Poland’s struggle against COVID-19 underlines the challenges facing brittle healthcare systems across Central and Southeast Europe.
By Claudia Ciobanu
oland has sealed its borders, closed malls and schools and banned gatherings of more than 50 people. And yet experts say the real fight against coronavirus has only just begun.
Paloma Cuchi, head of the Polish office of the World Health Organization, told BIRN the country was “on good track” to implementing WHO’s recommendations for responding to the pandemic, including preparing hospitals to deal with severe cases and communicating with the public.
But as Poland confirmed 150 cases of the virus on Monday morning, Health Minister Lukasz Szumowski said, “We must expect a four-digit number of people infected with coronavirus this week.”
An increasingly tired Szumowski has been giving daily press briefings, often accompanied by Prime Minister Mateusz Morawiecki and other ministers. Szumowski is now the second most-trusted politician in Poland after President Andrzej Duda, according to a recent poll.
Poland has declared a state of “epidemiological emergency” but not yet a full state of emergency.
The government says it still plans to organise presidential elections as scheduled in May, and a recent poll shows that the health crisis has boosted the popularity of incumbent Duda, making him more likely to win in the first round.
Despite a sense of decisive action by the government, doctors and experts across the country have raised questions about the state of the Polish healthcare system and its vulnerabilities to the pandemic, which has claimed more than 6,500 lives globally.
In recent years, Polish doctors have been at loggerheads with the government over health spending. Resident doctors even went on hunger strike in late 2017, demanding that a larger chunk of gross domestic product be put into the sector and calling for better pay and working conditions.
“Health systems in Central Europe have been under pressure for some time, reflecting a combination of staff shortages — in part caused by historically low salaries and high levels of migration — and a long history of underinvestment in health facilities,” Martin McKee, a professor in European public health at the London School of Hygiene and Tropical Medicine, told BIRN.
“A particular concern has been the long-standing underinvestment in public health. Although much progress has been achieved in a few countries, in general it has been difficult to complete the transition to a modern public health system, and in particular, with the appropriate skills needed for modern infectious disease epidemiology.”
For a decade, McKee ran the European Centre on Health of Societies in Transition, a team of researchers working on health policy in Central and Eastern Europe and the former Soviet Union.
“Another concern would be the shortage of intensive care facilities, and in particular, of ventilators and the staff who can use them,” he said. “We are likely to see a high level of demand, as is already happening in Italy.”
Since early March, many Polish doctors have spoken out on social media or in interviews, describing what they see as the grim reality of the health system’s lack of preparedness.
On March 11, when Poland had 31 confirmed cases, a doctor working in a large regional hospital complained that it did not have a single coronavirus test available — and argued that there were many more infections in the country than confirmed cases.
“Another problem is that we really do not have enough protective costumes, masks, glasses, gloves, etc,” the doctor wrote in a Facebook post. “No one trained us how to take off the protective gear and this when it is most risky and easiest for the medical staff to get infected.”
Describing the difficulties of finding an intensive care unit with the space to place a patient with a ventilator, the doctor continued: “The government and local politicians are assuring us that we have enough respirators, that we are efficient, prepared and we will manage. We are not ready and we won’t manage!”
The government has been trying to address some of the most obvious issues.
In the first two weeks of March, it increased the number of coronavirus tests done, hitting 5,493 as of March 15, according to data from the Ministry of Health. (Around 1,000 of the tests were performed within 24 hours of the number being announced.) The figure is low compared with some other countries.
Poland has recategorised 19 hospitals as being capable of dealing with infectious diseases, enabling them to receive patients suffering from COVID-19 in weeks to come.
Health Minister Szumowski announced on March 16 that “a thousand masks, glasses and protective suits” would be sent to each of the hospitals. (He added that in one case, Polish medics had used no fewer than 100 protective suits to deal with a single patient.)
The Ministry of Health also said that Poland has about 10,000 respirators it can use for severe cases — but many are in use already and would need repurposing. Moreover, experts say the issue is not only access to the machines but also the availability of medical staff able to care for the patients in intensive care.
Poland’s hospital wards have been chronically understaffed, with many hospital wings across the country announcing closures in recent years, in part due to a failure to fill staff positions.
A chat among Polish intensive care doctors on a private Facebook group page, quoted in a Gazeta Wyborcza article published on March 11, reveals that in many hospitals there are already no free places in intensive care units.
“We have a systematic overburdening of the system,” one doctor wrote. “There is a constant lack of free beds in intensive care units. You cannot fix this within one month.”
Pawel Witt, the head of the Polish Association of Anesthesiologist and Intensive Care Nurses, told Gazeta Wyborcza: “Already today, we don’t have enough nurses in intensive care units. And patients with respiratory failure need specialist care. They are in an extremely heavy state, they have circulatory failure, renal failure.”
Outside the health system, experts say limited access to infrastructure could thwart the fight against coronavirus. In some countries in the region, people live without access to running water, making protective hygiene measures difficult to implement.
“Countries in Central and Eastern Europe may face particular challenges because of their ageing populations, in part because there has been so much selective migration of young people,” public health expert McKee said.
“For example, in rural areas of some countries like Romania and Bulgaria, the average age in some of the villages is now very old. In addition, older people in Central Europe, and especially women, have high levels of chronic diseases and frailty, putting them at particular risk of COVID-19.”