Coronavirus crisis: doctor’s message to strategists: if you are not going to introduce quarantine, there will be a shortage of doctors

“There are very clearly indicated indications for hospitalization: more patients go to the admission department, but only those who meet the criteria are hospitalized. When there are a greater number of patients, correspondingly more of them come to the reception, more and filter those that meet the criteria.

In recent days we have more and more new patients, as many as five to eight a day. Those who are given diagnostic tests show that they can be treated at home because they do not have respiratory failure or severe pneumonia, nor do they have pneumonia but there are no risk factors, then we let them go home for treatment just because the hospital is not stuck. because then there may be problems with the places of hospitalization, ”explained L. Jančorienė.

According to the director of the Center for Infectious Diseases, the most pressing problem for them now is that there is already a shortage of staff.

“It just came to our notice then. If there were no scheduled services during the first wave during the quarantine, some doctors were relaxing from other jobs and could come to work, now the scheduled services are not yet limited and therefore not there is a place to get people from, all the more so since there are really few infectologists.

A couple of days ago, I heard an interview from a minister who said, “Don’t think we are putting those doctors in a box here, and now we will take them out and give them to you when necessary.” I understand that the problem is known, “said L. Jančorienė.

He explained the principle of planning.

To understand what particular staff shortages mean, it is important to understand how work is planned in hospital wards. The director of the center explained that it is generally estimated that a doctor must attend between eight and twelve beds.

“Let’s take an average of ten beds. This means that for every ten additional beds, there should be an additional doctor. When working with covid patients, the work is carried out according to the procedure specified by the National Health Center, that is, in shifts. The whole shift has to change. In general and physically, it is impossible to work in such clothes for longer, and that eight-hour shift is enough, “explained L. Jančorienė.

The director of the center is convinced that everyone understands the problem of human resources, from a common employee to the administration of the medical institution and the ministry.

“It just came to our attention then. There may be a nursing pool available because, although there is no quarantine, people meet safety requirements, children are significantly less sick. Perhaps it is that pool that can be created from the services that are provided to children if their volume decreases somewhat. The work of a nurse is similar. It is more difficult to remove a doctor from the pediatric profile because they studied differently. And during the first wave, doctors had to be invited from different specialties to work at least on call ”, said L. Jančorienė.

Patients go on and on

The director of the center said that patients come to them in different ways: some are referred by family doctors, others come alone or by calling an ambulance.

“The scenarios have not changed. They also spend a lot of time in the reception department, sometimes eight, sometimes twelve hours. If a COVID-19 test hasn’t been done yet, it is done. It takes about eight hours to get one. response. In addition, he is still undergoing radiological and other tests. The condition is well evaluated, and only then is it decided if the patient needs hospitalization or if the situation is still under control, and can be treated at home with supervision from a family doctor, ”explained L. Jančorienė.

According to the professor, the admissions department is another place where a lot more extra work is needed.

“Patients drive constantly, it is a process that does not stop. The speeds are high enough and are increasing. The reception department is another place where there is a great shortage of people. Of course we use doctors and residents there. During the first wave, when scheduled services were suspended, we simply wrote a separate request for most of the residents to be transferred to work in our center, so that they could work at those points where especially large staff are needed, ”said L Jančorienė.

The head of the center said that now it would not be possible to distinguish the age of the patients who visit them most.

“If in the past the outbreaks occurred in hospital resuscitations, in nursing homes, it was mainly the people who were there. Nursing homes – elderly people, hospital resuscitations – also more elderly people with various comorbidities. Now we can clearly see that there are no outbreaks in hospitals and that there are more diseases in all sports and leisure activities, so the age of patients is very different, ”said L. Jančorienė.

Apply all possible methods of treatment.

Speaking about the treatment, the professor said that the Center tested all possible COVID-19 treatments that were offered by experts around the world. However, little progress has been made in the world in terms of the specific treatment of this particular infection.

According to the professor, with regard to licensed antiviral drugs, only a certain limited indication for Remdisivir has been approved so far, where appropriate. The five main hospitals have received this drug for several patients. The Ministry of Health will buy more.

“Everything else is investigational or basic treatment. There are many medications that are not specific for this infection, but they are very necessary when a person has pneumonia, when they have respiratory failure. These include the supply of oxygen, in some antimicrobial cases, clotting regulators or anti-inflammatory drugs – all of this is very important and is part of the overall context.

After an international study, there was a publication that said that dexamethasone improves survival. This preparation also has very clear indications. Based on the sources, we apply all of this to patients, but we cannot say that it would be a specific treatment for this particular infection, ”said L. Jančorienė.

It has a message for strategists and neighbors.

The professor would like to send a message to health policy strategists that the quality of aid will depend on human resources: how will it be solved.

“If the number of patients is similar or increases, which could be the case, unless there are strict quarantine conditions, which guarantees to reduce morbidity, but if those measures are not applied, then the issue of the human resources. This means that you have to think about the reserves, close some other hospitals and release the employees, relocate them where those patients are concentrated, “said L. Jančorienė.

According to the director of the center, the question of the financial motivation of the doctors who work with this infection must also be addressed.

“Supplements have been prescribed, people work in special risky conditions. All attachments have been removed since June 15 and people work under the same conditions. Some hospitals sometimes even have more patients than they did during the first wave. This is also very offensive and hurts doctors. If that problem is not solved at all, it will also have a negative impact on the organization of work, ”said L. Jančorienė.

And most importantly, the professor advised people not to forget to follow personal protection measures: hand washing, social distance.

“If possible, we should live as we did during the quarantine: if it is possible to work remotely, so be it. It seems to me that gradually everything will go hand in hand with the threat of distance education, perhaps for schools , not only for higher education, and perhaps for some other means of restricting people-to-people contacts. It is unlikely that it will be possible to control morbidity just by limiting some narrow foci, “said L. Jančorienė.

Delphi spoke with Professor L. Jančorienė on Friday. On Monday afternoon, Prime Minister Saulius Skvernelis announced that supplements would be paid directly to doctors who work with coronavirus patients.

„Doctors and epidemiologists remain key people in our fight against COVID-19. We must protect them, create the best conditions for them and respect their work. Therefore, today we decided to pay supplements to the doctors of 5 hospitals who work directly with the virus and to allocate additional resources to strengthen the National Center for Public Health and motivate its employees, ”wrote S. Skvernelis on Facebook.

He says he is closely following the situation.

The Minister of Health, Aurelijus Veryga, agreed with prof. According to L. Jančorienė, at the time when the provision of scheduled services was suspended, extra beds were removed from where more doctors were used.

Now that during the first wave some of the planned services have been postponed and accumulated really well, we’ve been talking all summer about resuming services and the need for people to get other health care, and now it’s not so easy not just for infectious patients. , but also fever clinics or mobile points to find specialists. Almost everyone is busy with one job or another, ”said A. Veryga.

According to the minister, the system is dealing with challenges so far, but the situation is constantly monitored.

“It just came to our notice then. So far, she is dealing with those challenges, but we are monitoring the situation very closely and we are seeing the point where it will be difficult to provide services and we will have to think about tougher measures,” he said. A. Veryga.

According to the minister, the organizing institutions are discussing where patients can be accommodated if large institutions fill their departments with infectious diseases, and the condition of those patients will not be complicated.

“We are studying how to reorganize the provision of services. The system responds, but when we reach a critical point, when we do not anticipate, it is very difficult to guess. It will all depend on the behavior of society. If people are careful, if they wear masks , avoid meetings, maybe we won’t reboot the system, maybe there’s nothing to worry about, but of course we have to prepare, “said A. Veryga.