Impossible to avoid the mirrors, in the Covid intensive care unit of the central hospital in Warsaw. Caregivers do not like to see signs of their exhaustion there: seeing oneself reflected is a necessity. Each immersion alongside the sick, behind the airlock that separates them from the rest of the world, requires careful preparation: first put on the suit, the valve mask, the glasses, and finally close the hood slowly, taking care not to leave a visible piece of skin.
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There only, we can return in « zone sale ». On the other side, a dozen patients in acute respiratory distress – eight men, two women – mostly unconscious, are playing their last chance at survival.
500 patients for 400 places
In his office, the head of the Covid unit, Dr Piotr Suwalski, responds to requests that are surging from across the country. This cardiac surgeon can receive up to 80 calls for support requests. “I’ll make arrangements, I have to do some logistics”, he replies to one of them. The hospital has already exceeded its capacity with 500 patients for 400 places. Here, Poland offers the best it has: Extracorporeal Membrane Blood Oxygenation (ECMO). Before the pandemic, the hospital already had two of these German machines costing € 200,000 each. The state has provided eight more, and is promising five more.
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On the other side of the airlock, the belly of the sick swells and hollows at the rate of the respirators. A 42-year-old obese man is hooked up to the machine directly connected to the arteries. “We put it in priority to the youngest who can endure it for two weeks, the time necessary to obtain results”, to date the survival rate is 60%, comments Maciej Bartczak, a young cardiac surgeon reassigned to Covid.
Rotations every three hours
Three women, an anesthesiologist and two nurses go back and forth between the control room and the patients. A three-hour surveillance – the maximum bearable – to monitor the constants, to check the data calculated by the machines by blood tests, to recharge the medication pumps. After which they will be raised. Initially, this unit operated with one caregiver for two patients. “The workforce has been revised because the patients have become more numerous, and nurses have fallen ill”, explains Maciej Bartczak. In all, ten severe patients require the mobilization of 100 people.
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With the partial confinement that came into effect on November 7 (closure of non-essential stores, distance education, etc.) the curve of positive cases has subsided, but mortality remains high: 12.5 deaths per 100,000 inhabitants in the last two years. weeks, compared to 11.9 in France. Piotr Suwalski remains cautious. “The cheaper antigen tests have just arrived, it skews the statistic which only takes into account PCR tests. ” The latter costing € 110, a tenth of the average salary, many give up.
The national stadium requisitioned
Each capital deploys its own genius so as not to be overwhelmed. In New York, a hospital has been improvised in Central Park. In Madrid, the Convention Center welcomes patients. The Warsaw Central Hospital can count on the national stadium, a colossus of 60,000 seats requisitioned on November 6. Well placed, easy to access: “Of all the places identified, it is by far the one that lent itself the best”, assures Panek Tabkonski, coordinator of the structure, a former military nurse who served in Afghanistan.
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Two generators and an oxygen tank were placed on the lawn. Thirty patients are inside, in a large space of 285 beds. The press is unleashed against this device while few people have been taken care of, despite the storming of the admission platform.
But the criteria are strict: the national stage does not treat mild symptoms or severe forms of the disease. It helps stable patients who need help breathing. “We are still in the process of breaking in, we are trying to isolate ourselves from all this media coverage in order to concentrate on what we have to do”, says Panek Tabkonski. 250 additional beds are expected in the coming days, including 50 beds in intensive care, in the event of a deterioration in the condition of people already there.
This word composed of Greek elements which contains ” Oxygen ”, A name proposed by the French chemist Lavoisier who highlighted it, and therapeia (“Cure”), is used in the medical field to designate the techniques of respiratory assistance. Unlike an oxygen mask, a hyperbaric chamber, or an artificial respirator, extracorporeal membrane oxygenation (ECMO) does not pass through the lungs, but acts directly on the blood. The latter is sucked into the femoral vein, crosses a membrane which artificially replaces the pulmonary function of carbon dioxide purification and oxygenation, to be reinjected into a large vein in the neck.