INTERVIEW WITH KULKOVSKY: The doctor can’t say STOP! We don’t blame the unvaccinated, it can be their last moments – Topky.sk

Milan Kulkovský is the head of the Internal Department of the Hospital with a polyclinic in Považská Bystrica. He has been dealing with COVID patients since the beginning of the pandemic and became known mainly through his blog on the social network, where he regularly described the situation in COVID wards. He is behind the creation of the Cooperation for Slovakia initiative, which calls on people to be vaccinated and also to launch a vaccination raffle.

According to him, the closure of schools was right, compulsory vaccination should be introduced, without it we will probably not achieve sufficient vaccination. In an interview with Topky.sk, he also talked about the fact that hard anti-vaxers are dying in the ward, as well as grandparents who became infected from children.

Let me ask you at the beginning … how are you? How do you manage the onslaught in the hospital and the third wave in general so far?

The feelings of medics in general I would sum up about being alternately cloudy. We manage the onslaught of patients with all our might. It can be said that COVID in hospitals today unites people, as most health professionals already work or have worked in the reprofiled wards. The doctor can’t say stop, I can’t rule anymore. We are not in a production that can be easily stopped. If we stopped, gave up, people would die, and we don’t want that. After all, many people are dying unnecessarily and stupidly today, just because they did not want to listen to us. Truc and the period of defiance probably belong to life. But I thought only with children. However, the opposite is true, today we are witnessing the fact that relatively reasonable and theoretically mature citizens are also grieving.

Source: Miroslav Miklas

What is your current COVID situation in the hospital? Is it comparable to last year and the second wave or is it worse?

The numbers of patients are comparable to last year and thus the second wave. We have the fans fully occupied, sometimes some of them become loose after the patient dies, but we immediately connect another one. Non-invasive ventilation, so-called HFNO. I will not forgive myself for noting that, in my opinion, it is these devices, HFNO, that save lives and not artificial lung ventilation.

According to official data, most hospitalized people are unvaccinated? Is it the same with you?

Of course, it is still true that over 80% of hospitalized people are unvaccinated and almost 50 are under the age of 50. A vaccinated patient on a ventilator is a rarity. And this is not only true in our country, but throughout Slovakia.

Are you talking to COVID patients who have not been vaccinated?

I am talking to them in particular about what is important to me as a doctor, that is, the difficulties they have and which I would like to eliminate or at least alleviate. One can already feel when asking some questions is unnecessary.

Are they used to changing their minds about the vaccination or do they still refuse it? The stories of doctors and nurses are different, and among those who have not been vaccinated, there are still those who, despite the hospitalization of COVID, still denied, but also those who regretted the decision.

Among the patients, there are stubborn but also reasonable realists who will understand. We also had cases where they accused us of falsifying the results or infecting them during testing. That we are artificially increasing the number of patients. Those who understand mostly remain silent, certainly feel embarrassed. If we ask why they could not be vaccinated, they often answer that they were afraid, looking for some reasonable explanation for themselves. But we don’t blame them, it doesn’t make sense and we don’t want to stress them even more when we know that these may be their last moments in this world. They can no longer change their mind. And there are, of course, those who would rather take the vaccine right away, but this is not possible. Several hard antivaxers have died or are still dying in our country.

Paramedics and doctors had a hard time, they were on the verge of strength last year. This year, however, it was said at first that it should not be so terrible. However, the situation showed that the third wave had a much faster start. Are we already at the top or do you expect the situation to be even worse during Christmas or after the new year?

Initial assumptions did not take into account the high infectivity of the delta mutation, so I am concerned now that we are expecting omicron. The fundamental difference is in vaccinations, which I hope will rise and save many lives. If Darwin were alive today, he would flee Cape Verde to Slovakia quickly and enthusiastically follow the development of a pandemic influenced by the faith of part of the population in conspiracies and would certainly describe the influence of programmatic unsuccessful politicians on the development of their voter mortality. I will be optimistic. Thanks to closed schools, the peak will come before Christmas. The situation will also calm down throughout the company holidays. Not many children from school will be infected by Christmas, so their meeting with grandparents should not be so tragic. Holiday meetings should have only a small number of victims.

The two-week lockdown ended, the resort wanted to extend it for another week, but in the end they approved a different form. From 10 December, measures have been relaxed for the vaccinated and out of reach (open shops or fitness) and from 25 December, hotels, accommodation facilities and spas will also be opened. Do you think this is a good procedure? The measures are currently in force until 9 January.

I agree with the significant favoring of the vaccinated and overtaken. This is also a way to convince the unvaccinated that this little prick in the hand is worth it. Personally, I would relax the measures to an even greater extent. And as I mentioned, I consider the closure of schools to be essential. The shops were not even supposed to close. Unnecessarily, we pushed all the shopkeepers into a few shopping malls, where they bought everything but bread.

At the same time, the minister set a new critical threshold, namely 3,800 hospitalized. When this limit is exceeded, measures will be tightened. It is bearable, resp. the limit is set correctly?

I think so, I agree with the Minister on this.

Among other things, the schools have closed since 13 December and are likely to close by 10 January. The Minister of Education did not agree. Should schools have closed? If they open after January 10, will that be enough? I mean the almost monthly closure.

School closures will significantly reduce mobility and the risk of transmitting infection from children to parents and grandparents. We would all like the schools to be open, but I believe that this is the last constraint in education that we have to endure. We died several elderly parents who were infected by the children who brought COVID from school. That is a fact we should not close our eyes to. Those who care about patients in Covid’s wards may not care, we, the health care provider, no longer want to look at those unnecessary deaths.

The topic discussed was also the so-called family or christmas balloons. Do you think the creation of such bubbles is riskier than, for example, opening hotels, accommodation facilities or wellness facilities? They were released last year, although we have not been vaccinated yet, but on the other hand, we did not have a delta or omicron here, which are more contagious.

Each one of us should consider what risk he wants to take. Visits at Christmas were finally allowed, and if they are not “mass”, I have nothing against them. However, I would recommend participants in family meetings, both vaccinated and unvaccinated, to have at least an antigen test beforehand. Yesterday, for example, I examined a patient, unvaccinated, who contracted a funeral, where there were supposedly only 10 people. I approve the opening of companies in the OP regime, including hotels.

The government finally approved the easing measures on December 14. The Christmas bubbles have been resolved by the fact that the curfew only applies in the evening. Only the OP group can still go to shops, some establishments and services or accommodation facilities and wellness, restaurants are closed. But otherwise, everyone can go everywhere. Isn’t that a sudden jump? It may seem that way to some.

State officials are certainly aware that one of the motivations for vaccination is the benefits for the vaccinated. If I had to speak for myself, I would also open restaurants for the OP and I would allow more clients to enter the fitness centers. Many fitters did not open, as with 6 clients they would have costs higher than profit.

OTP mode will be introduced in trains, high-speed and long-distance bus routes. Is this the right step?

If we have allowed visits, we must also allow people to travel to the family. The minimum that can be done is to lift the OTP mode. I don’t think it’s a problem for the unvaccinated and the unsurpassed to take the test before the trip. So I think this step is the right one.

I have a lot of doctors around who are against vaccination. There are those who give strong advice to their patients, there are those who say so softly, but urge them not to be vaccinated. Do you as a doctor perceive it as? What would you refer to this doctor?

To think about whether it makes sense to continue to practice medicine if they are not guided by the principles of evidence-based medicine, but by the principles of quackery and conspiracies. In my opinion, withdrawing patients from vaccination, unless they have a contraindication, is a non lege artis procedure. I respect the opinion of colleagues who are not in favor of vaccination, but should keep it to themselves, as medicine is not about feelings but about the facts behind which there is clear evidence of effectiveness and safety.

Society is quite divided today, the moods are also aroused, which we see in occasional protests, whether bigger or local. What would you tell them?

To realize that one’s freedom ends where the other’s freedom begins. That they do not only endanger themselves by non-compliance with the measures, but ultimately every single citizen.

According to many, one of the reasons for low vaccination coverage is a rather weak vaccination campaign. What do you think about it? Is it sufficient or not?

Probably everyone knows and sees that the vaccination campaign could have been better. From my point of view, however, local governments could have been more active. Most municipalities left everything to the state or the region and volunteers. But this is certainly due to the fact that many mayors are opposed to the vaccination of political conviction, which is sad and therefore they have done nothing to increase vaccination. If every municipality were proactive, today we would have vaccinated perhaps 70% of the population. Belief in a mayor can be beneficial but also dangerous.

Do you think that the vaccination rate will increase to at least 60-70% next year? Will anything else help or is it an unrealistic goal in Slovakia? You yourself started the vaccination lottery with interesting prices and you said that the interest in vaccination increased slightly.

In my opinion, we are not mentally set up to have a vaccination rate of over 60%. It would only change the mandatory vaccinations. And with compulsory vaccination, I feel that it will start somewhere in the jungle than in our country, as ours have much more guaranteed information than all the world’s scientists and our politicians have shivering and angor mortis before unpopular decisions. Of course, I agree with the compulsory vaccination of risk groups, especially citizens over the age of 60.

In the end, I would like to know what Christmas will be like for you, resp. holidays? Will you rest?

Holidays, vacations and weekends are normal working days for healthcare professionals. Of course, I can’t avoid serving during the holidays, like most colleagues. But we already take it for granted, and so do our families. I spent more than one Christmas night in the ward. I believe that during Christmas, the situation around Covid-19 will improve, that patients will start to decline and we will get some rest. Typically, however, after the decline of patients with Covid-19, those non-cows with neglected health will begin to increase, so we could say that we will move from the rain to the gutter. But that’s what our job is.