In Lombardy, they struggled for the lives and good health of patients with COVID-19 disease. Later, rich in experience, they went on expert missions to Slovenia and the United States.

The coronavirus pandemic was spreading at a terrifying speed. In Italy, which had become the European center of the coronavirus crisis, the number of confirmed cases of COVID-19 was increasing with every hour, and the doctors would often have to choose who they should assist to. They desperately needed help. Responding to the dramatic reports from Lombardy, Polish medics offered their help.

“We heard that the Italians were calling for their doctors to come to the north of Italy and work in hospital emergency rooms and intensive care units. They desperately needed any kind of support,” says Capt Doctor Jacek Siewiera, anesthetist, the Head of the Clinical Department of Hyperbaric Medicine at the Military Institute of Medicine (WIM) in Warsaw, and the commander of the Polish medical mission. “We were aware that this trip posed a risk to our health, or even life. In Italy, 20% of over 30,000 infected people were medical personnel, and mortality at the time reached 10%. Despite that, we wanted to help save people, but also gain knowledge and experience, so we could later fight with the pandemic in our country. Intelligence and reconnaissance are the basis in military planning. It’s quite the same in medicine,” he emphasizes.

First Hit

The Polish medical mission was jointly created by the Military Institute of Medicine and the Polish Center for International Aid (PCPM). Fifteen people flew to Lombardy, including anesthetists, cardiologists, emergency medicine specialists, nurses and emergency medical technicians. “We needed highly qualified specialists, mainly anesthetists, people who are experienced in emergency care,” says Capt Siewiera. Most medics had already dealt with COVID-19 patients in Poland. “At that time, Poland had a low number of coronavirus cases, but the curve of COVID-19 infections was constantly going up. In Italy, there were already terrible things happening,” recall the medics. At the end of March, Lombardy was an almost desolate region. “On the hospital corridors you rather saw trolleys with dead people than people walking. Military transports carried away tens of tons of corpses daily.”

The doctors flew to Brescia, about 50 km away from Bergamo. There, in the local clinical hospital, they opened the Polish intensive care unit. They were directly assisting the sick patients and fought for their life. “Italy had taken the first hit, while other European countries had some time to prepare for the pandemic, this way or another. What’s also important is that Italians were very scrupulous and incisive in their reports on how the epidemic was developing, they provided exact data, never manipulated the stats. It was Italy that informed the world that COVID-19 is not another flu,” emphasizes Capt Siewiera.

Polish medics, during their ten-day work in Italy, were acquainted with, for example, organization of the healthcare system in crisis or dividing work among medical personnel. They also learnt about right medicines, diagnostics and treatment. They realized that the key element in treating patients with COVID-19 is to develop intensive care units at the hospital level. Italians had transformed one of the exhibition centers near Bergamo into a branch of Papa Giovanni XXIII Hospital. “This branch was designed exclusively for patients requiring intensive care. Americans were interested in how such a branch was organized, and they created similar units in Chicago and other cities,” says Capt Siewiera.

Transfer of Knowledge

What else did the Polish medics learn there? Ambulatory care over patients with COVID-19, ventilation of patients with respiratory failure, distribution of tasks among extremely overworked personnel, training doctors of other specialties to work in intensive care, and building an intensive care hospital – these are only a few examples. Experience gained in Italy was applied not only in Poland. Soon after the team came back from Lombardy, a decision was taken on delegating another medical team of experts on a medical mission abroad, a strictly military one this time. President Andrzej Duda, in the conversation with US President Donald Trump, declared the readiness of Polish medics to go the United States. “The Americans wanted to talk to the medics who had been to Lombardy. Although initially it was to be a team of different medics, it soon turned out that the team to Chicago will include mostly the »Italian« members,” admits Capt Siewiera. The trip’s primary goal was to support the allies in preparing their health protection system for COVID-19 response. The Poles were invited to Chicago by the Illinois National Guard. They participated in many meetings at the state and military level. They visited university hospitals, crisis management centers, rescue centers and other institutions responsible for organization of medical care during the pandemic. “We learnt about the management system, observed the role of the army in crisis response, and visited a temporary hospital with almost 3,000 beds built by the National Guard,” says Capt Siewiera.

The doctors shared their knowledge with the personnel of the emergency rescue control centers in Chicago, they would give lectures and webinars for hundreds of hospital emergency and intensive care unit workers. “This was a mutual cooperation. On our part, we primarily wanted to learn about their healthcare model, but also about the research results on the effectiveness of therapies with various drugs being in the phase of clinical trials. A crisis is often a time where miraculous drugs can appear, the verification of which takes many months. In the USA the results were already available, although still not published,” adds Capt Siewiera. He also emphasizes that the Military Institute of Medicine wants to engage in the scientific research with good prospects, not duplicate the allies’ experiences. “Unfortunately, it turned out that for the time being, there are no wonder-working COVID-19 therapies. What’s most important right now is the skillfulness of anesthetists in ventilating their patients and in life support,” admits the commander of the military medical mission. Doctors explain that the results of research conducted on the vaccine, in the USA and Great Britain hold more promise.

Four WIM doctors participated also in another expert mission – in Slovakia. They met there with professionals from the main Slovenian medical centers. “We didn’t go to Ljubljana to work with patients, but rather to get acquainted with the healthcare system of a country with the coronavirus infection trajectory similar to ours,” says Bartek, one of the doctors and a special forces soldier. The medics also visited the tent hospital in Ljubljana put up by the Slovenian army. “Civil healthcare had the pandemic under control, and this hospital was not being used. From what we saw in Italy, a tent is not necessarily a good solution for this type of disease, as it is hard to separate the clean and unclean zones in such conditions. The Italians initially also put up tents, but soon they realized it’s not working,” explains the soldier.

Unique Experience

Both in Italy and the United States, the army was quick to help after the pandemic had broken out. Soldiers were building temporary hospitals for the infected patients. In Illinois, the National Guard would launch “drive thru” coronavirus testing sites. “Obviously, they do it on the grand scale. They use the already existing infrastructure, e.g. barracks and vehicle inspection sites, and they do the testing on six or seven lines simultaneously,” tells us Capt Siewiera. He adds that Illinois soldiers do not work with patients directly, e.g. in hospitals, but rather deal with logistics. “The army supports the government structures, but in the non-medical phases, e.g. soldiers gather data on the number of infections,” he explains. Several dozen soldiers with no medical education just fill out a four-page form twice a day. They simply call hospitals and ask about the number of patients, deaths, discharges from hospital, the quantity of individual protection materials, or available respirators.

“For me, as a medical doctor and a special forces soldier, it was very important that I could use the experience I gained in the army,” says Bartek. “Usually, army doctors have to deal mostly with gunshot wounds and such in strong and young patients. Here, we encountered patients of a very different profile,” he adds. He also admits that after the Italian experience, they all agreed that more focus in educating army doctors should be put on intensive therapy. “It’s hard and cannot be learnt from books. In Italy, the patients in a serious condition were looked after not only by anesthetists,” tells us Bartek.

The first results of the mission can already be seen in the Military Institute of Medicine. Some solutions from abroad were being introduced on an ongoing basis. “We know now how to build temporary hospitals for intensive care patients. We know the construction rules for such objects, such as the height of rooms, cubic capacity, room ventilation. This is unique knowledge on the global scale, for which today the US National Guard asked to be generally available. Will we need it in Poland? Time will show,” says Capt Siewiera.