Fast Confession - Doctor Martina Vašáková: What's happening around covid seems like an overkill to me

When you hear 'lung month', what does that mean for doctors and the general population?

To focus more on lung health. It is a very complex thing, because we have to start with the health of our surroundings and environment. We want a clean environment to have healthy lungs. Whether it's exposure to tobacco smoke, thinking about how to better prevent young people from smoking, getting those who already smoke to quit, or external sources of air pollution, such as combustion products, exhaust fumes, chemical and microbial contamination of food, up to factory emissions.

This is the outer part of health. The inner part of lung health means that I will not harm myself and my lungs, that is, I will keep them in good condition. These include adequate physical activity and condition, optimal weight and, of course, non-smoking, or the fact that I will not inhale other combustion products, ie not only tobacco smoke, but also marijuana, which is also very harmful to the lungs.

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It is necessary to think very comprehensively about how an individual and society can help lung health. We also have an event within the Czech Pneumological Society focused on lung health, we have a Healthy Lung Day, we also have a one-day conference. It was supposed to be in person, especially for patients, but of course also for providers, doctors and non-medical healthcare professionals, unfortunately it only happened online.

To improve the environment, we would all have to move to somewhere in the woods. We can't just clean the environment around us.

That's why we should think about stuff. For example, I cannot understand why some people use their car as a means of transport if they commute literally and figuratively only a few blocks to work, and why they drive alone. One person thus destroys the environment for an incredible number of people.

I consider what's happening around covid-19 to be an overkill in many cases, however, the fact that air traffic was reduced practically in a day in a very significant way at the time of the first lockdown cleansed the environment in an unbelievable way. Suddenly it got cold and the sky was clear. Combustion products and toxic fumes and gases we emit have dropped. Reasonable compromises are the way. I don't think we have to move anywhere, after all, if we all moved to the woods, we would pollute and destroy them as well in a little while. It's about reason.

Chronic obstructive pulmonary disease (COPD) has practically become a disease of civilization. Is it even possible for people from big cities to avoid it in old age?

Of course. COPD is still caused by cigarette smoking in the vast majority of patients. If you do not smoke, you will certainly not develop severe COPD. You would have to be a woman in the developing world who is exposed to an open fireplace on which you cook in a clay hut. Or you will be unlucky, and this is a very small part of the population, who have a genetic defect that does not allow the consequences of inhalation of pollutants to be repaired, and that is also very few people. If there was no smoking, then it would be practically no problem.

I talked to one of the lung doctors who lives in the countryside, never smoked and has COPD. Is it possible to live with it?

Of course, some people, even if they are really small number, can have COPD even if they do not smoke. It is passive smoking, exposure to dirty air, which can cause this, together with, for example, a disorder in the production of substances that can, to a certain extent, correct the consequences of inhalation of pollutants in the lungs. But the symptoms are usually not serious, you can live with it. There are effective drugs that can treat COPD, alleviate bronchoconstriction, inflammation in the bronchi. When the so-called alpha 1 antitrypsin is missing, aka the substance that prevents damage to the lungs by its own enzymes, its substitute can be supplied and the defect can be remedied. Rehabilitation, regimen treatment including non-smoking, optimal weight, classic inhalation treatment, everything is important. It only depends on the patient being cooperative. Mainly, and I'll say this again, if one smokes, then quit smoking, otherwise the lungs will continue to be burdened.

How is it possible that you were a smoker too?

When I was growing up, smoking was still a matter of being cool and revolting against society. But I never smoked at home, I wasn't an avid reckless smoker. Many years ago, I stopped for good and it gave me incredible freedom.

Did you stop because you're a lung doctor and see what it does to your lungs?

For a number of reasons, but the main thing for me was freedom. It gives you a higher degree of freedom when you don't need something. It's incredibly nice, because people who smoke are addicted and having a terrible time, because they have to smoke, they have to look for where they can smoke, they have to count cigarettes to have enough, to think about where they can get them when everything's closed, take into account that in many jobs and situations, smoking is simply not permitted and socially unacceptable. Addiction is the same there as addiction to heroin, quitting is a very painful endeavor, the trace in the brain remains for an awful long time. As I say - the most important thing that it has given me, of course, apart from the probably longer life span and a lower risk of cancer and other diseases, is freedom.

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There is an effort to ensure that people stop smoking and do not become a burden on the health system and do not die unnecessarily early. But there is a high percentage of people who still smoke. But I don't believe that will change...

Restrictions are probably not that severe in our society. There are still methods available that make it even more difficult to access cigarettes, making aware smokers think if it's worth it at all. For example, in Hungary this year they took an important step, removing cigarette sales from all supermarkets and other stores, you do not see cigarette stores at all. Most of the time, they are in some remote and hideous places, where just going there is humiliating, because everyone will know that you are an addict. They do not sell tobacco products in shopping malls with all the marketing.

The restriction can be further increased. I know that many addicts think that that's one's freedom and what not, when Senator Kubera, an otherwise charismatic politician and man, may he rest in peace, fought for the rights of smokers and died from the consequences of smoking himself, thus negating all this "freedom". Laying down one's life for the freedom to smoke strikes me as unfortunate.

How has your medical practice been different before covid and now?

Completely. Of course, I have never limited or ever completely shut down or discontinued care for diagnoses other than covid. However, it is very difficult. Our clinic still has offices working with other patients, but we were forced to limit the numbers, so regular check-ups for patients who are basically not acutely in crisis, were certainly limited.

Many doctors have been, and still are, tied up in the work in the covid department, because in addition to having a part of the lung clinic directly working on covid, and the larger part at that, the entire ICU is dedicated to covid. We also expanded it, we borrowed beds from the postoperative thoracic surgery department. There are still a number of covid departments transformed from other former clinics and departments, that is, within rheumatology, neurology, ENT, surgery, internal medicine. We provide counseling activities everywhere, so our activity is mainly covid, but of course we cannot forget other diagnoses.

We can not forget the patients with lung cancer, that is still going. The problem is that sometimes people are so afraid that they do not come to us with another diagnosis in time. These are very sad stories where people come and we can basically just say that the patient has cancer and unfortunately they are already in such a stage of the disease that we can no longer provide any treatment.

One of your colleagues, a nurse, died from covid in the spring. That was big news then. How do you see it now that some time has passed?

Still with sadness. One still goes back to some moments when one thinks that if something were different let's say, it would not have gone so badly. If Věra had let herself be persuaded when we talked and if she'd come when she was not feeling well. She said it would tough it out. Of course, it was a huge blow to the whole department, and everyone had to deal with it. There was a kind of catharsis, some left, they couldn't deal with it. Others came, we got back up again. We had to fundamentally change our attitude to the work we love, to the risks it brings, to collegiality, to the very principles dictated by the Hippocratic Oath.

Do you still remember her these days?

Of course. Time passes and heals wounds. At the start of covid, my mom died in a very dramatic fashion. This whole time is very personal to me... not the tragedy, one has no choice but to accept it, but dealing with these emotionally tasking things. It goes hand in hand for me. One shouldn't forget their loved ones who have left, but carry their memory in them all the time even if it hurts when you remember them. But having them with you is important.

Do you think that as a society we needed covid to wake up a little? That it should have told us something?

You can't tell whether we needed it, but in a way it showed us a lot. Unfortunately, in my opinion, the whole covid situation is being abused by some people, and I consider that to be great trouble. People with very ill intentions feed off of it. On the other hand, it taught us a lesson. In a situation where we think that we have managed almost everything, for example in medicine we deal mainly with chronic diseases, and even there we have great successes, there suddenly comes a disease that we are not familiar with at all.

The truth is that it is far too mythicalized, that it is not as deadly as many other diseases we know. However, the fact that it suddenly invaded the immunologically susceptible environment here caused a lot of trouble, as many people suddenly became infected at the same time. And the small high-risk portion of people, who have been doomed to a serious course of illness, is large in numbers, although it is a percentage of two to four percent, it is still a large number. It puts a lot of strain on hospitals. It was and is a great learning experience, but I think that most of us, who have had the so-called task of dealing with it directly from the very beginning and we are still dealing with it, have learned to deal with it and work effectively.

Of course, what hinders this and does not contribute to professional well-being is the gross hype surrounding lockdown, and the anti-epidemic restrictions in society, which, let's say, sometimes don't make much sense, just complicate a people's lives. You wonder who has benefited from this, or why it is like this.

Aren't you afraid? You're on the front line, you haven't had it yet?

I have a private opinion that I already had it between January and February this year. In my opinion, many other people have. As I never suffer from common colds, I underwent a relatively serious two-phase viral infection and I think that could be it. Of course, I won't find out, because the antibodies disappear within three months and I didn't examine them at that time, back then nothing was known about the disease. It was something that was happening in China, and we weren't so interested here.

But I'm not afraid, should I get it. Of course I protect myself, I don't go purposefully try to get infected, even if I have to navigate that environment. But I can also get infected with something else, such as tuberculosis, I have had it once, I can still possibly get for example the multidrug-resistant strain. One has to deal with life as it comes.

Thank you very much for the interview.