Did the previous management of the Ministry of National Defense save on soldiers’ health? We obtained the documents

More than three years ago, the Military Institute of Medicine (WIM) created a medical research project called “DAGER SARS – Diving after SARS-CoV-2 infection”, which aimed to prevent health problems among soldiers of Polish special forces. However, the then management of the Ministry of National Defense abandoned the research.

Do you want money from the Ministry of National Defense? Look for support elsewhere

The research proposed by the Military Institute of Medicine was intended to comprehensively assess the health of soldiers after COVID-19, but the project did not receive support from the Ministry of National Defense. Instead, the Ministry of National Defense suggested that the Military Institute of Medicine look for money from external institutions, such as the National Center for Research and Development (NCBR) or the Medical Research Agency (ABM).

The Military Institute of Medicine project versus standard examinations by medical commissions

The DAGER SARS project was proposed to the ministry as a response to the health challenges brought by the COVID-19 pandemic. The aim was to conduct comprehensive health examinations, including:

Pulmonological diagnostics:

• Spirometry – assessment of air flow in the lungs.

• Bodyplethysmography – measurement of lung capacity and airway resistance.

• DLCO – assessment of the ability of gases to pass through the alveolar-capillary barrier.

• Chest X-ray – basic imaging assessment of the lungs.

• Chest CT – more detailed assessment of lung tissue.

Cardiological diagnostics:

• Echocardiography – structural and functional assessment of the heart.

• Exercise test (ergospirometry) – analysis of physical capacity and circulatory system functions.

• Resting ECG – assessment of heart rhythm at rest.

• 24-hour Holter-ECG – monitoring of heart rhythm throughout the day.

Psychiatric and neuropsychological diagnostics:

• ACE-III scale – assessment of cognitive functions such as memory, attention and ability to concentrate.

• WAIS-R – a test to assess general intelligence and cognitive functions.

• Various neuropsychological tests – include tests such as the STROOP Color Word Test, the TUS Attention and Perception Test, the Continuous Visual Recognition Test, which examine, among others, attention, memory and multitasking.

Laboratory tests:

• Biochemical blood tests (e.g. lipidogram, glucose, bilirubin).

• Inflammatory markers (e.g. hsCRP, ferritin).

• Markers of myocardial damage (e.g. troponin, NT-proBNP).

• Assessment of hemostasis (e.g. D-dimer, fibrinogen).

Provocative tests:

• Pressure test in a hyperbaric chamber – simulation of diving conditions to assess the reaction to pressure changes.

• Oxygen tolerance test – assessment of the risk of oxygen toxicity, important for divers exposed to high concentrations of oxygen.

As we read in the project, the aim of the research proposal was “an interdisciplinary assessment of the health of Special Forces soldiers after SARS-CoV-2 infection, taking into account key indicators of fitness and physical capacity as measures of the ability to perform professional military service in special operational conditions.”

Scientists from the Military Institute of Medicine also wanted to develop an algorithm for assessing the health status and ability to perform professional military service in the special forces corps of soldiers after SARS-CoV-2 infection. The project also included, among others: supporting the judicial activity of the Military Medical Commission by building a database of radiological images. The research was intended to provide a more advanced assessment of the health of soldiers exposed to extreme conditions, such as: divers and pilots, in a comprehensive way that goes beyond standard procedures.

Standard examinations carried out by military medical commissions, such as the District Military Maritime Medical Commission (RWKM-L), include basic health tests – ECG, chest X-ray and spirometry, as well as a general health assessment. However, these tests are not detailed enough to detect specific post-COVID-19 complications, especially those that may have a significant impact on the ability to serve in extreme conditions.

As research shows, COVID-19 may lead to permanent damage to the respiratory, cardiovascular and neurological systems, which may pose a direct threat to life in situations requiring high physical performance. Without hyperbaric tests, heart and lung examinations under conditions of physical stress, soldiers may return to duty without realizing the potential damage and complications that COVID-19 could cause in their bodies.

The Ministry of National Defense is aware of the problems, but has no money

The Military Institute of Medicine submitted a proposal to conduct additional tests for soldiers in the first half of 2021. At that time, the director of the Department of Military Health Service (DWSZ), reporting to Deputy Minister Wojciech Skurkiewicz, was Dr. Aurelia Ostrowska – a close friend of the then Minister of National Defense Mariusz Błaszczak. The management of the Ministry of National Defense was aware of the health problems caused by the pandemic. There is even a document called “Guidelines for referring soldiers who have recovered from SARS-CoV-2 virus infection to Military Medical Boards”, which includes guidelines on conducting additional tests for soldiers who have had COVID-19 and serve in specific situations. conditions, such as divers and pilots.

The document issued by the Ministry of National Defense was aimed at standardizing health assessment for people exposed to extreme physical stress. Nevertheless, according to the documents we obtained, the Ministry of National Defense did not consider these guidelines to be a sufficient reason to finance the WIM project, which was estimated at PLN 1.5 million. In response to the DAGER SARS project, the ministry suggested to the institute that “it should be considered to obtain financial resources for these purposes in a competitive manner, e.g. in proceedings conducted by the National Center for Research and Development (NCBR) or by the Medical Research Agency (ABM). The results and solutions obtained in this way may, after prior validation, also be used in the Polish Armed Forces.

Additionally, the director of the DWSZ replied, among other things, that “the assumptions regarding the assessment, among others, of this group of soldiers of the Polish Armed Forces, reflecting current global recommendations, were prepared by the Central Military Medical Commission (CWKL) and then agreed by the Department of Military Health Service. As the documents show, the research proposals presented by DWSZ are far from sufficient to properly assess the health of soldiers.

We asked Senator Wojciech Skurkiewicz, former deputy minister of the Ministry of National Defense, about the research project and the lack of its implementation.

Please remember that special forces have their own specificity, which is completely different from other types of Armed Forces. Not all areas of research and research projects should be and are implemented with the participation of special forces soldiers, because this data is very sensitive. We tried not to convey either medical or additional issues that would be a reason to target people who are outstanding specialists in what they do. These types of projects and undertakings must be, and I hope they still are, implemented at the Ministry of National Defense, after consultations with commanders, because they are detailed and very sensitive data. Over the years, we have made sure that this information does not leak out in any way outside a strictly regimented area. Conducting this type of research is not entirely suitable for those who have to operate in secret, says Senator Wojciech Skurkiewicz.

Consequences of lack of investment in soldiers’ health

The lack of full implementation of the guidelines suggested by military doctors and scientists, and the decision of the Ministry of National Defense not to allocate funds for the Military Institute of Medicine project, mean that soldiers may be allowed to serve on the basis of an incomplete health assessment. Standard medical board examinations may not detect complications such as changes in respiratory function, heart rhythm disturbances or neurological problems, which can be fatal in extreme conditions. As a result, soldiers from special units are particularly vulnerable, as they may find themselves in a life-threatening situation during a mission or exercise if health complications are not detected early enough.

The decision of the previous management of the Ministry of National Defense not to implement the project could have had long-term consequences that are worth analyzing in more detail. Currently, the director of DWSZ is Col. Arkadiusz Kosowski, MD, PhD, who previously served as director of the Uniformed Services Department at the National Health Fund Headquarters during the government of the United Right. Faced with the challenges related to complications resulting from COVID-19 and potential negligence from the past, the new management of the Ministry of National Defense could consider conducting a detailed analysis of the decisions taken in this matter and their impact on the health of soldiers. It is also important to establish whether steps have been taken to improve the situation since then.