How Slovakia Is Handling the Outbreak?

In Slovakia, the first case of diagnosed Covid-19 was on March 6. It was imported from Venetian carnival, where the son of the patient had a trip during February 14 to 16, 2020. The patient required the intensive care unit treatment and has had successfully recovered.

An emergency condition was declared for the state sector on March 16, 2020 and we were caught up with the lack of protective equipment. The aim of this study is to give the patients with diabetes appropriate specialists management system to keep the diabetes under control. On April18, 2020, the emergency condition was declared for the private health utilities too.

The main focus driven by government from the beginning was to stop the spreading of infection by usage of personal protective equipment (PPE) and regulation of movement and closing of the country borders. In the country, the official regulation was made so as to use PPE in public transport or any other institution from the very beginning of Covid-19 occurrence. The border was officially closed on March 15, and during two preceding days, more than 20 000 Slovakians crossed the Austria Slovakian border coming back home, and hence, the next 14 days quarantine with special facilities is mandatory.

As there was a lack of PPE, the patients and small companies started tailoring the masks, and the companies were changing their focus on alcohol disinfection products instead of alcohol products.

The virologist of Slovak origin Dr Sona Pekova developed test for Covid-19 detection by using her special one-step protocol and ultra-fast PCR (NextGen PCR) obtaining results in ten minutes. ¹

In Slovakia, research team for advanced method of artificial lung ventilation in Kosice Faculty of Medicine (VYMUVEP) was developed, “Multilevel lung ventilation method with variable pressure volume, flow, and time (PMLV)” and “Automatic proportional minute ventilation (APMV), and this was implemented by Chirana Medica. Stara Tura, Slovak Republic with their lung ventilators Chirana Aura. It was proved to be effective on SARS, H1N1, and ARDS, and it did not homogeneously affect lungs. ²

These ventilation methods increased oxygen transportation up to three times from affected lungs to blood, and together with special intensive care protocol, decreased mortality up to five times compared with standard ventilation protocols recently used. Methods are unique in the world and belong to protective lung ventilation but going far beyond it.

The second unique lung ventilation method ready for fight with Covid-19 developed in Slovakia is high-frequency jet ventilation with expulsion effect—artificial cough. This is also unique method in the world allowing the removal of mucus gently and safely from the lungs even by paramedics or nurses (Paravent, Kalas Medical Ltd. Povazska Bystrica, Slovakia).

Manufacturer of unique lung ventilator Chirana Aura has just applied for FDA approval.

How Does the Real Work Look Like With Patients with Diabetes in the Era of Covid-19 Attack?

Patients contact the site by webmail/phones. In the time of Covid-19, it is recommended to do remote assessment of individuals with diabetes. Preferably, the patients do the phone or video visit. For personal checks, we invite patients with unsatisfactory glucose control, new cases. Patients should be aware that the inadequate glycemic control causes weaker and slower immunology response, a more severe progression of pneumonia and complications with Covid-19. Interestingly, this information makes the patients understand more the importance of glucose control than the statistical numbers about risk of cardiovascular events.

The technology is nowadays the key feature of diabetes care: the possibility of point of care of the HbA1c, self-monitoring of blood glucose, continuous glucose monitoring, distant data transfer electronically, and technology-based communication with patient by phone, video, and patients’ communication based software.

The Lessons Learned From Covid-19

The Covid-19 accelerated science. It changes organization of patient care and excessive use of any kind of telemedicine.

Reducing the personal visits does not necessarily bring the time saving approach. The actual therapy can be called “online therapy.”

The question is Whether the remote control gives the same validity data as in person control? How can we adapt our patients’ work to this new word? But guidelines do not exist.

For patients’ communication, it is convenient to use special software like “e-casenka” in Slovakia for distant management of patients. ³

All these are coming close to the virtual diabetology practice and some of the features will be proved by practice. The change we need to do now will transform and modulate the future diabetes care.