The post-pandemic world – challenges and solutions. Interview with Prof. Dr. Grigore Tinică

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Interview published on cadranpolitic.ro

Although, by his nature, he is a rather discreet and modest person, even excessively weighted with public appearances, I don’t think there is anyone in our country’s medical elite who has not heard of Prof. Dr. Grigore Tinică. Not to mention the thousands of patients he has been there for. And because a recent survey by a public opinion polling company showed that more than 90% of Romanians are interested in the opinions of doctors regarding the management of the pandemic, I convinced him, as manager of the Institute of Cardiovascular Diseases Prof. Dr. George I.M. Georgescu Iasi, but also in view of his vast experience as a cardiovascular surgeon, to answer a series of questions about the present, but especially about the medical system and post-pandemic society.

Editor: We hear every day, on numerous channels, that “after the coronavirus, the world will be completely different from before”. Yours what do you think? What will the post-pandemic world look like and will anything major change in the perception of medical specialists, but also in our perception, the majority of people?

Prof. Dr. Grigore Tinică: I believe that the life of each one of us is determined by God and by the way in which we shape it, in relation to the time and space in which we grew up, according to the social and professional context in which we evolve. A virus, regardless of its structure or form of expression, cannot essentially change who we are. It may just redefine certain boundaries or accentuate certain behaviours.

To come back to the question asked, the current socio-medical context depends on the policies of each country, and I am not only referring here to public health policies: some governments have taken immediate, appropriate measures, such as those of the ASIAN countries, especially those addicted to China: Japan, South Korea, Taiwan, Singapore. The benefit of such rapid, immediate action has been reflected in lower rates of infectiousness and even mortality, which has allowed the population to weather epidemics/pandemics such as SARS-COV1, MERS, or other types of flu or viral infections with major epidemiological potential more easily. The adoption and immediate application of such measures was made possible by the secular social cultural education of those peoples: they are disciplined, more informed, have been wearing masks in crowded public spaces for 2-3 years already, becoming a way of life… whereas in our country it has only now been understood that it is necessary to wear a mask both for one’s own protection and for the protection of others. It is education that enables informed and rational understanding and adoption of personal hygiene measures for individual and community protection in equal measure. In 2017, for example, while travelling to a congress in South Korea, I met volunteers who politely warned those not wearing masks on the street and distributed a pack of two such sterile devices free of charge. Furthermore, masks were available in pharmacies at affordable prices. As for the US or EU countries, the Western-style culture has over time weakened the community perception of protective and preventive measures taken by the authorities, which may explain the high incidence of viral infections and related mortality rates. Belonging to Western culture, Europeans have a different perception of authority. Perhaps that is why it is not only Western Europe and the US that should dictate the course of medical history. Perhaps we should also listen to doctors in Eastern European and Asian countries about preventive and protective measures for the population.

A: Based on these measures, will we see the usual changes (daily habits, health habits, etc.) or will there be something deeper that will put society on a different footing?

Prof. Dr. Grigore Tinică: If we briefly go back to the memory of the history of medicine, the life of communities continued after any epidemic, regardless of its aggressiveness and spatial extension. Even if in this period for the moment, we are apparently more relaxed, at least apparently, we work from home, we don’t get angry anymore, we eat healthier, we rest more, the pollution of cities has decreased, psychologists draw attention to an insidious enemy, as invisible as SARS-COV2, our mind and the more or less inherent problems that it outlines, which invariably leads to the installation of psychological contexts. Stress, anxiety, depression, secondary to isolation or self-isolation, social distancing or restriction of freedom of movement can accentuate suicidal or obsessive compulsive behaviours. Limiting interpersonal contacts has instead increased adherence to virtual, online connections.

We have gone through a period where we could reconnect with ourselves, re-evaluate values once considered a priority, or even do activities we never thought possible to integrate into our daily lives. For example, for those who live in a block, a famous teacher from Chisinau sent me a video about how to plant different seeds in disposable cups to grow plants. On the other hand, writing and/or reading could be a means of expiation of loneliness, as could spending time with family. Intellectuals, those who have never written a book in their lives, could start now, those who have not read for lack of time until now, it is good to read, those who have not had time to spend with family, have now. We have time to do all those little things that we’ve put off because of major goals that we thought conditioned our lives, leaning towards doing what we like or enjoy. I was reading somewhere the memoirs of a political prisoner imprisoned in Ploiesti who said that he felt the most free during the time he was imprisoned.

I think it is good to look positively at the current context: we are not in prison, we are in our homes to protect our loved ones, technology allows us to stay in constant contact with our loved ones, with our colleagues, we can develop telemedicine, staying in constant contact with our patients, we can see at any time what is happening politically, socially, economically around the world, we can watch movies, which otherwise time would not allow us to watch, we can be alone with ourselves, analyzing our lives and perhaps making decisions that we leave to an uncertain future. We can watch tutorials on the internet learning or practising hobbies: from gastronomy to robotics, from horticulture or house cleaning to IT. In other words, we can achieve everything we ever wanted but time, or rather the lack of it, has prevented us from doing so.

Everyone’s life has moved fast forward in the last few decades, technological progress has been huge and we’ve been trying to keep up with it, alongside each other, and we haven’t noticed ourselves, we haven’t paid attention and maybe we haven’t understood what’s happening to those around us. It is possible now to look at life from a different angle, from a different perspective, to become aware of what are the really important things, those that we would take with us on an island isolated from the world, to appreciate first and foremost those close to us, those with whom we live together.

I don’t know what post-pandemic society will look like for sure. But I do know that life goes on, we must not stop and we must not get hung up on the obstacles of the moment! As the late Professor Francis Robicsek said when I asked him around 2000, “Professor, when did you manage to write so much?” (he had over 80,000 pages written), and he told me “When something doesn’t work, I move on to something else and do something else that works… I don’t focus on something I can’t do.”

A: Avoid wasting energy and unnecessary negative charge…

Prof. Dr. Grigore Tinică: – Exactly. And each of us might do well to act accordingly, according to our minds, souls and hearts. We all had plans for the future, which we thought we would solve as soon as possible, and today we are anxious because we do not know when and if we will be able to achieve them. But when you focus on just one idea, you become unproductive, creativity gets blocked, and instead of finding solutions, we see more and more obstacles. We become like Sisyphus, who climbs the rock on the mountain, but the rock keeps rolling downhill… and he climbs it again, but all in vain! to no avail! Wouldn’t it be better to leave the stone where it is and build stone by stone, so that this tumulus of small stones can help us reach the top of the hill? The current pandemic has taught us not to miss the point, to live anchored in the present. On a personal level, tomorrow is not a certainty, and may not exist.

A: How soon do you think we will have a vaccine against SARS-COV2? Do you think the presence of a vaccine will solve this epidemic once and for all?

Prof. Dr. Grigore Tinică: In Romania, immunization – vaccination of the population has been respected for various pathologies, even in the post-December period, when Western European populations gave up for ethical reasons the complete vaccination schemes in the 80s. The effects of the BCG vaccine are now being studied in the Netherlands. Personally I don’t have access to the final results yet, but it seems that this vaccine also helps the body to strengthen immunity against this virus. Mankind will get over Covid-19, it will surely beat this disease, and researchers will sooner or later find the vaccine that will give us the protection we need when we encounter this virus.

I also believe that the major vaccine companies must properly inform the population, take responsibility for all adverse reactions and pay for them when they occur. This will probably make the population more informed and consequently more peaceful and less manipulable by various conspiracy theorists. The truth is somewhere in the middle, but from my own experience I know that you can’t make a man well by force! If he wants you to do right by him, you do, but if he doesn’t, you can’t force it on him. After five decades of living under communism, Romanians should know best: what is imposed by force lasts only as long as the force lasts. And I think we should open the eyes of others to this, especially societies that have not gone through our experience.

Currently, more than 70 scientific centres are known worldwide to be working on the creation of the SARS-Cov2 vaccine. It’s really an international competition, who will make the vaccine first and who will succeed in pushing it globally. Because it is about prestige, even pride and – no specialist denies this – a lot of money. Yes, all the companies in what we colloquially call Big Pharma are fighting over this vaccine. I’m sure a solution will be found, if it doesn’t already exist, because this virus has been known for a long time: we have identified descriptions of the coronavirus in Russian newspapers from ’72 to ’77. Many specialists initially considered it to be a very weak virus, but as we know today the virus has undergone many changes (naturally or not!) becoming extremely aggressive, with a major infectious/endemic potential. It is important that the spread of any infection is limited, because with globalisation we can no longer say that we are unaffected by what is happening today in Australia, positioned on the other side of the world. Wrong! Nooo, tomorrow someone can get on a plane to Sydney and in 24 hours, after a stopover in London, arrive in Bucharest or Iasi, where they can spread any contagious infection. Mankind needs to be more alert, more prepared, and I believe that health systems and the population in general are ready to face such challenges. Nobody is and cannot be protected one hundred percent, new outbreaks can appear at any time or an infection considered in the past annihilated can reactivate, outbreaks can develop, especially in asymptomatic people, who are active, dynamic, interactive, and can spread the virus; each of us should protect ourselves by wearing masks and keeping that social distance even without being imposed by ordinances, constitutional or not.

A: In this context, as a manager, do you think that hospital management plans need to be rethought and adjusted? What should MS do and how much of this responsibility falls directly on managers?

Prof. Dr. Grigore Tinică: – First of all, we should rethink medical and social behaviours, i.e. start with ourselves. Then we should reconfigure the health systems and the material base in which they operate. In the future, we have to change the construction of hospitals, we have to accept that in the next 30 years, probably one of the main causes of mortality will be infectious and viral diseases, because viral, bacterial, mycotic infections (caused by a bacterium, viruses or other microorganisms) develop quickly, they adapt faster, and we, trying to simplify things, have fed antibiotics to plants and animals, and we have processed pretty much all foods. Every day, in fact, by buying processed or fast food from the supermarket, we potentially increase our eventual dose of antibiotics, destroying beneficial microbial flora, lowering defence mechanisms and implicit immunity.

Most likely, in the future, hospitals will have a different architectural design, they will be designed differently, multi-block or mono-block, the ventilation and air conditioning system will have to be modified, changed on sections, on specific areas, giving up a common air conditioning system for the whole building. Because a particular infected space, through air recirculation, allows the infection to spread to the rest of the building instead of limiting it.

In my wanderings through the USA, I visited modular hospitals in California which were made up of many buildings, double connected, underground and above ground, the administrative and technical part of the hospital being at a considerable distance from the other buildings; the polyclinic was separate, the scientific research area also occupied a separate building, and the treatment area, i.e. the operating theatre was also completely separate from the rest of the modules. To move from one area to another you had to follow well-defined, separate circuits for medical staff, septic or aseptic patients and carers. To move from one area to another, you follow clearly defined and delimited circuits. In Romania we should stop making hospitals out of any building available at any given time. Over the last 30 years, however much this truth may disturb, we have adapted old buildings and repurposed them for health care purposes; in other words, we have refurbished buildings designed for other requirements, we have patched up old ones, we have not planned, thought long-term and built a hospital from scratch, which is why the current epidemiological circuits in the vast majority of hospitals are not adequate. In the context of the current pandemic we have had to adapt new epidemiological circuits to the old buildings in which we operate.

At the same time we should understand that infectious diseases and epidemiology are extremely important specialties for the medical future of modern societies, which is why we should rethink the related curricula and how they should be implemented in modern medicine. In our case, treating cardiovascular disease, teams should be made up of doctors with different specialties working together and treating patients and comorbidities, but especially ensuring the prevention of complications.

“This pandemic was like an X-ray of humanity”

A: What would be those post-pandemic measures and priorities (especially as we cannot exclude a new challenge in a year or two, once Pandora’s box has been opened) that are mandatory to be included in a future national health strategy adapted to the new global crises?

Prof. Dr. Grigore Tinică: In my opinion, the relaxation of the measures should be combined with an increase in the number of tests in the population. For example, in companies with a large number of staff, I consider it advisable to test staff at least once a week. Romania ranks in the middle of the population testing charts, there is still room for growth.

In another sense, I am not of the opinion that shopping malls and businesses should be closed, but that certain protection conditions should be met in each shop, with thermometry areas at the entrance, disinfection, masks or even rapid tests. Such areas should also be set up in hospitals, pharmacies, retail areas, factories and plants. Taxi drivers or persons affiliated with public transport in extensive contact with a large public must have the opportunity for regular testing and the correct means of self-protection carried out in a somewhat uniform manner.

The government should think of measures that protect the population but also allow the economy to develop, to go one hundred percent, but also protect workers, employees. Every company, institution must have a white plan to protect employees in case of epidemics. We expect to be free of the current pandemic by the autumn of 2021, immunised and perhaps learning from these troubles we are going through now.

A: One measure that has raised many opinions for and against has been the militarisation of some hospitals. Although, as we know, the army enjoys excellent trust from the Romanians. Yours What do you think?

Prof. Dr. Grigore Tinică: Speaking of the militarization of hospitals, I would really like to say something that I hope will not offend anyone. I didn’t like the fact that the military hospitals, as institutions in their own right, as many as we still have, didn’t come to the front line in the fight against Covid 19. They’ve stayed somewhere in the back all this time. In retrospect, I think the anti-Covid fight became for each of us like a biological war in which military hospitals should have flanked the front line. They weren’t. It’s true that we being a less disciplined people, sometimes we need to get the militia down from the bridge! This militarization of some hospitals, where some employees did not follow the rules, or did not want to follow the rules, was probably welcome. Instead it was the military doctors and military personnel who got involved, and for what they did each and every one of them and all of them together deserve our respect and admiration! Looking at it from another perspective, hospitals with problems during the pandemic were run by people not affiliated with the medical staff. The Americans showed statistically years ago that hospitals run by doctors do better than those run by economists or lawyers. I don’t know how it is that modern Romanian medicine follows models adopted completely from abroad, but which are examples of bad medical practices, forgetting to adapt them to the epidemiological, genetic, social or cultural characteristics of our people.

Returning to the military arts, I proposed to the rector of UMF Iasi the introduction of a course in Disaster Medicine or Military Medicine. My generation, from the second year of university to the fifth year, also took courses in military medicine, toxicology and traumatology, medicine of war wounds caused by white weapons, firearms or medicine of chemical and nuclear poisoning. After the 5th year, in the army I did practical applications, and even participated in the erection of a field hospital.

I do not know of any courses in Romanian medical universities dedicated to diseases arising in theatres of war or disaster medicine, which belong only to the Faculty of Military Medicine. It seems unfair to me that students at general medical faculties in Romania do not benefit from such knowledge, which I believe is elementary for all personnel involved in civil protection services, both in the face of natural disasters and military disasters, chemical, viral, bacteriological or nuclear attack. May we never experience a major disaster or war where the number one priority is the protection of the population! Or to achieve this, we must first train doctors, military, firefighters, policemen, all those whose job description is to protect the population.

In a different paradigm, I believe that the secret services should also reconfigure themselves on a different basis, refocus their objectives and try to prevent disasters like COVID 19. Even the SRI needs to modernise. I think they should have known in advance and warned the authorities in Romania about what happened in China and other countries, and unfortunately we did not see the early warning that should have come from them. (or maybe they warned?!…)

I think the current pandemic has been like an X-ray of humanity: we have found out what is best and what is worst, equally in the human being, both in patients, in health professionals, in those who lead us and in the general public.

As far as I am concerned, I am a doctor, and since I can remember, I have been battling illness and death, treacherous enemies, sometimes silent, sometimes noisy. For my daily work and life, political or social contexts matter less: I know that I have to protect my patients, colleagues and hospital and ensure the best conditions for the treatment of all diseases, regardless of their causality, even or especially in pandemic conditions. And by the way, it’s not just Covid 19 in this world: people also suffer from heart, lung, kidney, eye, teeth or gastrointestinal diseases.

I do not know of any current relevant technical solution to the medical problem we are facing and I believe that we must by all possible means ensure equal chances of survival for our patients, regardless of resources, epidemiological schemes, political, social or economic contexts.

We have seen over the last few months who our friends are, who are traitors, who is brave and who is a coward.

A: What will happen to us after the pandemic?

Prof. Dr. Grigore Tinică: It’s hard to predict. There will certainly be many challenges, health systems will be remodelled, modern techniques and technologies will be implemented, political structures will have to be adapted to new social behaviours in line with individual rights and new rules of social distance. States led by powerful people will change their economic and social policies in order to protect their own people, repatriate and reconsider the means of production for the protection of the population, protect and develop the resources necessary for defence, such as: army, education, health, infrastructure, natural resources, communications, banks, food. Those led by puppets will go through this pandemic like a duck to water, learning nothing and remaining at the mercy of chance.

For now, the important thing is to draw the right lessons, to see where each of us is positioned so that in the future we will be better prepared. And preferably more united!

Otherwise, any change ultimately depends on each of us, on how we rethink our own lives, our own behaviours and how we try to write our future.

So help us God!