"Those who refuse the vaccine ought to pay for their treatment if they get Covid. A single day of intensive care unit treatment costs no less than 1,000 euros 'excluding labour' – as the folk expression goes – i.e. not including the monthly pay and overtime of doctors and nurses," Professor Nebojša Lađević, anaesthesiologist and Chief Physician at the UCCS's Anaesthesiology and Reanimation Centre and coordinator of anaesthesiologists within the Covid system, said in an interview with Kurir.
There are many anti-vaxxers, but everyone has the right to choose and the right to select the treatment they want.
"We have offered everyone a chance to be healthy and to receive preventive healthcare, and you don't want it. OK, I have a solution. If someone offers you free vaccination in epidemiologically adverse circumstances, when there is a chance that your behaviour puts your life and the lives of others at risk, and you refuse, then if you get infected, you pay for your treatment. Our healthcare system allows us not to give any thought to the actual costs. People know that they have free treatment, and perhaps that's why they're relaxed, thinking, 'I'll get everything from the state free of charge anyway, including free medical treatment.' So they keep going on their merry way, which comes at a high cost, as does shutting down stores, because a lot of people have no income then. The sooner large swathes of the population are vaccinated, the faster the economy will recover."
Are you in favour of a lockdown?
"I'd like for everyone to understand that we have a good chance of coming out on the right side if we all follow the measures and if the vaccination rollout keeps up the momentum. We wouldn't need a lockdown then. But, we have to stop this incredibly rapid spread of the virus, which is why we need stricter measures and continued vigilance afterwards. Then the solution is a simple measure – everyone must wear face masks, both indoors and outdoors. Allow it here and disallow it there, and you will only have misunderstandings on your hands. Everyone wearing face masks everywhere and everyone getting the jab as soon as possible is the way to go."
Is sending those attending Covid parties to community work at Covid hospitals an option?
"It's one of the options if the law permits it, if it's ethically acceptable, and if it doesn't violate the rights of those punished. There's always work to do. Just yesterday we brought oxygen cylinders into the red zone by ourselves. For over a year, medical workers have had no right to a private life – we can't even take a leave of absence. We haven't used up our 2019 vacation days either, let alone the 2020 ones. People got five days for an entire year. Medical workers will be upset with those who are the reason why at some places there are 100 or 200 new infections. It would be a good idea for these people to come to a Covid hospital and see for themselves that the coronavirus exists and that there are people dying from it. They need to also consider those who are sick, but not with Covid, who need treatment."
How many patients who have had two vaccine doses have been infected?
"It should be said right off the bat that it wasn't the vaccine they took that infected them. If it had been, they would have gotten ill immediately after getting it. We keep warning people that it takes two to three weeks after the second dose for a significant number of antibodies to develop and protect us. That said, we all got relaxed when we took the first dose, and started to act in a more casual manner, including us medical doctors. You feel safer somehow and you loosen up."
Are you saying that there are also doctors who got infected after vaccination?
"There certainly are, I know of some colleagues of mine. To be frank, I felt relieved when I got the first dose, but I still wear a face mask. The same thing happened in many countries, even in Israel. But, the colleagues who took the jab in January and then tested positive had a very mild clinical presentation. The clinical presentation of those who got infected between two doses is much more severe. More than anything else, vaccines prevent death and a severe clinical presentation. However, there's no guarantee that the vaccine will protect you against infection, but the symptoms can be expected to be milder."
Many complications after Covid
What are the most common complications after Covid?
"There's work for all medical specialties. There is the chronic heart or cardiac muscle condition, lung damage, various types of fibrosis. Then there are peripheral nerve problems, as well as the psychological impact."
Does the UK strain – which is now dominant here – actually result in a more severe clinical presentation?
"The clinical presentation and the problems – with the lungs and coagulation – are the same as at the start. I subscribe to the view that the clinical presentation of Covid-19 is precise to the day. The treatment that we provide is also based on timed therapy. The National Treatment Protocol specifies that in the early stages of the disease the medications needed include, first and foremost, antipyretics and antibiotics. Broad-spectrum antibiotics are not necessary, only those preventing a superinfection. Antiviral drugs can also be used. When the early stage is over, there is no need for antiviral drugs anymore, as the virus has now replicated in the body. And then, sometime between day eight and ten, the disease reaches a stage when we monitor the development of the pneumonia and assess the laboratory parameters. We put together the patient's lab results, X-ray findings, and oxygen saturation measurements. These days are critical, and some patients might overlook them because they are at home. This is where we need to prevent the cytokine storm – a hyper-immune response of the body which can significantly worsen the clinical presentation. According to the Protocol, it's only then that corticosteroid therapy should be used. If corticosteroids are used on day one, you weaken the body's immunity further, resulting in an accelerated replication of the virus. So, we carefully monitor the patient from day one, and know what to administer and when to administer it. We are good at this as we follow our National Treatment Protocol – which is exceptionally well made – in dealing with patients with the coronavirus."
'Anaesthesiologists are always in short supply'
How do you cope?
"Even with twice as many anaesthesiologists, there wouldn't be enough of us for this sort of pandemic. We still have training sessions for young internists, pulmonologists, who come to anaesthesiology wards to study intubation and mechanical ventilation. We have a so-called show room, and we have brought in ventilators and infusion pumps, and held many seminars at the CCS. Here I have to commend the doctors hired through job ads, who work at the Batajnica facility's intensive care unit. We have 65 young doctors there who basically started their work right after graduation and traineeship. Most of them now know how to set a mechanical ventilator, insert an arterial line, and do a gas analysis… Wonderful young doctors."
(Kurir.rs/Jelena S. Spasić)