Doctor Balík: I think we are at the height of a pandemic

What do you say about the current state of daily increases in the number of people infected, hospitalized and in severe condition? Do you feel that we are already at an imaginary peak, or will the numbers increase here?

I think we are at the top, even though the numbers of infections are not ideally declining. However, I believe that even with the current 5,000 infected a day, it is possible for our teaching hospital to manage the situation well even after a horizon of 5–10 days, when this will begin to show in the number of people in serious condition.

However, many hospitals are on the verge of being able to reach their reserves and thus start suppressing planned care, which happened in the spring and is something really unpleasant. It is not only a matter of postponing some orthopedic or gallbladder surgeries, but there may also be a postponement of oncological surgeries or demanding vascular surgeries, which not only significantly improve the quality of life of patients, but are also needed. Surely the next time will show the readiness of hospitals.

How is your department in this regard?

I’d say good so far. We still accept covid patients, but also all the others, so we manage everything with capacity.

But if there is a significant, dramatic increase in the number of patients in the next time, we will have to regroup the department, reducing some procedures to cover the needs of patients with coronavirus.

So how many patients do you have now with covid-19?

At present, there are about 30 covid patients in the General Hospital, ie about whom I know personally. Of these, 11 are in intensive care. Six patients are in a very severe condition, five of whom have invasive pulmonary ventilation, and one is even on ECMO (extracorporeal membrane oxygenation).

Smaller hospitals are beginning to complain about the lack of paramedics, such as the hospital in Uherské Hradiště for the lack of anesthesiologists. How are you?

Relatively good. We have enough doctors and we are still able to cover the increased traffic, should it occur. Of course, there is still a risk that our staff will become more infected, so that they really cannot work, and then there is a risk that schools will close and a few employees will remain at home with their children. In fact, we are more afraid of closed schools in this regard than we are positive.

On social networks, people share various excerpts from interviews with experts questioning government measures. Among them is your quote: “We have scared the company crazy. We test thousands of people a day, it costs three-quarters of a billion a month, and the result is 71 patients in severe condition. There are six of them in our country, they have a lot of risk factors, I call it intensive obesity. Influenza can be more destructive than coronavirus. ”Do you stand behind this text?

Yes, I stand behind every word in this quote. I don’t think the number of people who tested positive is really important, the numbers of patients in the hospital and, of course, the numbers of patients in a serious condition are much more important. With numbers in the last 14 days hovering around 3-5,000 positive tests per day, with a median of seven days before patients reach us in intensive care from infection, it can be said that we are already working with numbers of hospitalized corresponding to this high number of infected.

Nevertheless, we are now getting into a situation where we are starting to think about limiting care, and it is certainly not on the agenda yet to have to reduce other care to 30 percent because of the number of patients, as was the case in the spring. This was expected of the impact of the sick, which did not come at all in the final.

Of course, I don’t want to sin for that, I keep saying that coronavirus is a serious disease, especially because of the one percent that gets intensive care. This is definitely not fun for these patients, and I emphasize this, but at the same time I claim that serious forms of the flu are exactly the same misfortune.

From a scientific point of view, we are constantly comparing what coronavirus does to organs and then other viruses, including the flu. From our experience so far, we can even say that in some aspects, the flu may ultimately be even worse than the coronavirus. However, the flu is not as contagious as the coronavirus, so there are fewer cases in a serious condition. Therefore, the health system can manage the flu period without restriction, while coronavirus is at risk of being overloaded.

So how do you view the calls of some experts today to be less tested on covid, that it is useless to test asymptomatic people?

Personally, I think that people should be tested if their hygiene is determined by tracing or if they have symptoms of the disease, or if they live in a household with a risky person and want to be sure that they will not infect them.

Testing is also important so that we have as few people in quarantine as possible, which harms them at work and in everyday life. Then I see the point in testing if people need it to perform their profession, or because of traveling. But to be tested just for their good feeling that they are negative, or because they have a cold, I think it’s wrong.

As a doctor, would you sign the petition of Professor Pirk, Dr. Šmucler and other experts, who called for the repeal of “drastic government measures”, which, in their opinion, mean a “much greater risk of endangering overall health” than covid?

He didn’t sign, I think it’s foolish to put it this way.

You are one of the doctors with the greatest experience with the drug remdesivir. What are the rules for its deployment today? I therefore ask that, for example, Dr. Trnka from the hospital in Jihlava mentions that only a small number of patients can reach this medicine and that very strict criteria apply to its indication.

Yes, international criteria have been set for the use of the drug remdesivir, but I do not think it is strictly so far. But it is likely that the criteria will be set more strictly, because we are constantly obtaining new data on its effects, on the basis of which its indication is being adjusted. In our country, remdesivir has so far been administered to over 900 patients, and therefore all those who had an indication for administration of the drug received it.

So the main thing is that remdesivir has only a certain spectrum of its effectiveness, so it does not help everyone, and it is therefore important to make sure that only those patients it really helps get it. Therefore, everything is coordinated by an indication group, which consists of eight specialists who have divided individual regions, in which they approve the administration of the drug on the basis of requests from hospitals.

Personally, I think that the system set up here is very objective and fair, and everyone who really needs this medicine will get it.

How long are patients with severe conditions hospitalized in your ward?

You said that the incubation period of covid-19 is only 3-5 days. Is this the case only in our country or elsewhere in the world?

Indeed, current world data speaks of 3-5 days, so it is true that the disease usually appears within five days or not. Thus, either people will remain asymptomatic, which is the case in half of the population, or they will have a milder course (another 40 percent), or it will be a more serious form of the disease.

According to the Minister of Health Prymula, up to 40 percent of all hospitalized people were still people who no longer had a reason to be hospitalized, but due to their positivity they did not want to take them back to the homes of the elderly or simply had nowhere to go. Is this situation still present, or has it already been resolved?

I really hope that a solution has been found and that this is no longer the case today.

What do you say as a doctor on President Donald Trump’s treatment?

I’d say they basically gave him everything they could. The first drug, regn-cov2, is still an experimental drug for which one study has been performed. These are two monoclonal antibodies against the coronavirus spike protein. Thus, this drug may be important in people who are beginning to be symptomatic and at risk of a more severe form of the disease. The drug essentially blocks the penetration of the virus into human cells.

Subsequently, Donald Trump was apparently given oxygen and, according to the available information, he was also at risk of developing pneumonia, so he was also given remdesivir. All other drugs and supplements were already functioning as supportive care. Only time will tell to what extent the treatment has been used correctly.

If such effects of the experimental drug regn-cov2 are known, do you plan to order it in the Czech Republic as well?

This is really a complete novelty, when the company produces this drug in chimerized mice, which produce monoclonal antibodies applicable in humans. However, since this is only the first study, I do not believe that this drug is commonly available in the United States, let alone in other countries.

This experimental drug was apparently given to Donald Trump as well, because there was a real fear that he would become ill with severe form and that he would not be able to complete his presidential campaign. After all, there are only less than four weeks left until its end.

And how do you view the administration of Dexamethasone, a steroid that was also given to Donald Trump?

In some cases, we also use this drug to suppress an overly large inflammatory response in the lungs, but we are really careful not to harm the patient. The point is that every patient can have a lot of other problems, such as a bacterial infection on the coronavirus, so we need to know the true state of his immune system before taking this drug. This medicine really cannot be given immediately to all patients, as it could even damage them.

That is why a certain recommendation of the Czech Society of Intensive Care Medicine has been made at this time when to apply this medicine.

Most experts today agree that the best prevention of covid-19 is strong immunity. What would you recommend to strengthen people’s immunity?

Personally, I would recommend to the Czech nation not to pay as much alcohol, to reduce smoking and to start moving sensibly, at least in some recreational sport. But it is also important that people pay attention to prevention, and therefore go for preventive check-ups with their doctors or for examinations in hospitals, even at this time.

Indeed, the only thing modern medicine is working on now to fight coronavirus is the patient’s own immune system. In each patient, we try to immunomodulate the response of his body to coronavirus shock. It is currently the only way to survive this difficult period until there is an effective drug or a functional and safe vaccine.

And what recommendations do you have in terms of taking vitamins and other dietary supplements, such as vitamin D?

It is true that a lack of vitamin D, for example, is related to cellular immunity and also to how difficult patients manage to overcome all health complications, so it is necessary to have enough in the body. Vitamin C, for example, can also help. However, it must be borne in mind that vitamin D can be overdosed, and too high a dose of vitamin C can be harmful.

Personally, I would rather recommend people to focus on a balanced diet, have enough exercise, especially outside, and therefore in the sun, because then there is a high assumption that they will have enough of all necessary vitamins and minerals for the proper functioning of the immune system.

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