A team of medical professional from the Polish military is in the United States visting the Illinois National Guard to share lessons learned and best practices from their fight against COVID-19 in Europe.
ING and Polish military officials hail the move as a learning experience for all involved.
Polish doctors, nurses and emergency medical technicians arrived April 23 as part of the National Guard’s State Partnership Program with the Polish military. The Polish medical personnel visited several Chicago-area medical facilities and offered lessons learned from its experiences in Italy and Poland. They’ve also come away with observations about how the U.S. medical system is handling the deadly pandemic.
The Polish team will stay in the U.S. until May 2.
“We are leaning a lot from the National Guard and we are trying to provide the best practices we have seen,” said Polish Military Medical Corps Capt. Jacek Siewiera. “We have some experience in how it was accomplished.”
And also what didn’t work. Among other things, Siewiera called the anti-malaria drug hydroxychloroquine “too risky” to use on COVID-19 patients.
Siewiera told Military Times his team was in the Lombardy region of northern Italy from March 30 to April 9, and had picked up a number of valuable lessons there as the Italian healthcare system collapsed and had to be rebuilt.
With more than 200,000 confirmed cases and nearly 28,000 deaths Italy has been hit hard by COVID-19.
The first lesson, said Siewiera, highlighted what medical professionals in the U.S. have been urging.
“The spread of COVID-19 was related to social behavior,” he said, adding that social distancing was a factor in controlling the spread.
Demographics are another factor.
“The spread of COVID-19 is related to the age of the society,” Siewiera said. “The more society is elderly, the expression of symptoms is bigger.”
In Italy the first wave of patients were the weakest — the elderly and those with comorbidities like heart disease and diabetes.
“After four or five weeks the admissions were highly related to much younger patients, below 50 years old,” he said. “This COVID-19 is different from other viral pneumonia. It does not take one week to recover like the flu, but if the condition of the lungs is bad and the injury of lungs is in place, the treatment will last for long, long weeks or even months.”
During the first phase of the pandemic in northern Italy, the Italian military was involved and used their barracks as field hospitals, said Siewiera.
“But they realized these are not good for intensive care treatment and life support,” he said. “The barracks are too small and you cannot move around the patient. The second factor is that during the ventilation of the patient, the droplets stayed in the air for a very long time, which infected the personnel.”
Another lesson, said Siewiera, was that with a large influx of patients, tomography, also known as CT scans, was not possible.
“When you have the huge wave of patients, you cannot scan tomography for all patients,” he said. “It takes time, and is quite an engaging procedure.”
Instead, he recommend the use of X-Rays, which are “cheaper and more available. The access is quite easy.”
In addition, he said Italian medical personnel developed a scoring system that helped quickly identify patients at risk of respiratory failure.
Beyond treatment, Siewiera said that facility design was very important, including a system of airlocks and doors and curtains that help counteract the spread of the virus.
Siewiera minced no words in his assessment of the effectiveness of hydroxychloroquine, an anti-malaria drug once touted by President Donald Trump
“Hydroxychloroquine does not work,” he said. “The risk of heart injury and arrythmia is higher. It is too risky.”
Ventilation, he said, is the key factor in determining a positive patient outcome at this point.
“We have to do a very good ventilation of the patient” he said. “We have to use ventilators appropriately. The lungs are very sensitive, especially during COVID. We have to avoid injuring them, and have to be very precise in providing ventilation treatment.”
He also recommended ECMO, or extracorporeal membrane oxygenation.
The ECMO machine is similar to the heart-lung by-pass machine used in open-heart surgery, according to the University of California San Francisco. It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest.
“If we would be perfect in these techniques, the outcome of the patients will be much better,” Siewiera said.
Another factor to consider is that the virus is mutating “very fast,” he said.
“We know there are different types and mutations of this virus, and it is changing very fast, Probably we will have to take into consideration that this particle and symptoms are changing,” he said,
There are difference between the Polish and American approaches, said Siewiera
While the situation seems to be under control in Poland, which has nearly 13,000 cases and more than 640 deaths, he said that the Polish medical community is not trying to provide polymerase chain reaction testing to everyone, but will guarantee free testing for medical personnel if they want it.
“That’s a little different than the United States,” he said. “We see that the approach is trying to provide PCR tests to as many citizens as you can. Time will show which approach will be more effective.”
There are now more than a million cases of COVID-19 in the U.S. with more than 60,000 deaths.
Another difference, said Siewiera, is that in Poland, the weakest point in the medical system is the lack of ICU beds, forcing the military to set up temporary mobile hospitals, while in the U.S. “we see ICU beds available.”
Siewiera said he was impressed by the huge efforts in the U.S. to set up large-scale temporary medical facilities like the one at McCormick Place in Chicago, which has been scaled down as the number of new cases in the area has slowed.
Siewiera added that another lesson he has learned from the Illinois National guard is how they manage data and how they support the data driven decision making process, so that they can prepare for the future.
Col. Eric Vaughn, a medical professional serving with the Illinois Air National Guard, said the learning experience has gone both ways.
“They were really helpful in providing a different perspective,” Vaughn told Military Times.
One of the biggest differences is treating patients in austere environments.
The Polish medical team “had front line experience working in Italy,” said Vaughn. “They went in to help Italy go through their process, which was one of more devastating exposures to COVID-19. They were there during the collapse of their medical and helped them rebuild.”
Vaughn said while the U.S. is staying ahead of the curve in terms of treating COVID-19, the Polish team brought in an important insight that will come in handy moving forward.
“The fact is that they are not as well-supplied and funded as the United States,” Vaughn said. “They were able to share how to provide services in more austere situation. That is going to come in incredibly handy when the virus moves form the major metropolitan areas, which are fairly well funded and supplied. to the rural and more remote areas. It gives us insight how we can set up adequate treatment in less funded areas.”
Vaughn pointed to the setting up of mobile treatment centers in tents with a lot of open bay situations.
“They were able to logistically establish negative pressure rooms” where contaminated air gets moved away from main corridors, he said.
“They had insights how to turn large open bay area into a ventilated negative pressure environment, ideas we haven’t really run across and didn’t have to do previously.”
The Polish military medical team is helping more than just the Illinois National Guard, said Vaughn.
“They are providing education for us nationally, putting on academic webinars, where everybody dialing in,” he said. “It is not just Illinois, but doctors from the entire U.S. and around the world are dialing in and sharing best practices and firsthand information about the management of COVID-19,” said Vaughn. “It is a huge information sharing and learning opportunity.”
The Illinois National Guard’s state partnership with Poland began in 1993 and is one of the oldest of the partnership programs, in which every state and territory National Guard takes part. Polish military forces have deployed with Illinois National Guard units to operations in Iraq and Afghanistan since 2003, contributing more than 35,000 troops to both operations, according to the Illinois National Guard.
RELATED
In Maryland, the Maryland National Guard has been called upon to guard the state’s supply of COVID-19 tests, according to the Washington Post.
In an interview with the Post, Maryland Gov. Larry Hogan, a Republican, said that the Maryland National Guard and Maryland State Police were guarding the tests at an undisclosed location.
“It was an enormously valuable payload,” Hogan said. “It was like Fort Knows to us because it is going to save the lives of thousands of our citizens.”
Hogan said he was reacting, in part, to “reports, for example, in Massachusetts, Gov. Charlie Baker told the story of his plane load that came in with masks was basically confiscated by the federal government and he had to get Robert Kraft, owner of the Patriots, to fly a second mission, with a private plane, to bring some of that equipment in. There were a couple of other states that had similar stories.”
“It’s not uncommon for the National Guard to support with security and logistical-related missions,” Maryland Army National Guard Maj. Kurt Rauschenberg, a spokesman, told Military Times.
The number of Guard troops mobilized in the effort to cope with the coronavirus pandemic rose slightly.
There are more than 45,000 Air and Army National Guard professionals supporting the COVID-19 crisis response at the direction of their governors as of Tuesday afternoon. That’s about a slight increase from Wednesday Tuesday.
In addition, 43 states, three territories and the District of Columbia have now been approved for use of federal funds for state missions under Title 32.
As of Thursday morning, 821 Guard troops had tested positive for COVID-19, according to the latest figures provided by the Pentagon. That was an increase of 12 from Wednesday.
Of those troops activated in the COVID-19 response, 37,400 are currently under orders authorized for Title 32 502(f) status, said Army Master Sgt. W. Michael Houk, a spokesman for the National Guard Bureau. That’s an increase of about 500 troops since Monday.
“As states amend orders and issue new ones based on their needs this number will keep moving,” he told Military Times. "Also based on response needs, as determined at the state level, some orders may remain under state active duty."
The status, ordered by President Donald Trump, means the federal government is picking up 100 percent of the cost, with control remaining in the hands of governors. It also means that those troops — risking thier health and that of their families by being on the front lines of the coronavirus fight — receive healthcare and increased housing allowance equal to active duty and reserve troops doing the same work.
There was an initial catch. Only troops on 31-day orders were eligible for the increased benefits. That problem, however, was since fixed by Trump and now states are going through the process of either initiating or amending those orders to meet the 31-day requirement for increased troop benefits.
In addition to those on Title 32 orders, there are also about 7,600 Guard troops across the nation on State Activated Duty who are not receiving increased benefits.Current National Guard COVID-19 response missions include, but are not limited to:
*Full-time, 24-hour state Emergency Operations Center staffing to synchronize National Guard efforts with local and state mission partners to plan and execute an effective response;
*Flying ventilators and other critical equipment to support response efforts in other states;
*Providing mortuary affairs assistance as needed with dignity and respect;
*Providing time saving support to local law enforcement, freeing officers to perform their duty in the communities they serve;
*Conducting force health protection assessments to ensure our Guardsmen are taken care of;
*Manufacturing, sewing and distributing masks for mission essential personnel;
*Building and outfitting alternate care facilities to alleviate stress on medical infrastructure;
*Supporting warehouse operations and logistics efforts to help deliver and distribute lifesaving medical equipment and critical supplies;
*Delivering and distributing food in hard-hit communities and supporting food banks;
*Manning call centers to be a knowledgeable and calming voice;
*Providing vital personal protective equipment training and delivery to civilian first responders;
*Performing sample collection and delivery to medical personnel;
*Providing support and symptoms screening to testing facilities and passenger terminals;
*Providing transportation and assessment support to healthcare providers
Here are the latest updates of National Guard actions across the United States and its territories:
Florida
The Florida National Guard has more than 2,745 soldiers and airmen in a mobilized status.
The FLNG continues supporting community-based testing sites, and mobile testing teams throughout Florida. To date, the FLNG has assisted in the testing of nearly 1 million individuals.
Additionally, more than 90 FLNG medical professionals are supporting the U.S. Army Corps of Engineers’ alternate care facility at the Miami Beach Convention Center.
Massachusetts
More than 1,800 members of the Massachusetts National Guard are activated for a variety of missions, to include delivering PPE to first responders, food bank operations, drive-through testing and mobile testing teams, and medical staff assisting at public hospitals.
New Hampshire
The New Hampshire National Guard continues to support around-the-clock warehousing, creating a steady stream of providing PPE to first responders and healthcare professionals across the state. To date, they’ve delivered 1,700 orders, an estimated 100 tons of freight.
New York
The New York National Guard has more than 3,650 personnel on mission across the state, six joint task forces to support state and local governments with logistics management and warehouse operations. They also provide medical staff at Javits Center, New York City hospitals and testing sites.
NYNG members continue to manage Javits as the unified command post for the multi-agency response. To date, more than 1,095 patients have received care at Javits NY Medical Station.
*New York Air National Guard pararescue airmen, 106th Rescue Wing, who are trained as emergency medical technicians, are also assisting in city hospitals.
*The NYNG is supporting the alternate care facility at the South Beach Psychiatric Center on Staten Island. Additional forces are providing support at three other potential alternate care sites on Long Island or Westchester.
*NYNG is supporting 12 drive-through testing sites. A test site at Niagara County Community College opened on April 29, and a site at the State University of New York, Binghamton opens April 30.
*Guardsmen conducted 4,800 tests April 28, with more than 175,400 tests administered at NYNG-supported sites through April 28. The sites are located at: SUNY Stony Brook; Jones Beach State Park; Staten Island; Glen Island State Park in Westchester County; Anthony Wayne Service area in Rockland County; Lehman College and the Bay Plaza Mall in the Bronx; Aqueduct Racetrack in Queens; Flatbush in Brooklyn; SUNY Albany campus; Niagara County Community College in Sandborn; and SUNY Binghamton. Soldiers and airmen are collecting samples and providing general-purpose support at the testing locations.
*The NYNG is preparing to provide administrative and logistical support to three new testing locations, in central and western New York, later this week. These sites will be located at: the Buffalo Sabres Parking Lot in Buffalo; Monroe County Community College in Rochester; and Griffiss International Airport in Rome.
*National Guard personnel continue packaging and distributing food today in the Bronx, Brooklyn, Queens, Staten Island and Manhattan in New York City, and in Yonkers. They provided 205,525 meals April 28. To date, soldiers have distributed more than 3.3 million meals.
*Similar food distribution missions are underway in Westchester County, where Guardsmen distributed 3,184 meals April 28, and have provided 90,408 meal packages since the start of the mission. In Albany County 2,589 meals have been provided to quarantined residents as of April 28.
*NYNG soldiers and airmen have been working at the regional food bank in Latham, and have prepared 139 pallets of food for shipment across northeastern New York.
*Soldiers helping to process and ship goods at the regional food bank in Schenectady delivered 2,558 meals April 28.
*A one-time food support mission was conducted April 24 in Amsterdam, Montgomery County, where 1,000 meals were distributed. Another one-time food distribution mission is planned for Delhi April 30.
*New York soldiers and airmen continue conducting logistics missions, including warehousing and commodity distribution of medical supplies at six sites in the Hudson Valley, the Albany area, and Mohawk Valley.
*Hand sanitizer delivery to areas in the lower Hudson Valley is ongoing, with 107 gallons delivered April 28. A total of 50,228 gallons of sanitizer have been delivered to local governments.
*The National Guard continues to provide logistics support to the Office of the Chief Medical Examiner of New York City where 250 National Guard personnel are working with members of the Medical Examiner’s Office to assist in the dignified removal of human remains, when required. The support mission also includes assistance to the Westchester County Medical Examiner, and the Orange County Medical Examiner.
*NYNG soldiers continue to man phones at two New York City call centers, including one for the New York City Division of Veterans Services. Soldiers also continue to provide administrative support at two New York City 911 call centers.
*Soldiers continue packaging COVID-19 test kits for the New York State Department of Health at the Wadsworth Laboratory in Albany. They assembled more than 15,500 kits April 28 for distribution across the state. The team has built 462,350 testing kits since starting the mission.
North Carolina
The North Carolina National Guard has conducted more than 25 delivery missions of PPE to 80 counties across the state, logging nearly 49,000 miles to ensure medical facilities and other locations have the essential items they need.
Oklahoma
Oklahoma National Guard members are assisting at two food banks that have seen a 60 percent increase in demand for food assistance while having to decrease volunteers due to essential-staffonly restrictions.
Rhode Island
The Rhode Island National Guard delivered more than 800 sampling kits to five locations across the state, and collected more than 300 samples for transport.
Washington
Washington National Guard members continue supporting food banks. They have provided more than 800,000 meals, which is approximately 6.4 million pounds of food. Additionally, they continue to support COVID-19 testing, having tested more than 1,300 people at sites throughout the state.
West Virginia
Currently, 705 members of the West Virginia National Guard are on duty supporting the state’s COVID-19 response. To date, WVNG has completed 732 missions across the state.
Guardsmen provided PPE training to Eldercare of Ripley, area healthcare facilities and six retail establishments. To date, this team has trained 670 stores, 3,382 personnel and 77 medical or long-term care facilities.
West Virginia Guard personnel continue assisting in sanitization lanes for first responder and public transport vehicles. They have sanitized 225 vehicles, including ambulances, police vehicles and public transport buses, in Huntington and Charleston.
Task Force Sustainment, dedicated to receiving and moving critical supplies across the state, continues their mission of distributing PPE to various county emergency managers. This team delivered PPE supplies to 14 counties April 29.
Guardsmen assisted packing 1,200 box meals at the Mountaineer Food Bank and 596 family meal boxes at the Facing Hunger Food Bank in Huntington April 28. In addition, they delivered 4,520 meals to Greenbrier, Ohio and Raleigh counties via refrigerated trailers April 29.
WVNG medical personnel, augmenting the Department of Health and Human Resources’ regional epidemiology teams, supported 214 voluntary COVID-19 mapping engagements and expedited three transfers to the state lab. To date, the state’s seven regional epidemiology teams have conducted more than 4,343 voluntary COVID-19 mapping cases.
Wisconsin
The Wisconsin National Guard is supporting sample collection across the state, with more than 3,000 samples collected from eight sites to date.
This story will continue to be updated as the National Guard Bureau releases daily reports on National Guard activities nationwide. If you or someone you know is in the National Guard responding to COVID-19, and would like to talk about your experience, please contact Military Times managing editor Howard Altman, haltman@militarytimes.com.
Howard Altman is an award-winning editor and reporter who was previously the military reporter for the Tampa Bay Times and before that the Tampa Tribune, where he covered USCENTCOM, USSOCOM and SOF writ large among many other topics.
