On the frontline: 2020 for healthcare workers

January 13

For a year now, Moscow medical workers have been combating a dangerous and treacherous enemy, the novel coronavirus. Last spring, during the peak of the pandemic, more than 69,000 healthcare professionals, including doctors, mid-level and junior nurses and ambulance workers, were treating patients. They were on the frontline risking their own health every day.

What was 2020 like for Moscow doctors and when will we be able to declare victory over COVID-19? Is the current situation much different from the peak of last spring and how are medical workers coping with their workload? Chief doctors and directors at local outpatient clinics, inpatient facilities and research institutes spoke to Mos.ru correspondents about the power dynamics in this struggle with COVID-19 and whether it is possible to get the disease under control.

Denis Protsenko: The purpose of the vaccination is to control the morbidity rate and reduce the number of severe cases to the minimum.

Chief Doctor, Medical Centre in Kommunarka

Last spring was the hardest. We had to face an unknown disease which we didn’t know how to treat. We didn’t know what caused the severe illness. We had to learn on the go, analyse, study and discuss it with our colleagues, including from other countries.

The current situation is different because we now know how to diagnose this disease fast and we have specific tools to stabilise and treat severe forms of the coronavirus. But, unfortunately, there is still no perfectly suitable drug that can specifically target this disease. It is another limitation that we have to deal with.

Of course, a vaccination is the only possible method of disease prevention when there is an epidemic. The fact that the vaccine was developed so fast and Russia also has a vaccine (actually, more than one) encourages me to stay optimistic.

Moscow’s efforts to counter COVID-19 are exemplary not only for other regions but for other countries as well. We responded quickly to the pandemic and repurposed our medical facilities. There was no shortage of hospital beds. Reserve facilities were built and set up very quickly. Hospital beds were equipped with the necessary equipment in record time. We increased the number of intensive care beds and the oxygen supply. There was no lack of oxygen for patients. The equipment was also in sufficient supply. We developed local treatment protocols and held regular discussions with our colleagues. I think all this should serve as an example for other cities and regions.

My advice to Muscovites who have been fortunate enough to avoid the coronavirus so far would be, first, to get the shot, and second, to stay vigilant. Wear masks, change them regularly, observe social distancing and refrain from unnecessary contact and large public gatherings as much as possible.

A vaccination may not eliminate the virus completely but it will help us handle it easier. It is actually very difficult to defeat an infection, but this is the year to control it, minimise severe cases and manage the incidence rate thanks to the vaccine. I have big hopes for and faith in this campaign in this year.

Valery Vechorko: We must stay alert.

Chief Doctor, Oleg Filatov City Hospital No. 15

COVID-19 is evil and unpredictable. Even though scientists have already studied its genome and how it affects the human body, it is not possible to calculate and predict how the virus will behave in each specific case. Some people are asymptomatic while others end up in intensive care.  

We do all we can to help our patients recover. And it’s been a success. Since 27 March, we have treated more than 40,000 people. I’d like to note that since the pandemic, more than 700 patients over 90 have been released from this hospital. A quarter of them were actually over 100. The coronavirus is not a death sentence but people should stay vigilant. Muscovites must stay alert, even those who already had COVID-19. This virus is extremely contagious. Everybody must take epidemiological safety measures, wear masks and gloves, use hand sanitisers, maintain social distancing and avoid crowded places if possible.

Nobody in the world can tell you when the pandemic will end. One thing is clear: for the virus to become weaker and blend in with other seasonal respiratory diseases, we need herd immunity. Herd immunity can be achieved if more than 70 percent of the population is immune – that is, if people have recovered or been vaccinated. In my opinion, the second option seems safer.

Andrei Shkoda: We defeated smallpox and we can defeat the coronavirus.

Chief Doctor, Leonid Vorokhobov City Clinical Hospital No. 67

We already know how to diagnose and treat COVID-19. We have gained significant experience, which is no small feat. All healthcare workers in Moscow, at all levels, have been working as one team. We are constantly sharing experience which we have literally been accumulating since day-one. We always feel each other’s support, and it’s very important.

We opened four new medical facilities in the past year. What does opening imply? We needed to set up and fine-tune all processes, from food service to treatment, medical supply and cleaning. It is a big system. Not only did we open these facilities but they are running like clockwork. I would like to particularly mention the reserve hospital at the Krylatskoye Winter Sports Palace. It is a huge space, enough for 1,347 beds, including 42 intensive care beds.

Another of Moscow’s achievement is arranging the fast-track diagnostics of lung damage based on a neural network, or a “CT calculator” as people call it. Our hospital worked on this project with scientists from Lomonosov Moscow State University and Moscow’s Department of Information Technology. This service may not fully substitute computer tomography but it is a new medical tool that helps doctors predict the course of an illness (in case of pneumonia) based on blood work and other parameters. This calculator is over 90 percent accurate.

We can defeat the coronavirus. People used to ask doctors if it’s possible to defeat smallpox. And we did it. What about measles? We did that, too. We can defeat the coronavirus if we comply with doctors’ orders. Public vaccinations will contribute to this victory as well.

Sergei Petrikov: Moscow has been one step ahead in the COVID-19 struggle

Director, Sklifosovsky Research Institute of Emergency Medicine

When we just started dealing with the novel coronavirus, we did not understand the actual scale of this challenge. Later, we received an order to have our facilities repurposed. We approached the task responsibly; we changed the layout of the floors, built gateways, and bought personal protection equipment for our staff. Our research departments worked very hard. We needed to prepare for treating patients. After all, we are a research institute. We opened as a hospital on 20 March and realised the scale of the problem since the first hours.

You see, the logistics of coronavirus patient care at the institute is different from that of hospitals. We have a big intensive care unit; there are 92 intensive care beds and only 43 regular hospital beds. Half of the patients in intensive care need various methods of respiratory support. These patients are very ill.

No other country and no other city prepared for the coronavirus like Moscow. Moscow has been one step ahead. Many measures were taken preventively; jobs were assigned way in advance. Different scenarios were considered.

Moscow has a streamlined public healthcare system, which allowed us to regulate the number of hospital beds for coronavirus patients in a fast and efficient manner. Entire inpatient facilities were repurposed when necessary. If it was no longer needed, they were converted back. It is important to note that, besides treating COVID-19, we managed to continue providing the same amount of emergency and elective care.

The most important task is to withstand the pressure until this whole coronavirus armada runs its course. And it will eventually happen; this is how epidemics work. We must keep going – and preferably, without too many losses.

Nikolai Plavunov: We must make the coronavirus manageable

Chief Doctor, Alexander Puchkov Ambulance and Emergency Medicine Station

At the onset of the pandemic, it was difficult to predict how it would unfold. But we knew that it was an airborne infection with its own specifics and treatment. However, in terms of spreading, it is not like any other infection.

Today the situation is still difficult but we understand more. We know how to deal with this infection and have a clear response protocol. The incidence rate is not declining in the regions or in Moscow. But there is one nuance. In the early days of the epidemic, patients in Moscow accounted for 75 to 80 percent of all the cases across Russia while now the situation is reverse. Moscow now accounts for 20 to 25 percent and the rest of the cases are being diagnosed elsewhere in Russia. The regions are relying on Moscow’s experience that was built up in spring. The epidemic is hitting other areas harder and, of course, Moscow was the most prepared for the autumn surge.  

The combination of two methods, prevention and vaccination, will eventually lower morbidity. Our ultimate goal is to make sure that COVID-19 becomes just another infection with a low incidence rate.

We must make the coronavirus manageable. That will be our victory over COVID-19. This is what we are striving for. It is extremely important that everybody participates, including healthcare workers and all city residents. Every person must contribute to the fight against this disease.

You can’t fight the epidemic alone; there must be a system

Natalia Kuzenkova: The vaccination is the most efficient protection against the coronavirus

Chief Doctor, City Outpatient Clinic No. 68

Photo by Vladimir Novikov, Press Service of the Mayor and Moscow Government

The most efficient protection against COVID-19 is the vaccination and using PPE. This is what can stop the spread of the coronavirus. Doctors and healthcare workers are exhausted. We have been working non-stop since March. And the public services that are involved in countering the pandemic have been working with us.

Setting up outpatient CT centres meant operating around-the-clock, which outpatient clinics had never done before. House calls also required mobilising additional resources. All these efforts required a great number of specialist, higher focus and strict compliance with treatment protocols.

Now we know more about this infection. We have clear treatment protocols and recommendations. The city has been buying the latest equipment and providing us with the necessary supplies. However, the city remains open and not everybody observes the personal safety rules, which is why the infection is spreading further.

Of course, we will defeat COVID-19. How long we have to live with this virus depends on how socially responsible we are towards ourselves and our loved ones.

Maryana Lysenko: Now we understand and can do a thousand times more.

Chief Doctor, City Clinical Hospital No. 52

Moscow is not only a capital but also the country’s largest transit hub. The city was hit by COVID-19 the hardest. But this is not the first challenge for Moscow. Our authorities, public services and essential facilities are ready for the most difficult work. The public healthcare system was mobilised instantly and is promptly responding to any new developments.

Our main job now is to prevent an overwhelming surge in cases.

In the beginning, COVID-19 was considered a bigger threat for older people but now, we have very young patients (under 30) in our intensive care wards.

It is hard to predict the progress of this disease. A patient’s condition can deteriorate at any moment. Therefore, every patient needs to be constantly watched even if our experience shows that there is no reason to worry.

The ultimate weapon against the coronavirusthe vaccine – is finally available. All the epidemics since the era of Catherine the Great have been stopped. It was also during her reign that vaccines were first used. Back then, doctors extracted the substance from smallpox pustules, dried it and used it to vaccinate others. It is impossible to imagine something like this today. But that vaccine worked and smallpox was no longer an unstoppable force.

Now we understand and can do a thousand times more. The end of the public vaccinations may actually become the moment when we finally declare victory over this disease.

Source: mos.ru

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