Battling the pandemic: Moscow doctors get Devotion awards

July 7
Healthcare

On the eve of Medical Worker’s Day, doctors in Moscow were presented with Dovotion awards. The statuette of a doctor’s golden hands holding a patient’s crystal life, considered the main award for people working in the medical field, was presented to 21 Moscow hospital employees. They won the For Creating New Direction in Medicine category. They were responsible for organisational work during the pandemic and the urgent readjusting of hospitals for treating COVID-19 patients.

Moscow was Russia’s first city to face a large number of COVID-19 cases so all the infrastructure of the healthcare system had to be promptly changed. The city hospitals had to be fitted out with oxygen stations, additional ICU beds and more places for CT scans.

Over 25,000 beds for coronavirus patients were put in over 70 federal, city and private hospitals. The Kommunarka hospital was one of the first medical facilities to accept coronavirus patients. It was converted in just two days and an infectious diseases hospital in Voronovskoye took only a month to build.

We spoke with the winners of the prize about how they had to readjust their lives and work. These doctors personally took part in the conversion of hospitals and have been working at COVID centres.

“People’s safety comes first”

When a hospital is being turned into an infectious disease facility, it is necessary to organise the space to comply with sanitary requirements and to divide flows of people.. The hospitals received sanitising stations and the buildings were divided into ‘clean’ and ‘unclean’ zones. They also established facilities to sanitise and remove waste and sanitising stations for transport of food and laundry deliveries. All personnel underwent training courses.

In order to organise this work comprehensively, a team of experts helped hospital administrations. One such person was Maria Serova, an infectious disease specialist at Infectious Diseases Hospital No. 1. Experts studied the layout of floors, collected information about the equipment at hospitals and devised detailed plans of the readjustments that required to be made.

Photo: Press Service of Moscow Mayor and the Moscow Government. Maxim Mishin

“It is no easy job to create sanitization zones in facilities that were never intended to house them. Some hospitals had to even use their courtyards for this purpose, because the plan of a building simply did not allow for any other solution,” Maria Serova said.

Specialists inspected intensive care units, assessed the condition of the oxygen systems and the possibility to divide personnel and patient flows. “This all has to be done so that a  medical facility not designed to treat infectious diseases, could work properly for  patients and personnel at the same time,” Maria Serova explained.

According to Maria, the job of converting Moscow hospitals got underway already during the first days of March and was carried out 24/7 . Needless to add the workers had little time off.

Photo: Press Service of Moscow Mayor and the Moscow Government. Maxim Mishin

Overall, Maria Serova said that she was not much bothered by the COVID-19 pandemic. “Infectious disease doctors mustn’t be frightened by yet another new virus,” she said. However, she says that she is confident that the virus is still with us, and it is important to lower the risk of catching it.

She pointed out that people should remember to frequently wash their hands, wear face masks, use sanitiser, not touch their faces, stay at a distance from others and avoid crowds.

“Feeling like a knight at a tournament”

Andrei Mylnikov, deputy chief surgeon at the Vinogradov Hospital, shared his experience of readjusting to the new working conditions. A COVID department opened there in the middle of April. A system of gateways was established to divide personnel and patient flows.

“Medical staff has to enter the gateway, change, put on scrubs and PPE and go on to the closed ‘red’ zone. At the exit there is a shower and special rooms for taking off and sanitisation of all the PPE. Then, it’s possible to go back to the ‘clean’ zone,” explained the surgeon.

Before entering the ‘red’ zone, each person must put on disposable scrubs, airtight protective gear, overshoes, double gloves, a hat, mask and goggles. “This kind of gear is really heavy and a bit like a knight’s armour, and it’s not easy to work in it, especially when it’s hot,” he said.

He said that he had to use the same gear when he was working in Dagestan clinics where Moscow doctors went to assist their counterparts. “It was over 30 degrees Celsius, and the ventilation system was off, because the air containing viruses must stay inside. You can lose a couple of kilogrammes in just a few hours or so,” Andrei Mylnikov recalls. Doctors have to wear the protective gear for 6-12 hours a day, depending on their shifts.

The situation was also difficult because COVID-19 is a new infection. Treatment methods had to be developed, and Moscow specialists were continually communicating with doctors from other countries. According to Andrei Mylnikov, initially they used the experience of Italy, Spain and China, who were the first to encounter the virus. Meanwhile, Russian doctors began to develop their own treatment recommendations, which are still being constantly updated.

“It was decided to replace some medicine with other sorts that were more effective. In the process of interaction with patients, various treatments were reviewed and partly changed based on the experience of Russia and other countries. The entire world was combatting the pandemic and exchanging information. The more people are involved, the faster a solution can be found,” the surgeon pointed out.

The hardest time for doctors working in Moscow was between late April and early May, during the peak of the pandemic. According to Andrei Mylnikov, the situation was aggravated by the fact that each doctor had to treat many more patients than usual. Now, after 2.5 months, they managed to develop convenient treatment algorithms and switch to the new conditions.

Crews from Moscow hospitals are now being sent to hot spots in the regions. Since late May, they have been helping their counterparts in Dagestan, North Ossetia, Ingushetia, Pskov, Vladimir, Chita, Kamchatka and the Yamal-Nenets Area.

“You can’t stay dry in the rain”

The new pandemic has caused a hike in the number of severe cases in almost all countries. Some patients were moved to intensive care units, but the Moscow healthcare system was ready for this, says Andrei Bykov, anesthesiologist and resuscitationist at the Kommunarka Hospital, which had to cope with the first coronavirus patients as early as in March.

“The work at the ICU has not changed much. Resuscitationsists always work at a good pace and under significant pressure. So I can’t say that there have been so  many changes here. We are treating more patients than usual, but in terms of our workload, it was not a blow or something extreme,” he said.

According to Andrei Bykov, it was difficult to switch to working in an environment knowing the high risk of getting infected, and having to wear PPE. This is how Andrei describes a typical working day: “Upon arriving at the hospital, you use sanitiser, receive a mask, go to the changing room and don your usual surgical scrubs so that you can get to the ‘red’ zone. Then you have to put on the main protective gear, respirator, goggles, and then only after that can work get underway.”



It became a challenge for many doctors to have to wear this kind of protective gear for hours on end. In the beginning, they joked about  the new conditions they had to endure, but soon it was no longer funny. “Have you seen photos of people after wearing this PPE stuff, with marks on their faces? Try and imagine having to wear it for four months in a row. It’s extremely hot in the gear and especially with a couple of pairs of gloves on too. It’s more like a sauna,” Andrei Bykov says.

However, despite all the measures that are taken there’s no guarantee that a medical worker is completely safe. “There is always a risk of contracting the disease. You can’t stay dry when it’s raining, your hands, feet and face will get wet anyway. But I’ve been working for four months, and my blood tests have been clean so far,” the doctor says. But his colleagues did catch the virus. Infectious disease specialist Maria Serova had to go on sick leave, while surgeon Andrei Mylnikov went through the disease symptom-free, which was confirmed by an antibodies test.

Another challenge was the separation from their families, for many doctors had to isolate themselves from their spouses, children and elderly parents. “We didn’t know what we were facing. Everyone was self-isolating, and it was hard to be apart from our families and friends,” Andrei Bykov said.

In the search for the most efficient treatment of COVID-19, Kommunarka doctors have been cooperating with leading foreign experts. According to Andrei Bykov, when the pandemic began, doctors were following  the procedures used during an atypical pneumonia epidemic. The diseases looked alike, but in the very first days doctors in Moscow noticed that the novel virus was progressing in a totally different manner. They had to come up with new ideas on how to tackle it.

“Research continues and we are getting new clinical and experimental data, and we are frequently adjusting the treatment protocols. We are trying to make everything as safe and efficient as best as possible,” the anesthesiologist says.

According to doctors, communications with foreign colleagues and joint development of treatment protocols has allowed them to minimise the fatality rate.

Andrei Bykov noted that Moscow doctors are not afraid of a second wave of the pandemic because the capital managed to organise how the hospitals worked. Also, doctors know more about treatment methods, they have developments and protocols, plus they are now more experienced.

The operational standards of the Moscow COVID hospitals are being introduced to the Russian regions. Seventeen multidisciplinary crews were sent to these places to help readjust their hospitals and to develop new algorithms of patient flow organisation.

Back to normal

Due to the reduction in the number of cases Moscow hospitals are returning back to normal. However, temporary COVID centres will be kept at  17 hospitals just in case. These include the Sklifosovsky Research Institute of Emergency Medicine, Filatov City Hospital No. 15, the Kommunarka hospital, and some others too.

Due to these circumstances, it is now easier for the city to allow hospitals to resume their planned medical schedules. Pletnev, Mukhin, Demikhov, Zhadkevich and Davydovsky hospitals, Hospital No. 31, Shabolovka Hospital and hospitals for war veterans No. 1, 2 and 3 are all back to working normally. In the near future, planned medical assistance will be given at hospitals No. 17, 51, Bauman Hospital No. 29, the Spasokukotsky Hospital, Pirogov Hospital No. 1, as well as the Rabukhin tuberculosis centre.

Photo: mos.ru. Maxim Denisov

These clinics are dismantling equipment, sanitising the wards, and every week their personnel are being tested for the coronavirus. For all the hospitals that are switching back to normal, temporary standards have been put in place which include a greater distance between beds, additional ventilation and air disinfection.

The admission rules have also changed. Patients are admitted via a separate entrance, with an interval of at least 15 minutes for disinfection.

All patients also get tested for the coronavirus, and planned treatment only gets underway if the test is negative. While waiting for test results, patients are put in single rooms which comply with all sanitary and epidemiological requirements.

Source: mos.ru

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