The desperate battle of doctors against time

A Covid-19 patient is being treated in the intensive care unit of the University Hospital in Krakow. The photo is from April.

Omar Marques / Getty

“One of my patients died an hour ago. Heart attack. “Aleksander Kania struggles with composure for a moment. Then he continues in a calm voice: The man was 59 years old, with previous illnesses, one of thirty corona patients being treated in the lung department of the University Hospital in Krakow.” they are very serious cases, the patients have to be ventilated, but most of us can still stabilize, “explains the chief physician in his office, which is full of medical equipment, during a short break in his 24-hour shift. The hospital uses 2,500 kilograms of oxygen at the same time.

Aleksander Kania, chief physician of the department of pulmonology at the University Hospital in Krakow.

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Kania is an internationally recognized lung specialist working in the largest and most modern hospital in Poland. “This is a completely new situation,” says the 46-year-old. You are familiar with many procedures and have learned a lot. “But I have never worked with a disease that I feared.” You don’t have much time to think about it: two nurses are already waiting for you outside to update you on the latest news. You have to get back to your patient.

The second wave

The university hospital is one of the few hospitals specialized in Covid-19. 310 people with the virus lie here, more than ever. After the first weak, Poland will be overwhelmed by the violent second wave of the pandemic: 150,000 of the 242,000 positive tests in the last eight months were in October, with new records being set every day. President Andrzej Duda also tested positive on Saturday. 4,350 people were victims of the virus, 827 in the last week alone. After all, the death rate is still low, as those infected are mainly the young.

The government has imposed drastic measures due to the sharp increase. He declared that the whole of Poland is a “red zone”. Restaurants and most schools are closed and there is a strict requirement for masks on the streets and indoors. There is a partial curfew for children, young and old.

The reaction is late, in contrast to the spring when the government cordoned off the country early. Not only Warsaw, but most of the European capitals were surprised by the spread, which experts in Germany attribute to the start of the school. But in Poland there is also the fact that until a few weeks ago the national conservative coalition was more concerned with internal disputes and recruitment than with crisis management. In addition, the Health Minister had to resign in August due to a procurement scandal.

The breaks in Poland’s intensive care units have become very brief.

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Weak health system

There are also structural weaknesses. “The pandemic hits a health system that is in poor condition,” says Marcin Jedrychowski, “and we wasted time preparing.” Everyone hoped it wouldn’t turn out so badly, believes the director of the Krakow University Hospital, which until recently was the only one in the badly affected region of Lesser Poland treating corona patients. “The situation in the smaller hospitals is now tragic, they have very few resources for the attack they are experiencing.”

Marcin Jedrychowski, director of the University Hospital in Krakow.

I / NZZ

The situation in Krakow seems calm, even if ambulances with blue lights can be seen regularly and two red tents, which in the future are supposed to absorb the rush in front of the entrances during the cold season and act as a silent warning signal. But reports of chaotic conditions and rejected patients come from provincial cities. Jedrychowski assures us that we can organize places for emergencies in Krakow. But you weigh each case. The transfers are also complicated, says Wojciech Szczeklik, chief physician of the intensive care unit at the city’s military hospital. “It took us fourteen hours on Thursday to transfer patients from a regional hospital only thirty kilometers away because the organization was so difficult.”

The lack of hospital beds is the biggest challenge in Poland, but it is growing at an impressive rate. The Ministry of Health shows 19,500 beds, 4,000 more than a few days ago. However, 12,000 are already occupied. “On Thursday alone we created eight new intensive care beds; they filled in half a day,” says Szczeklik, describing the feverish race against time. The availability of fans is equally precarious. In Warsaw, the authorities are building a military hospital in the national stadium that will soon house 1,000 patients.

Strict testing, understaffing

But the admirable talent of the Poles for improvisation does not solve all problems. One is the unreliability of the figures: with almost 60,000 tests per day, the capacity limit of the laboratories has already been reached, according to an expert from the University of Economics in Krakow. Therefore, the country only knows very imprecisely where and how the virus is spreading. Also in Krakow there are long lines in front of the test centers every day, and waiting does not guarantee success, increasing uncertainty.

Director Jedrychowski also complains about the bureaucratic effort in the state health system, which has grown despite the acute crisis situation. He also looks at his staff with concern: Due to the additional protection measures, twice as many nurses are needed than usual, in addition, 300 hospital employees are currently in quarantine, although they were infected outside the institution.

The shortage of beds, doctors and nurses is Poland’s main problem in the pandemic.

Omar Marques / Getty

The university hospital, which only opened in 2019, with more than 5,000 employees can cope with the failures. But the health system was already short of staff before the pandemic. With 2.4 doctors per 1000 inhabitants, Poland ranked last in the EU in 2017. The main reason is emigration, as the opportunities to earn income in Western countries are significantly higher. The situation with the nurses is considered even more dramatic, as an entire generation left the country in the years after the collapse of socialism.

The material alone is not enough

Staff shortages mean that additional equipment alone is of little use. For example, poorly operated fans do more damage than they do, Jedrychowski says. Therefore, the specialists at the university hospital also carry out a great deal of training for other institutions. This is all the more necessary because the Ministry of Health, for example, has surgeons and pediatricians who have little experience in this area to treat corona patients.

In these circumstances, it is difficult to guarantee treatment for other life-threatening illnesses. Oncologists successfully defended themselves against government attempts to use them for the treatment of Covid-19. Cancer, heart disease and stroke patients still receive treatment at the Krakow University Hospital, but some of them have to be moved to older buildings, a possibility that many small hospitals do not have.

Employees at the University Hospital in Krakow have cured 3,000 corona patients since March. At 200, they couldn’t avoid death.

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In the limit

No one dares to say how long the Polish health system will resist the virus at the current rate of infection. Pulmonologist Aleksander Kania can take the strain for now. “But even a single case of illness in the team would greatly complicate the situation.”

Marcin Jedrychowski, whose employees have cured 3,000 Covid 19 patients since March but were unable to prevent death in 200 cases, expects the pandemic to drag on for a long time. But he’s also scared of what comes next: Jedrychowski awaits another wave, then with all the treatments that have now been postponed for weeks or months. “We are changing everything right now to save as many people as possible, but with that we could destroy the whole system.”