The Time of Uncertainty in Poland

The ongoing COVID-19 pandemic affects almost all aspects of everyday life in Poland. Although morbidity rates are quite stable (300-400 new cases daily in a population of 38 million), we are still anticipating a sudden rise in these figures. Will it happen eventually or not? At present, epidemiologists hold divergent views so health care professionals as well as our patients are living in a state of uncertainty for the moment. It seems like we are all looking to the future but we do not know exactly what to expect.

Almost 3 million poles with diabetes are facing the fact that they are particularly prone to a severe course of the SARS Cov-2 infection. So, diabetes is now perceived as a potential fatal COVID-19 comorbidity not only by doctors but also by people with diabetes. Yes, it seems to be fact but living with the continuous stress due to this uncertainty and anxiety can also result in a substantial rise in glucose levels which in turn could give rise to a deterioration of diabetes control.

Our patients with diabetes are not left alone to suffer. We are performing e-appointments, tele-visits, providing medical advice as well as words of encouragement. We can also provide medicines and supplies (sensors, strips) through e-prescriptions, but is all that enough without personal contact? This time of social isolation provides a positive motivation to improve diabetes control for some patients. They have started complying, using diet and physical activity enthusiastically, and controlling blood glucose levels more vigorously. On the other hand, others present a state of resignation. Isolation, loneliness, sudden unemployment, and lack of social and financial support make diabetes control more demanding so they give up healthy eating, physical activity, and even discontinue taking medications including insulin.

The COVID-19 pandemic has changed the organization of our health service in Poland. There are almost 20 hospitals repurposed and dedicated to COVID-19 treatment exclusively (for example, the Jagiellonian University Clinical Hospital in Cracow). The structure and organization of all other hospitals has also been changed. I have now worked at the university hospital in Lublin for more than 30 years. As the head of the division for diabetes, together with my fellow workers consultants and residents, we were required to provide care for patients referred from our infectious diseases department after just one negative SARS-Cov2 molecular test. So, we are now looking after patients presenting symptoms similar to COVID-19 (lobar pneumonia, pulmonary embolism, lung cancers, or COPD exacerbations, among many others). They all have elevated blood glucose levels—one-third of them have diabetes. In other cases, this could be stress hyperglycemia or “cytokine storm.”

Is one negative result sufficient to exclude COVID-19? Of course, no one can be sure but the clinical experience of infectious disease consultants makes ourselves less uncertain. Trust in the clinical expertise of our colleagues is extremely important these days. In fact, our infectious diseases department is doing a great job as we have one of the lowest COVID19 mortality rates in Poland and we are introducing new therapies (tocilizumab, remdesivir, convalescent serum, or even extracorporeal membrane oxygenation (ECMO) for the most serious cases).

As for clinical experience, I consider it to be the most important factor for successfully practicing in medicine, even more important than guidelines, algorithms, and Evidence-Based Medicine (EBM). Now, what I desperately need is reliable solid data from randomized controlled trials concerning COVID19. Anecdotal scientific communications, brief reports, and small studies results do not make me confident. Only EBM data can provide assurance or I should rather say make us less uncertain.

University life in Poland has also changed. As normal activities were suspended around mid-March, like all other university teachers, I started delivering lectures and classes via the internet. E-learning is a very useful educational tool but definitely inadequate without the experience of direct physical examinations. That is why my students ask me when will they be allowed to come back to the hospital for regular clinical classes? I cannot give them a definite answer. When they inquire at university administrative offices, they always get a response that the decision will be dependent upon the current epidemiological situation, which is still unpredictable.

In these times of uncertainty I wish you both perseverance and immunity. We shall overcome. . .