that flu is a very serious disease, and besides it, there are many other diseases caused by parainfluenza viruses or various coronaviruses. The vaccine protects against the serious flu, and not all respiratory infections.

It also protects you from complications from the flu, which can be fatal.

I know from experience what complications of the flu look like, and they really aren’t benign. They often affect the cardiovascular system, leading to arrhythmias or heart failure. And these are really serious tragedies that we deal with together with the patient in order to bring him out of these complications. Once again, the flu is a very serious and serious disease.

You were not saddened by the words of the president, which were recently spoken on the arena of nationwide television: “Let me tell you openly – I personally never got vaccinated against the flu, because I don’t think so”? When spoken with full conviction, I would even say carelessly.

Of course they made them sad, because I know there are arguments that flu vaccination is good. But on the other hand, we have freedom in Poland and not everyone is obliged to get vaccinated. If this is not compulsory vaccination, no one is required to get vaccinated against the flu.

I regret that more people do not want to get the flu vaccine, but I don’t want to stigmatize anyone for their personal decision. I will talk to the president, I will try to convince him to this vaccination, this is my role as a doctor, but it is not my role and I believe that neither is the media, stigmatizing anyone for a lawful decision concerning himself.

Of course, fortunately, we still have freedom of speech and freedom of choice. However, from public figures, and this is what the president is, we expect a careful choice of words, because everything they say is a message addressed to millions of people. Therefore, comments on vaccines should be left to specialists, for example to the minister of health, who should be the authority on this matter.

I have the impression that, fortunately, this campaign, which has already passed, was to be attributed a little too much to the president’s words. However, I agree that the opinion of the head of state is extremely important here and that pro-health measures should be promoted. Of course, Mr. President, like every citizen of our country, has the right to a different opinion, but I will – as I said – try to present to him all the advantages of vaccination and maybe I will be able to convince him one day.

So maybe in some time we will see photos of the president during the flu vaccination?

I hope.

So I take the minister at his word and I also hope that it will happen, because it will surely be a good example for millions of Poles.

Definitely.

In view of the flu season, which will start in autumn as always, and the current COVID-19 epidemic, is the Ministry of Health planning free flu vaccinations?

We have specific risk groups, where these vaccinations are free, and these are the groups most prone to complications: mainly the elderly and the chronically ill. Unfortunately, even they do not graft. This year we want to import more vaccines, because we hope that more people will want to get vaccinated against the flu due to the epidemic. But will it happen …

In Poland, we have almost five months of fighting SARS-CoV-2 behind us. You recently said that “Polish medics must have passed the exam with flying colors”. Meanwhile, bitter voices are heard from medics that now the government is thanking them for their work, but when they ask for pay raises, no one is taking them seriously. At the same time, the President of the Supreme Medical Council considers the increase for residents and interns, which came into force on 1 July, to be too low, as it does not change the financial situation of young medics.

Residents have obtained quite significant increases in the last two years. With the duty hours, which are compulsory in the specialization, it amounts to approx. 8-9 thousand. PLN gross. It seems that for a student who is still learning, the money is not dramatically low, on the contrary. Doctors with the second degree of specialization have gained an average of 2015 thousand. PLN gross, with the first stage – over PLN 5,6. gross. Nurses obtained 4 thousand. PLN to remuneration. Paramedics received a supplement of 1,6 thousand. PLN to salary, which seems to be quite a significant increase. As we can see, the real increase in wages has taken place.

Besides salaries, another hot topic is the so-called anti-crisis shield 4.0 and amendment to Art. 37a of the Penal Code Doctors want to take to the streets again, this time because they are afraid of stricter regulations, they will make it possible to punish doctors with imprisonment for a medical malpractice without fault.

You have to be very precise here, because Art. 37 of the Criminal Code says not about medical malpractice but about manslaughter. I asked the Ministry of Justice for a report, and it turned out that only three doctors had been convicted of this article in recent years. One thing has changed at the moment. If the act is punishable by more than one year’s imprisonment, then no fine may be imposed. But, of course, there is a lot of social anxiety around this matter and that is why I have started discussions with Minister Zbigniew Ziobro on the regulation of this provision. I think that some compromise will be achieved here, which will satisfy the doctors’ side.

Now let’s move on to the patients. The Ombudsman for Patients’ Rights now receives almost four times more reports than before the epidemic in relation to the operation or rather non-operation of facilities. There are also appeals from doctors that when the epidemic has passed and the wave of patients requiring treatment, often with delayed diagnosis, the problem of overcrowded facilities may arise. Does the government have a plan to solve these problems?

I think it is worth mentioning that from 2018 to 2020 the number of people satisfied with the health service increased from 30 to 36 percent. This shows our activities in the scope of the entire health care system. And looking at the pandemic period, many people used remote solutions. And, contrary to appearances, patients’ satisfaction with these solutions has increased, as shown by the latest CBOS study. The telemedicine solutions that have been introduced are working well. E-prescription or e-release allowed us to actually function during the pandemic. Moreover, Poland is starting to be a leader in the field of telemedicine solutions.

Now, of course, we encourage patients to come to the clinic, clinic, specialist. Healthcare needs to get back on track from before the epidemic. But many people are still concerned about the virus. Hence, it is extremely important to promote preventive examinations so that in a few years this lockdown will not be revealed to us by an increase in even oncological diseases.

You mentioned prevention. This is an extremely important matter, because even before the epidemic, the attitude of Poles to their health left a lot to be desired. As shown by the National Health Test of Poles 2020, conducted by Medonet in February and March, still too many people do not perform screening tests, even though they are reimbursed, not to mention implementing a healthy lifestyle. Is the ministry planning any educational campaigns that will draw attention to these important issues?

Of course, it’s not easy to reach out to people and convince them to do research. In many countries it is not just administrative action. A very interesting example is the Scandinavian countries, where we have a huge improvement in the field of cardiovascular diseases after the local rural housewives’ circles have joined the promotion of healthy eating and a healthy lifestyle. Therefore, a much wider campaign is needed, not only ministerial and medical, to promote these pro-health activities. Then perhaps we will have an effect. Certainly, by “talking” and sending letters inviting us to research, we do not achieve what we would like.

Looking to the future. In 2017, the so-called Act 6% GDP, according to which expenditure on health care is to be gradually increased to reach these 2024 percent in 6. Will it be implemented as planned? Many analysts are concerned about the rising level of public debt.

It will be implemented. Due to the “n minus 2” rule, in times of crisis we will be able to come out unscathed in terms of financing health care. However, let us remember that at the moment there are further projects to transfer funds from the state budget to the area of ​​health. For example, a medical fund from the president’s idea. These are gigantic amounts, as much as PLN 4 billion next year. So I do not see any threat to the achievement of the goal of the 6% bill.

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As we are already at the money, will the government learn from missed investments during an epidemic to avoid situations such as masks, respirators or tests for the new coronavirus in the future?

Shopping in times of a pandemic is an extremely difficult topic for all countries of the world. It is enough to give examples of Germany, whose 6 million masks died in March at one of African airports. Israel spent PLN 2 billion on respirators, which arrived but turned out to be useless. Respirators with a Chinese menu have come in Portugal. These are just a few examples from the media. Please consider how many countries received defective goods, how many countries paid a fortune for goods that turned out to be questionable.

We bought 100 masks that turned out to be sub-standard. But what is important – we ourselves examined these masks and did not send them to the medics. We also reported ourselves to the prosecutor’s office. Non-conforming masks were bought in millions of pieces by the European Commission, the Great Orchestra of Christmas Charity bought, and a medical chamber bought.

Unfortunately, the time of the pandemic was also used by manufacturers and suppliers of dubious quality. As for respirators, it is worth emphasizing that before the epidemic we had just over 10. and now we have over 11 If someone has not complied with the contract for the supply of equipment, it is natural that he returns the money paid to us and pays fines.

We have several hundred new cases of coronavirus infection every day. Nevertheless, we can see in the streets that the sanitary regime has become a fiction. Poles have forgotten about their masks, they do not keep their distance, they meet in large groups.

If we stop behaving responsibly, if the fear of the virus disappears completely, it can become very dangerous in the fall. That is why I urge you to remember about the masks. Wearing them is a major factor in preventing the spread of the virus. And each of us should do it. Everywhere where distance is impossible and in every room where we meet other people, we must use a mask. It is a matter of responsibility for others. If we do not cover our mouth and nose in public, we put others at risk if we are asymptomatic. Let’s be responsible.

Mr. Minister, thank you for the interview.

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