2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
MEASURES INTROUCED IN 2020
The transformation of some hospitals into infectious disease hospitals and the constantly increasing number of patients has required repurposing of facilities, such as renovating wards and adapting rooms, creating isolation rooms and implementing physical barriers to keep patients apart. The situation is very dynamic and constantly monitored, with new orders for equipment such as respirators and personal protective equipment (PPE) being placed on an ongoing basis. In order to increase the stock of PPE in the early days of the epidemic, purchases of PPE not authorised for trading in the EU were allowed (https://www.politykazdrowotna.com/55977,koronawirus-mz-kupi-maseczki-bez-certyfikatu-ce). However, some of this equipment proved to be faulty and not suited for use.
In addition to the central government, some provincial governments have provided funding for medical and diagnostic equipment as well as PPE or have made facilities available to take overflows of non-COVID-19 patients from designated infectious disease hospitals. For example, on 21 April, the University Hospital in Krakow received the first delivery of PPE bought from funds of the ‘Lesser Poland Anti-Crisis Shield - Medical Package’ project, which is co-financed from the EU’s Social Fund. Despite these efforts, shortages of surgical masks, gloves and as well as medical equipment, such as respirators, have been reported in some hospitals.
The Material Reserves Agency has secured reserves of some required equipment, such as surgical masks and other equipment. In other initiatives, in April the Industrial Development Agency took delivery of a shipment of PPE ordered from China, consisting of 180,000 protective suits, 1 million surgical gloves and 50,000 goggles. In addition, on April 15, a new batch of equipment (80 tons of PPE) arrived from China to support health workers and other services. The purchase was financed by a number of state-owned companies including PKN ORLEN (oil refiner and petrol refiner). A further delivery of PPE, purchased by Grupa LOTOS on behalf of the Prime Minister’s office arrived on 18 May. The shipment consists mainly of protective suits (about 170,000). This is another delivery organized as part of the NATO SALIS (Strategic Airlift International Solution) program. Therefore, the Ministry of National Defense and the Polish Armed Forces were also involved in the operation. Logistic support was provided by the Industrial Development Agency.
The Ministry of Health reports that the 19 single-infection hospitals have approximately 700 respirators but require another 300. The number of ventilators in infectious hospitals (91): about 1,400. Since 20 March a ban has been in place on the export and disposal of respirators and cardio-monitors. In addition, for specific listed medical products companies must notify the district government about any planned sale or export outside the country.
Private sector firms are providing material support; for example, lending transport vehicles to hospitals free of charge, providing free courier services to help deliver supplies of PPE, donating cleaning and disinfectant products to hospitals and co-operating with food banks to provide food and meals for people in isolation centres or home quarantine.
https://www.gov.pl/web/koronawirus/od-dzis-wprowadzimy-stan-zagrozenia-epidemicznego [online access: 27.03.2020r.]
https://polskatimes.pl/raport-polska-press-grupy-czy-szpitale-sa-przygotowane-na-pandemie-koronawirusa-problemy-ze-sprzetem-i-srodkami-ochrony/ar/c1-14868135 [online access: 27.03.2020r.]
https://www.money.pl/gospodarka/antonow-an-225-mrija-w-warszawie-morawiecki-bedziemy-sciagac-jak-najwiecej-sprzetu-6499751479195777a.html. Access: 17.04.2020.
https://www.su.krakow.pl/nasz-szpital/aktualnosci/pierwszy-transport-zakupow-w-ramach-realizacji-projektu-malopolska-tarcza-antykryzysowa-pakiet-medyczny.[online access]: 25.04.2020.
https://wgospodarce.pl/informacje/79667-kolejne-wsparcie-lotosu-w-walce-z-pandemia [access online: 19.05.2020]
On 13th May, the Minister of Health announced that in regions where two designated single-infection (COVID-19) hospitals are operating, plans are underway to return one of them to their former activity. This will reduce the overall number of COVID-specific hospitals; decisions are pending based on current patient volumes that these hospitals are experiencing. For example, the ministry reported that the largest occupancy rate in the country is in single-infection hospitals in Silesia, where (as of May 18) there were 239 patients with 592 places. By comparison, in Lubuskie there was not a single patient in the province, while Warmian-Masurian province had 15 patients, Lublin province had 16.
In addition, the possibility of conducting other activities and services in some hospitals designated as single-infection (COVID-19) hospitals (i.e. restoring their normal services) is being analysed. The Ministry of Health, National Health Fund and regions are analysing the role and current occupancy of these hospitals.
Such changes will be introduced gradually, starting from 1 June, taking into account the epidemiological situation in each region. Should incidence rates increase or a second wave of infections materialise, the hospitals will be able to revert to single-infection units dedicated to COVID-19 patients.
https://www.newsweek.pl/wiedza/zdrowie/koronawirus-w-polsce-19-maja-ile-jest-zakazen-koronawirusem-na-slasku/xr1qgc9 [access online 19.05.2020]
In July, the University Center of Maritime and Tropical Medicine in Gdynia received a highly specialized computer tomography apparatus that will be predominantly used for diagnostics of COVID-19 patients. The tomograph will also be used in other patients, including children, as it is safe for pediatric examinations. Purchase of this equipment was co-financed from the EU funds.
https://www.gov.pl/web/zdrowie/szpital-z-gdyni-z-nowymi-mozliwosciami-w-walce-z-covid-19 [Access online: 13.07.2020].
Some healthcare facilities, such as the University Hospital in Krakow have been struggling to cope with the increased number of new COVID-19 ones. The hospital’s management is concerned that, with increased morbidity expected in the fall, the hospitals ability to provide all patients with an adequate level of care will be compromised. The management is concerned with potential shortage of oxygen cylinders. Further, the high use of PPE (600,000 pairs of gloves per month at the cost of PLN 600,000) is a cause of financial concerns.
In order to effectively coordinate the process of purchasing to fight the pandemic, the Ministry of Health released data on purchases made by the purchasing office. All data on the amount of tenders and the winning offer are publicly available at https://www.gov.pl/web/zdrowie/covid---ewidencja-zakupow. The Ministry also provides the latest data on the number of tests performed in each of the provinces.
In order provide care to COVID-19 patients effectively while at the same time maintain the normal functioning of health care facilities instead, the Ministry of Health does not recommend creating separate hospitals dedicated only to COVID-19 patients. Instead, the Ministry recommends that each hospital should set up its own isolation facilities.
As part of the autumn strategy, the Ministry of Health and the voievodes in the provinces issued over 600 decisions designating individual wards and hospitals for patients with COVID-19. Over the first week of October, 1,200 beds have been added, bringing the total number of COVID-19 beds to approx. 8,000 beds. There are also have over 800 respirator beds.
Poland is now departing from the concept of single-name COVID-19 hospitals. A three-stage hospital security system has been operating since September. During autumn, coronavirus patients will be examined and treated in one of the following three types of hospitals:
· All hospitals belonging to the hospital network will provide beds for suspected coronavirus cases. Patients will remain in the facility until they do not receive test results. If necessary, life-saving procedures will be implemented.
· Single-named infectious diseases hospitals will provide beds for the treatment of people infected with the coronavirus. 87 infectious and observation-infectious wards were prepared for the COVID-19 patients. In total, there are approx. 4,000 internal medicine beds.
· Patients already diagnosed with the coronavirus can also be referred to multi-specialist hospitals. People with severe symptoms will be sent to these facilities. Such hospitals will provide over 2,000. beds.
https://www.gov.pl/web/koronawirus/wiecej-lozek-dla-pacjentow-z-covid-19-i-zaostrzenie-obostrzen-w-powiatach. [Access online: 05.10.2020]
https://www.gov.pl/web/koronawirus/plany-na-jesien--strategia-walki-z-pandemia-koronawirusa. [Access online: 05.10.2020]
On the 19th of October the Ministry of Health announced that, in order to increase the number of hospital beds for COVID-19 patients, some of the poviat (county) hospitals will be designated as COVID-19 hospitals, while non-COVID-19 patients will be treated at other hospitals.
Central government also has decided to start building field hospitals in the biggest Polish cities. In Warsaw, the National Stadium was transformed into a hospital and warehouses were used in other cities. To prepare for an increasing number of cases, field hospitals for COVID-19 patients were also set up within the Hospital of the Ministry of Interior and Administration in Warsaw and the University Hospital in Krakow. The Ministry of Health announced that some of the voivodeship hospitals will also be designated as COVID-19 hospitals.
The Małopolska voivodeship received over PLN 2 million from the state budget's special-purpose reserve for the purchase of high-flow nasal oxygen therapy devices for the local hospitals.
Further bed capacity is being sought in the private hospital sector.
https://polskatimes.pl/stadion-narodowy-zamienia-sie-w-szpital-polowy-przyjmie-pacjentow-zamiast-sportowcow-nowe-zdjecia-2510/ar/c2-15244980 . [Access online: 29.10.2020]
https://www.gov.pl/web/zdrowie/podwojenie-bazy-lozkowej-i-udogodnienia-dla-personelu-medycznego. [Access online: 29.10.2020]
While the first patients have been admitted to the temporary field hospital at the National Stadium, bed occupancy remains low. Patients admitted to the hospital should have a positive COVID test result and not to suffer from any co-morbidities.
Another temporary hospital is also being built in Warsaw by the Polish Army. The hospital will be located at the biggest Polish Airport - Warszawa-Okęcie – and it will have 250 beds. Temporary hospitals are also being built in the capitals of the other voivodeships.
https://szpitalnarodowy.pl/wp-content/uploads/2020/11/Kryteria-przyje%CC%A8cia-SN-v-003-9-NOV-2020AZ-2.pdf. [access online 17.11.2020]
https://szpitaltymczasowy.wim.mil.pl/. [access online: 17.11.2020]
The Ministry of Health has launched the Home Medical Care (DOM) project, a remote monitoring system for COVID-19 patients across the country. Within DOM, anyone who tests positive for the coronavirus can receive a pulse oximeter. This device measures the level of oxygen saturation, i.e. the saturation of arterial blood with oxygen, and transmits the data to a monitoring center. In the event of deterioration of parameters, an ambulance will be sent quickly. The Home Medical Care programme is free of charge and fully financed by the Ministry of Health's own funds within the special purpose reserve.
https://www.gov.pl/web/zdrowie/rozpoczynamy-system-zdalnego-monitorowania-pacjentow-z-covid-19. [accessed online: 10.12.2020]
MEASURES IMPLEMENTED IN 2021
With the introduction of vaccinations, most of the temporary field hospitals have been turned into vaccination sites. In addition, vaccinations are also administered in the so-called nodal hospitals, clinics and other hospitals. There are 6,154 vaccination points nationwide. All vaccination points are listed on the government’s website (https://www.gov.pl/web/szczepimysie/mapa-punktow-szczepien#/).