Sewage, bacteria, tetanus. What does floodwater leave behind? Episode 72

Monika Rachtan
Hi Monika Rachtan, I welcome you very warmly to the next episode of the programme. First of all, a patient. A week ago, we talked about the fact that there was a cataclysmic event in the south of Poland, a flood, in which a great many people were affected. But how does this flood translate into the health of the south of Poland? This is what I will be discussing with my guest today, and that is Minister Paweł Grzesiowski. A very warm welcome, doctor. Doctor, well, precisely, are people who live in the south of Poland today safe? Is it possible to live and stay there peacefully?

Paweł Grzesiowski
A great deal depends on what kind of damage the flood has left. We can't say in general they can and generally they can't, because first of all there are places that have been very badly damaged by high water. If, for example, a building is damaged, the facade or even the load-bearing elements of the building are destroyed, then it is simply impossible to live there. In fact, we see and hear a lot of information here from the building supervisory authorities, who exclude buildings from use because they are simply unsafe. So this element of the decision as to whether or not one can return to one's own home that has been damaged by flooding is not just an epidemiological or poisoning issue, but is also dictated, and indeed above all, by whether or not the building has been damaged in its structure. If the first condition is fulfilled positively, i.e. the building has been qualified for possible reoccupation, we then proceed to assess the situation with regard to contamination, i.e. with regard to what the flood water has brought and what it has left behind.

Monika Rachtan
Minister, but what does this assessment of the building look like, do the services at the moment, for example, I don't know, peel the paint off the walls and see if there are any harmful bacteria in that paint that could harm the residents.

Paweł Grzesiowski
No, this does not need to be done, because the premise is simple, floodwater is wastewater. And it is an effluent of the most varied composition chemical effluent, biological effluent and, of course, also mechanical impurities.

Monika Rachtan
I'm sorry, Doctor, to get into the word, but we have to realise, because we say chemical effluent, mechanical effluent, that what could be in that water.

Paweł Grzesiowski
In the flood water there is everything cars, fridges, corpses, dead animals, chemical components, for example, leached from fields, as fertiliser has just been sown on some fields.

Monika Rachtan
But also from such fertiliser stores, because such places were probably flooded too.

Paweł Grzesiowski
Well, even if it's a farm where there were bags of various substances just used for fertiliser, well, after all, they have been swept away by the water and are floating in that water.

Monika Rachtan
And the water also hijacked the sewage treatment plant.

Paweł Grzesiowski
Water has unfortunately damaged more than a dozen sewage treatment plants in the Opole and Lower Silesia regions. And this means that all the waste we produce flows into the river, just as it would have done in the 19th century. Which is to say? That is, the waste discharged from the houses, from the farms, simply flows into the nearest river or even flows into the soil in the area, because often the supply pipes have also been damaged, so. So we have to talk about. i.e. floodwater is simply a mixture of different kinds of substances. For the most part, these substances are not friendly to humans, and so we are talking about the fact that surfaces or rooms contaminated by flood water are dangerous to the health or life of humans and animals. And that is why we come to such premises prepared. We should enter such buildings, however, protected, at least so that there is no skin contact with these contaminants. So high boots, overalls or gloves. And only in such protection do we try to assess the situation. If there is a lot of sludge, silt, this sludge simply contains a concentrate of the sewage, as if we had extracted the water. It has evaporated, and what remains is this concentrated substance, which can really have components such as oil, can have heavy metals.

Paweł Grzesiowski
It can have bacteria, fungi, parasites. So it's a really dangerous, hazardous material that also needs to be disposed of properly. We have even issued recommendations that this sludge should not be removed by hand, but preferably with some kind of mechanical equipment. And if it's a difficult-to-reach surface, we use shovels, some kind of shovels. Just don't touch it with your bare hands. However, so as not to create a risk of direct contact with this contaminated material.

Monika Rachtan
I think that in these premises it is also very important, as the Minister has said many times in the media, to wear a mask, because we do not want our skin to come into contact with the hazardous material that is in these premises, but also our respiratory tract to be exposed to dust.

Paweł Grzesiowski
Of course, the more, the more this sludge, this slurry dries out, the drier it gets, the more dust we have in the air and the more dust we inhale if we are not protected. So, of course, we should also enter such rooms wearing masks, and not surgical masks, but FP2 or FP3 masks, that is, dust masks which have a valve for breathing, for example, simply to make it easier to work in them. But from the point of view of protection, let's also remember about the eyes, because the mucous membranes of our conjunctivae are also able to absorb, and we now have a lot of reports from flooded areas. Just such irritation of conjunctivitis through these dusts that are released during cleaning.

Monika Rachtan
So these are the special glasses we should wear?

Paweł Grzesiowski
We have various solutions; there are specialised goggles, the kind for contact with dust, and protective goggles. The point is that the eye should be protected against dust, because, unfortunately, the mucous membranes we have are open, and they will collect these contaminants. And then, after a few hours of working in such an environment, it may turn out that we have a problem with our eyesight. Simply conjunctivitis will make it impossible to continue working.

Monika Rachtan
We know that these hands are needed in the south of Poland and that many people break off like that naturally. They simply take time off work and go there to help. However, do we have any special services in our country, specialised services, which are prepared for such an eventuality, which are trained, which can give some kind of instruction to those people who come to these places, so that, above all, they can help, taking care and protecting their own health.

Paweł Grzesiowski
This is a difficult question, because, on the one hand, of course, there are over 20 000 soldiers there, there are firefighters, there are police officers, so we have rescue workers there, there are specialist chemical troops there absolutely. Officers and soldiers who are trained in these kinds of situations. Something completely different is this. Just this kind of reflex of the heart and a large number of volunteers who show up there and want to help, they just don't quite know where. Let's say if they do it spontaneously. And here it is certainly good when such people who want to help come forward to the coordinators. In each, in each municipality, there is, because we have this hierarchical system, there are crisis teams, voivodeship teams, poviat teams, and then at the municipality level there are these teams, where you have to ask exactly, where you need help, whether, whether there is some kind of organised team that goes to the areas. Because the most important message we should be communicating, however, is that the person who wants to help should be safe themselves. That's what we repeat in medical rescue, right?

Paweł Grzesiowski
A rescuer is good when he is alive and not in danger. For example, carrying help somewhere out in the open in the street. So the first thing is every person who carries help has to secure their life and health, and then they can give help or just take part in the clean-up in these conditions. So what we have been repeating, let's repeat it again is skin protection, so high boots that are puncture resistant. High trousers of some kind or overalls. Gloves I mean thick rubber gloves, not surgical gloves, because these will be torn immediately. Face protection by means of a high-filtration mask and eye protection and such if. If it's just a room where there's some damage, remember head protection too. So some kind of helmet. Or that kind of protection so that there is no injury. And such a person, prepared in this way, can set out to help in a safe way, without harming themselves.

Monika Rachtan
Are these personal protective equipment available there on site, or do we have to equip ourselves with it?

Paweł Grzesiowski
I would say yes if I were going alone with such an action. Anyway, I was in Wrocław at one point and we had the opportunity to see the effects of the flood up close, so I took my own mask and gloves, because you cannot count on everything always being there on the spot. But we should take care of that beforehand and not rely on someone else there on the spot to equip us. So if we already have such a plan, that we are going to help, it is better to take these personal protective equipment with us so that we are not dependent on the conditions later on.

Monika Rachtan
Or a burden for the teams that arrive, that we still need to be taken care of.

Paweł Grzesiowski
And the second thing is, in my opinion, above all, that we are going there to help, and not ourselves to be subjected to some additional effort on the part of those who are there. So we should do everything we can to be as light a burden as possible on those who are already working there. And I think it's best to have your own equipment, like some basic tools, I don't know, like a shovel or some shovel or other things, you can take everything with you so that you can start working there straight away. And, of course, the officers or the military who are there, they have the equipment, they have all these protective measures. What is more, almost from the very beginning, we introduced preventive vaccinations for those who are there. I am thinking in particular of tetanus, because it is a disease that develops as a result of a wound infection, that is, an injury.

Paweł Grzesiowski
It is a job that is a very high exposure to all sorts of just cuts, abrasions. And the tetanus bacterium lives in this dirt, in this, in this sludge, in this muck, there are anaerobes, a lasex, tetanus, which can be dangerous, very dangerous to life and health.

Monika Rachtan
Minister, who should be vaccinated against tetanus? Is it everyone or just those? Do all residents? Or all those who help? Should we in Poland in general be reminded that there is such a vaccination and on this occasion we can talk about the fact that it is worthwhile to be vaccinated?

Paweł Grzesiowski
Well, that is very good. A good reminder that every adult in Poland should receive vaccination against tetanus, diphtheria, whooping cough and once every 10 years. We are rebuilding. We remind that immune memory, we strengthen that kind of vaccination. So if someone has not had these vaccinations in the last 10 years.

Monika Rachtan
The vast majority of us probably.

Paweł Grzesiowski
And he is going to a flood area, he should take the vaccine before this trip. It is simply a matter of already being protected in case of an injury, and not at the moment when there is an injury. It is also possible that if there is an injury, there is a wound, and it needs to be cleaned, say in a hospital emergency department. The tetanus vaccine is then administered, but as post-exposure prophylaxis. That is, we reckon with the fact that the wound may have already been contaminated. It is better to have immunity already in the body than to react after the injury.

Monika Rachtan
Are such vaccinations free for residents?

Paweł Grzesiowski
At the moment, yes. Tetanus vaccination in flood areas is free of charge and voluntary. That is to say, it is our job as the health inspectorate to deliver the vaccine to the vaccination centres. And whoever needs it, whoever wants it, can be vaccinated. Here is another important piece of information, that many people who are currently in the flood areas are not people who are covered by the GP area, because they are visitors. Have they changed their place. And here the National Health Service has also guaranteed that if they report to the GP, the patient not enrolled in this clinic will also be billed. Again, no one will lose out here.

Monika Rachtan
And what is the Minister's assessment of the evacuation of the hospital in Nysa? Could something more, something better have been done there. How do you view this event?

Paweł Grzesiowski
I am a doctor. And I assess such a situation from a primarily medical angle. And for me, the absolutely most important criterion is whether the patients were brought out of the hospital safely, whether anyone's health deteriorated, whether anyone died during this holiday action. And the balance of this action is absolutely, 100% positive. Nobody died, nobody suffered any additional injuries or deterioration of health. So, in this way, we can say that the evacuation operation went off without a hitch. Of course, if we are looking at it from the rescuers' point of view, whether it could have been, I don't know, faster, slower, earlier, later, this is already an organisational issue. I look at it as a doctor. If you managed to get the sick people out of the hospital and none of these people are there, this evacuation action has not affected them negatively. As far as their state of health is concerned, I believe that the action was successful and fulfilled its purpose. It will be possible to analyse the individual stages after the event, precisely when the decisions were taken and whether the means used for evacuation were adequate. This can always be improved, refined, optimised. But the basic message is did anyone get hurt as a result of the action? No. If not, it means that the action was successful.

Monika Rachtan
Will the Chief Sanitary Inspector also have a lot of work to do at the hospital in Nysa? Now, after this flooding, does this hospital need special assessment and special work so that patients can return to it?

Paweł Grzesiowski
Well, yes, the sanitary inspection has as part of its remit the control of the conditions of provision of health services, as it is referred to professionally, in other words the conditions of treatment of patients. We enter medical entities and assess whether the professional and sanitary conditions meet the requirements of Polish regulations. And here, until the hospital is rebuilt, until certain conditions for the provision of health services are restored, we will not be able to issue such a permit. Here, it is primarily the possibility of securing the patient that is decisive, and here, of course, no one will require some excessive criteria, no one will build some artificial, I don't know, artificial requirements. However, if the building is restored to proper architectural and equipment conditions and the requirements we have in the regulations are met, then, of course, the hospital will return to normal functioning. But at the moment, at this stage, the part of the hospital that has been flooded does not meet any criteria and simply has to be rebuilt.

Monika Rachtan
In Lower Silesia, in the Opole region, how many medical facilities were affected by this flooding, how many of them now cannot function? What does it look like?

Paweł Grzesiowski
There was a brief moment when a number of outpatient clinics, primarily GPs, were out of operation, but at the moment this one actually. These outpatient clinics have returned and there has been a very quick restart. Of course, there will still be flood recovery or construction work to be carried out, but under the conditions in which we have been able to assess this, we even issued such guidelines at one point to start up clinics or some kind of medical aid stations with some ad hoc precautions. For example, there is a damaged toilet, let's put it out of service. Let there be a toi toi that gives you the opportunity to use the toilet outside the clinic area. That will meet the requirements. It is known that normally we would not recreate a clinic with a toi toi. However, under these conditions, what matters most is efficiency, i.e. that the patient has access to their GP. For example, if there is no water in the drinking tap, if we provide bottled water, why should such a clinic not function and on such terms? Of course, these are ad hoc solutions, but our inspectors have taken such advice, using practically, as far as I know, 90% or even more of these facilities, which were to some extent excluded, are already in operation at the moment.

Monika Rachtan
And please tell me, how much longer can this transitional situation last? Precisely those toi toje that must Be in outpatient clinics, or those excluded rooms in various places in hospitals.

Paweł Grzesiowski
This is a very serious matter and a very serious question, because we do not yet have an inventory, a damage inventory. They are only being written down, this damage, and there is such a collection, how many buildings have been damaged, to what extent, to what extent they will need reconstruction. And these processes will not be short-lived. All the more so as winter is approaching. In fact, it is already cold enough in the mountains that construction work could be a problem. So we really have to get ready for spring, when these construction works can be finished or completed. Well, it's going to be very difficult at the moment, if, for example, plaster had to be knocked down to a height of one metre in a room, well, that can still be done indoors somehow. But if we are talking about construction work outdoors, when the temperature drops below zero at night, it is simply very difficult or even impossible. Also, I am afraid that in some cases we will have to wait a few more months before this situation returns to some kind of normality. Because let's remember that it's not just about buildings, it's about the whole infrastructure.

Paweł Grzesiowski
If a sewage treatment plant has been destroyed in a place, after all, it will not be rebuilt in a month. It will be an investment that will take two years and during that time the sewage network is not working. If the sewage network is not working and no other solution is provided, I don't know, a portable sewage treatment plant or at least a toi toi, or some other kind of temporary solution, then we have a serious problem, because people live, they produce waste, they produce waste. Well, it's impossible to live in an environment where this waste is dumped on the street.

Monika Rachtan
Many of us are criticising in the media, even if only on social media, I am criticising the work which, in their opinion, is moving too slowly, but I think that common sense should be taken into account here, because we do not want to put a plaster on today and then tear it off in the spring and have to bear the costs of modernisation again, but we would like to do it once and for all. We know that this flood has cost us billions of zlotys and will cost us billions of zlotys, and we cannot afford just any solutions.

Paweł Grzesiowski
Well I will give an example from our plot, that is, the sanitary supervision of drinking water. In the first moment, right after the high tide passed, we had almost 130 water mains damaged. This is a very big problem, because water, if a water supply is damaged, we actually cut off and cut people off from drinking water.

Monika Rachtan
That is, several thousand people may not have had access.

Paweł Grzesiowski
Not a few are tens of thousands of people could be without drinking water on tap. And this is a problem that needs to be fixed Very quickly, but it cannot be fixed on an ad hoc basis. We are not in a position to patch up the water supply. Water. The water supply has to be repaired and then there is a period of water testing. We test the water 24 hours a day, 7 days a week at the sanitary inspection laboratories at the moment, precisely to determine whether the water that this water supply already provides is drinkable, or whether it needs to be boiled before consumption. And so on and so forth. As of today, we still have about 60 waterworks where the water does not meet the safety criteria and, for example, has to be boiled before consumption. This is a very important element, because without water there is no life. If the water has been cut off from a building or a neighbourhood, then it is impossible to live there for long, because, of course, the water there is supplied in barrels or cisterns or bottles. But you can't wash and live and clean. Without water in the tap.

Paweł Grzesiowski
So there is a lot of energy here. It's going right into getting the waterworks up and running. It is very fast, after all, well, actually these works last about a week, 10 days, and already half of the water pipes that were damaged are working. So here we clearly have a quick intervention by the local authorities to get this water on tap. But it's not a simple matter, and it needs to be reiterated all the time that this kind of infrastructural repair, investment is a matter of months, not days or weeks. And the population on the ground also needs to be prepared for this. It is true that you cannot repair damage that requires major investment in a few days. And these people need to be provided with ad hoc conditions so that they can survive there.

Monika Rachtan
What does the Chief Sanitary Inspector do when he gets information probably from the Prime Minister's office that a flood is coming, that probably cities will be flooded, that this very infrastructure will be destroyed. What is he doing, what is he thinking? What was going on in the minister's mind?

Paweł Grzesiowski
Well, I am a person who is used to operating under pressure. As a doctor, I was often aware when I was still working in the hospital that sometimes people's health or lives depend on decisions made within minutes. So for me, this kind of situation is simply an intellectual challenge to plan our intervention in the best possible way. We as a health inspection do not run around with pickaxes, with hammers, with shovels. We have slightly different objectives. Our tasks are to secure the conditions for safe water, food, learning and treatment of residence. And it is our action, here I would say, directed at the early detection of risks. To assess risks and to adapt our various concepts, guidelines, recommendations precisely to these to this risk assessment. And this is also how we approached it, we set up, actually we didn't set up, because there was already a crisis team, but in the Law and Justice party, you could say we reactivated the crisis team and in agreement with the provincial inspectors, especially of those provinces which were affected by flooding, because at the moment there are actually seven of these, right? It's not just the south, because it's also Małopolska, Silesia, Opole, Lower Silesia, then Lubuskie, now Zachodniopomorskie.

Paweł Grzesiowski
So, one by one, as this water moves, so do we react And our task is first and foremost to anticipate risks. So what will happen in the next stage? What can we expect? One of the things we have done is to set up a 24-hour laboratory standby service so that the water can be tested at any time. Secondly, the same applies to food, because let us remember that over 1 200 different entities which produced food or prepared food were damaged in the flooded areas. And that is subject to our oversight. And now, if food production is to resume in these places, we have to be there.

Monika Rachtan
I can't even imagine how to clean such places, how much work is involved in, say, a factory producing, processing meat.

Paweł Grzesiowski
Well, that is it, this is a very serious challenge, which, by the way, has already been met in more than 50%. Because imagine that out of probably 800 inspected entities already reported by entrepreneurs that they are ready to restart, more than 600 are already up and running.

Monika Rachtan
This is an incredible motivation.

Paweł Grzesiowski
The motivation and mobilisation of people is incredible. I have to say that if you look at it as if from my point of view, from the point of view of these large scales and large numbers, it is true that people are doing everything to return to normal functioning as quickly as possible, that these workplaces, which are related to either water supply or food preparation, are already functioning as much as they can, simply in order to provide people with food and, at the same time, to give people work, because this is also a dramatic situation. If we stop the operations of the company. People are without work and also customers are without goods. So that's just one part of it, because of course another problem is infectious disease surveillance. As soon as there was a threat of flooding, we implemented strict monitoring, daily monitoring of the number of cases of typical diseases, associated precisely with contamination of water and food, i.e. all kinds of salmonellosis, dysentery, bacterial diseases or viral food poisoning. This can be an early warning signal that something is wrong, that contaminated water, for example, is still being used, or that contaminated food is still being marketed.

Monika Rachtan
What does this data look like at present?

Paweł Grzesiowski
As far as the current situation is concerned, we can say that it is stable. Good. There was a moment last week when we saw more of these enteric illnesses per day. It was about 40 for the whole of this post-flood area, so that's not a lot either, but nevertheless it was an increase on previous data. However, looking at these figures now, they are slowly stabilising at a lower level. It also seems that after a short period last week, when there was a slight increase in the number of cases, we are not seeing any epidemic trend, that there is an increase in the incidence of some, let us say, one or two forms of food poisoning, that we have a lot of salmonellosis or some other intestinal problems. There are also no cases of hepatitis A, no typhoid fever, no tetanus. So we can say that at the moment the health situation in these areas is not bad in the sense that the flooding has not brought an epidemic, has not brought some dramatic health threat. But let's remember a lot of services are working to make it so. That is, this water, which from the beginning, by the way, our efforts have been to reach the people who are there.

Paweł Grzesiowski
So we have issued two RCB alerts precisely on drinking water and food, not to use flooded food. We have adopted the principle of absolutely in the world at the moment also the so-called all or nothing principle. That is, if anything has been contaminated by floodwater, it must be thrown away and there is no reason to think that something that may still look intact because it is, for example, a jar or a bottle. That is, it must also be thrown away.

Monika Rachtan
That is, a sealed bottle that was standing in my cellar, but was not touched by the flood water, but there was this flood water on the ground in the cellar. It too must be thrown away.

Paweł Grzesiowski
Yes, because, after all, we have to realise that it is not a question of something simply being doused with floodwater. If the water has been standing in a room for several dozen hours, then the vapour of that water has been on everything, and it must. Well, I am using a very perhaps blunt comparison, but if a jar falls into a septic tank, would it occur to anyone to eat anything from that jar?

Monika Rachtan
Well, rather not.

Paweł Grzesiowski
We have a clear association, don't we? And we are not in a position to ensure that this jar is cleaned at home. Of course, if someone now came from some professional company and took this jar and sterilised it ok, we can allow ourselves that maybe there is a chance that this jar could cope. Yes, but after all, no one can do it at home. We'll wipe it down with a cloth like that. I don't know. We'll try to wash it with water, and under these conditions we certainly won't restore the safety of this packaging. Therefore, we have adopted a principle and this is the principle we have been communicating to the public from the beginning. Anything to do with food that has been flooded, we throw away.

Monika Rachtan
And in the post-flood areas, is the food that is in the shops safe because these shops have opened?

Paweł Grzesiowski
Well, yes, the shops also only opened after the visit of the sanitary inspector, because the conditions of sale, the conditions of distribution of the goods where the food is, are also subject to our supervision. So the shop would not have opened if it was not safe.

Monika Rachtan
And in a situation like this, when it turns out that I've already been allowed to go back into my house, I've actually managed to remove all this contamination that the flood water brought in, should I somehow now do some disinfection in that building? What should I do so that I can put my children to sleep there safely.

Paweł Grzesiowski
This is another element, too, in which we are involved. Namely, after we have cleaned up the mechanical dirt, i.e. the sludge, the objects that have been deposited, some waste from our home, damaged furniture, anything that has been damaged, textiles, carpets, bedding, all of this must be thrown away. However, once we have cleaned up the room, i.e. when it is empty, after the inspection we assess whether it is necessary to knock down the internal plastering to a certain height, where the water stood. Why? Because if we don't strip the plaster, there will be dampness under the plaster where fungi will grow very quickly, which we will never be able to deal with. Therefore, in many cases, this plaster should be beaten up. I think it is also worth making everyone aware of this. This room, where the water has stood a metre high, is in most cases completely devastated, the floor is coming away, the door frames or some kind of joinery is all warped. Consequently, it's there to be ripped up anyway. So, in fact, the room where the flood water stood is up for a general renovation. But in order to carry out this renovation, first of all we remove all the objects and this contamination from it, and then we carry out disinfection.

Paweł Grzesiowski
This disinfection is carried out, among other things, by the district sanitary and epidemiological stations, as we are currently supplying the chlorine agent for disinfection free of charge. In other words, if someone has a contaminated house or flat, they take special tablets or powder from the district station, dissolve them in water and use this chlorinated water to disinfect the room. Depending on how big the room is, how high it needs to be, what it needs and how much, this has to be assessed individually for each room by the owner. If in doubt, he also receives instructions from the district station. Only after such disinfection can renovation work begin. You can start trying to re-inhabit this room.

Monika Rachtan
Minister, and should such a person who needs such a disinfectant apply somewhere? Is it done online or do we just come in?

Paweł Grzesiowski
We report to the district inspectorate or call the emergency telephone number and find out that, say, the point is open from 8 a.m. to 3 p.m. We report, collect, give a receipt and that is the end of it. The procedures here are absolutely simplified so that this can be done as quickly as possible. Anyway, at the moment we have probably already distributed more than a tonne of these disinfectants in various places just after the floods. And these agents are still being distributed. Besides, we received, and here it is also worth emphasising, from this mechanism of EU aid from the Swedes. The second measure is still awaiting approval. Also, there is no shortage of this disinfectant, although, as far as I know, its consumption is high and will be too. But that is probably a good thing. Well, because it is. Well, because there are a lot of these rooms that need to be disinfected. There is another problem when it comes to disinfection. Namely, some of the households in the areas on these flood plains have a well, which is the only source of water, because there are not water pipes everywhere. There are still places in Poland where the domestic well is the only source of drinking water.

Monika Rachtan
Can it be cleaned, disinfected?

Paweł Grzesiowski
There is a huge problem here, because the well is absolutely closed after the floods have passed. It cannot be used because flood water has accumulated in this well and all this sludge is there at the bottom. So it all has to be pumped out. This is done by special companies, which are generally organised by the municipality, and only the empty well is chlorinated and can be filled back up after the chlorinated water has been extracted. And then we only test the water. That is to say, it is not allowed to use water from a well that we have not tested and we have a specific procedure again in this regard. Our employee from the sanitary inspection comes, takes samples from the well and only when they are good, the results are good. It will be possible to drink water from this well. This is also a very serious problem. There are several hundred such wells in floodplains. We counted more than 500 households, I think, where the well is the only source of water and today these people have to have bottled water or water from cisterns. It is impossible to provide drinking water in these places otherwise. And this disinfection of wells will also take time, because one such company, which specialises in cleaning wells, can do no more than two or three wells a day.

Monika Rachtan
And probably these companies are not so common. Well, because who would want them? Who would need such disinfection beforehand? And do companies that are planning to do construction work right in the floodplain, once, say, the health inspection allows it, disinfection will be done and the house can be renovated. Should they consult any of your guidelines? Have such guidelines been established? Should they? Should these companies work in a standard way, as before, or should they modify their work in view of where they will be doing the work?

Paweł Grzesiowski
We have not dealt with this aspect so far, how construction companies should operate, because we have primarily focused on the cleaning stage, disinfection, waste removal, disinfection of water and wells. I think that here above all, however, construction companies should be in contact with the building supervision, because we assume that a room that has been disinfected is already prepared for construction teams to enter there. It is just a question now of what methods? I don't know what should be used for such post-flood renovations. Can it be ordinary mortar, or does it have to contain something extra? This is beyond our remit, but I imagine that it would be good for such guidelines to actually be created. Can it really be the normal work of, I don't know, bricklayers or finishers, or should we be doing something extra in these areas, in these buildings that the flood water has gone through?

Monika Rachtan
In that case, let's leave this matter to the specialists already. And is the Minister afraid of the coming winter?

Paweł Grzesiowski
I mean the word afraid is perhaps not appropriate to my mood. I assess the situation on the basis of certain indicators or rational criteria. And as I say, we are in the business of risk estimation, that is, assessing risks. That is our job. And here, well, fear is not the best adviser. We must, above all, look at what can happen, what will affect public health, because this is the role of our inspection. We are responsible for public health in Poland, and it is the largest service which operates in this area. There are more than 17 thousand of us and situations such as floods, epidemics or seasonal increases in disease. Well, these are, of course, elements that we analyse and they can affect public health. We have several parallel threats at the moment. We have an ongoing COVID wave since July. We have had a huge increase in the incidence of COVID. We have an ongoing high wave of pertussis cases since the beginning of the year. The flu season is beginning, with temperatures dropping rapidly. We have, please note, a jump from hot weather to almost already freezing temperatures. Already the heating has turned on in most homes, so there will be smog.

Paweł Grzesiowski
Unfortunately, this also makes the epidemiological situation very much worse for us, because viruses and bacteria travel on these smog particles, on this smog dust. So where there is more smog, there is also a greater risk of infection. We are therefore approaching a time when the autumn-winter infection season is set to intensify, which means that the current situation in Poland does not inspire optimism regarding the expected increase in the number of infections. In the next two or three months, we will be faced with a wave of covovirus influenza and whooping cough, which will result in an increased number of visits to family doctors. We are already seeing this, we are already at the level now, in September, at the level of March. So there are already a lot of these cases, especially among children and adolescents for the time being. But this is how every season starts. First the children who have returned to school and the young people get ill, and in a moment the adults, their carers and parents will be ill.

Monika Rachtan
We will be able to cope with these diseases this year. Are we in for a surprise again like we had with the COVID 19 pandemic? Because what the Minister is talking about seems very dangerous. When we think of covid returning, of whooping cough, which we have not seen in Poland, please correct me, but for 40 years.

Paweł Grzesiowski
Well, it has been a very long time since there were 15,000 cases, and yet this is only a fraction of those detected. And how many people have whooping cough? And no, no, they are not reporting to doctors or getting blood tests. So we can say that these last two years have been very difficult in terms of infectious diseases, primarily respiratory. We have an increase in pneumococcal pneumonia, we have an increase in scarlet fever and streptococcal disease, caused by streptococcal influenza, and what few people remember is that this is the kind of disease that we used to think was actually maybe not non-existent, but rare.

Monika Rachtan
There were a few cases detected each year.

Paweł Grzesiowski
At the moment we have a situation really, well it's a very long time since we've seen it, and every wave of streptococcal infections, influenza, and autoimmune diseases follow as well, because these bacteria give just such cross-reactions, so rheumatic fever or heart damage are things that are appearing more frequently at the moment, So the epidemiological situation after two, actually three years of a pandemic, has clearly deteriorated. In 2023 and 24, we're seeing a lot of infections that sort of compensatory started to get stronger. And these viruses and bacteria kind of picked up after this pandemic period and we are looking for reasons for this phenomenon. One possible hypothesis is that our immune system has somehow been damaged by COVID, though, and we are more susceptible. But this does not completely explain all these cases. So it is also considered that because we have been in less activity for two or even three years, we have had less contact, more at home, a lot of remote learning or work. This meant that these viruses and bacteria had no one to infect. As a result, they are now sort of compensating, making up for those lost two years, and that is why there are so many of these illnesses, not helped by the war in Ukraine either.

Paweł Grzesiowski
We are not helped by the gigantic migration flow through Poland. Let us remember that it is not only a question of Ukraine, but in recent years a great wave of migrants of various kinds, whether refugees or foreigners from countries where the epidemiological situation is not too good, has been sweeping through Poland. I am thinking of south-east Asia or Africa, because we have a lot of people from these areas who are either staying in Poland temporarily or for longer periods of time. And their health situation is often much worse than that of Poles. As a result, they are, in a sense, becoming a bit of a ticking, a ticking epidemiological bomb for us, because in their organisms there are often microorganisms which can also be dangerous to us.

Monika Rachtan
I think that also looking at this situation which the Minister is talking about, I think that there is another very important factor, we have stopped trusting in vaccinations and, unfortunately, in Poland, the vaccination rate has fallen very much. Diseases such as influenza, diseases such as whooping cough, really could have been prevented by vaccination, and Poles have stopped vaccinating. On top of that, some vaccines are in short supply in pharmacies, so I think there has been a really serious problem with vaccination rates.

Paweł Grzesiowski
Well, that's because you said it all in one sentence, and it doesn't quite look like that, because yes. Why is there a shortage of vaccines? Because the number of vaccinations has increased. So, on the one hand, what you said is that, yes, there was a shortage of pertussis vaccines, but why was there a shortage? Because there was such a high demand. Lots of adults, having heard that we have an increase in whooping cough at the moment, wanted to be vaccinated and demand outstripped availability. And at the moment the vaccine is being delivered. Additional stocks of vaccine have been mobilised and this is where manufacturers are coming to our aid. But in fact these adult vaccinations are recommended vaccinations. They are not bought by the Minister of Health. They are simply in pharmacies and wholesalers. When demand is so high that supply can't cope, they are in short supply. And this just happened in the autumn or at the end of the summer with the pertussis vaccines, whooping cough. There was a very strong campaign, including information to pregnant women, that pregnant women should also be vaccinated, because then they protect their child. Lots of pregnant patients are coming in for vaccinations at the moment.

Paweł Grzesiowski
And these vaccines simply weren't enough. Such situations can also occur. It is a little different with influenza, because there is no shortage of flu vaccine. Here we still have a lesson to learn, because Poles are not necessarily willing to vaccinate against flu. However, one can get the impression that after this pandemic period, when vaccination was on the front pages of newspapers, on everyone's lips and so on. Today, there has been a bit of a backlash, as it has turned out that these vaccinations do not protect against COVID one hundred per cent, so we have lost a bit of confidence in them. But I would also not like to translate this into the incidence of, for example, whooping cough, because when we look at provinces where vaccination rates are good, there is whooping cough there too, because it is mainly adults who are ill. And let's remember that the pertussis vaccine lasts 5, 7, maximum 10 years. So if we finish vaccinating children at 14, we are already susceptible to the disease at 25. Again, this is a completely different situation. It is simply that the pertussis bacterium has hit a high susceptibility and that is why we have so many cases.

Monika Rachtan
Any chance this vaccine will return to pharmacies this year?

Paweł Grzesiowski
It is already in pharmacies. As far as I know, at many points this three-component vaccine - diphtheria, tetanus, pertussis - is already there.

Monika Rachtan
And we can be vaccinated with that too. We do not have to wait for the single-component one.

Paweł Grzesiowski
No, there is no monovalent vaccine against cross-vaccination; there is only a trivalent vaccine. Pregnant women should take these vaccines, as well as diphtheria, tetanus and whooping cough, which have reduced antigenic content. And these vaccines are in short supply, because we have no shortage of vaccines in the vaccination calendar. Also, children are and adolescents are vaccinated from this pool of vaccines purchased by the Minister of Health. And here we have full stockpiles, so there is no problem. There was just a shortage of these pharmacy vaccines, which are precisely for adults.

Monika Rachtan
Looking at the health situation in our country, would you go to Lower Silesia for a weekend to relax?

Paweł Grzesiowski
I would, above all, choose a place where my presence would not be a burden on those who are there. Because, let's remember, there are already quite a few places both in the Opole region and in Lower Silesia which have already reopened spas, private accommodation, etc. So where it is safe, where it is possible to get there, where the conditions are good. So where it is safe, where you can get there, where the conditions are good, I would not hesitate to go. However, this needs to be checked first, because really, going there blind and then burdening these people with the thought of what to do with us, because there is no, I don't know, water, because there is no sewage system, would, in my opinion, be imprudent, and at the same time burdening these people. So first of all, let's find out whether the conditions are already there where we want to go, whether there's nothing missing, whether these people are waiting for us, because it's also important for us to keep going there, because we'll leave money there for these people to live on, so surely these areas, which are there, for example, I don't know, Jelenia Góra or the surroundings, typically tourist areas. Well, if we start to avoid these areas, these people will suffer even more because of the lack of tourists, so let's do everything, but knowing where we are going, what the conditions are there and whether the people who invite us are prepared. If they are, I do not see any obstacles.

Monika Rachtan
This information can be checked on the internet, with reliable sources, but also with those people we were supposed to go to.

Paweł Grzesiowski
Let's contact the host of where we want to go. Because this is the best news, the best of the first. From the first source, from the first, from the first mouth.

Monika Rachtan
So we appeal to you not to withdraw your bookings just by going to Lower Silesia, but also to the Opole region. We are simply helping these people by boosting their wallets, which they will probably be able to use to rebuild their homes. My guest, but above all your guest, was Minister Paweł Grzesiowski. Thank you very much, Minister. And I thank you very much. This was the First Patient programme. My name is Monika Rachtan and I invite you to subscribe to my channel.