In early April, a trauma and orthopedic center named after Vreden in St. Petersburg was placed under quarantine after a person infected with the coronavirus was found in the hospital. More than 700 patients and staff were quarantined. By the end of the quarantine, almost everyone in the hospital was infected. At least two health workers died. The BBC tells the story of 35 days of the country’s most extensive quarantine through the eyes of doctors and their patients.
“I found myself in a terrible situation, I am in quarantine, where 500 patients and 300 employees of the institute are locked up! I came here healthy, like many others, and now I am not. The most serious patients have been sent to hospitals… some of them are no longer alive”. Patient Nadia wrote this post on social media on the 19th day of her stay within the walls of the hospital.
The majority of patients at the Vreden National Medical Center come from outside the city; they operate on people from all over Russia, from Kaliningrad to Vladivostok. The clinic has been “granting freedom of movement” (the institution’s motto) since 1906. It ceased operations on April 8, 2020. My husband brought Nadia to the hospital the day before from a regional town in northwestern Russia. She had been waiting for the federal budget quota for the operation for almost two years, but they still couldn’t operate on her. By the time the Vreden center was closed for quarantine, there were 474 patients and 239 medical and technical staff, the center’s director, Rashid Tikhilov, later clarified.
At the same time, doctors and patients learned about the risk of infection in late March. “We were told that someone had started coughing, but there was no confirmation, and just in case we needed to get masks. There were no masks in the institute’s pharmacy, so we made bandages out of bandages,” another patient, Irina Efremova from St. Petersburg, told the BBC. She had already undergone two operations by the time the quarantine began, but did not have time to be discharged home.
Irina Efremova in a homemade mask made of bandages
We explain quickly, simply, and clearly what happened, why it matters, and what will happen next. Episodes. The End of the Story Podcast Advertising The coronavirus was confirmed in a patient with pneumonia in the clinic 5-7 days after the analysis. As soon as this was discovered, the patients were told that they would be “quarantined”. On April 8, all the institute’s doctors were sent home on the condition that they return the next day – two shifts per department. “Like schoolchildren on a field trip, happy and carefree,” recalled the acting head of the clinic’s orthopedic department, Yevgeny Sorokin, as the staff gathered in the parking lot that morning with their packed belongings. At the same time, patients who were ready to leave were not allowed to go home. By that time, only half of the patients admitted to Sorokin’s department had been operated on. When the quarantine was announced, the management still hoped to operate on all the remaining patients. But the surgeons underestimated the situation, he admits. In the ward where Irina Efremova lay, one of the patients was still being prepared for a scheduled operation. On the morning of April 8, the woman was taken to the operating room, but they turned her away and said, “That’s it. We’re in quarantine, we’re taking you back.”
“Ride a bike. Run. Take a walk. Because it’s not going to happen to you. Just don’t do one thing. If you feel scared, if you have trouble breathing, if you develop a high fever – do not call a doctor, do not call an ambulance. Ask for help from people like you. And remember that I cannot leave work because you cannot stay at home,” Yevgeny Sorokin wrote on April 9, sitting in his office. A month later, when the quarantine was lifted, the doctor was already infected with the coronavirus.
Cabinet of Evgeny Sorokin
According to Irina Efremova, the floor where her neurosurgery department was located was closed, and the general ventilation in the building was turned off. Deliveries could be made to the entrance barrier, and the kitchen staff left food outside the department’s door. “Your” medical staff distributed it to the wards. “A huge institute with patients and shifts of medical personnel behind an iron door looks out the window at a multitude of cars, crowds of people in the park, smoke from barbecues, posts about meetings and even parties on Instagram… He looks and waits with anxious impatience for the results of his analyses,” said Dmitry Nakonechny, head of the hand and foot surgery department. “At this moment we are separated not only by a food passage ‘by will’ and glass windows.”
Inside the hospital, nothing was adapted to quarantine: there were no airlocks separating infected areas from “clean” ones, no division into red and green zones, and, at first, no personal protective equipment. By the time they arrived, it was too late: everyone was already infected, Sorokin told his Moscow colleague Yuri Glazkov. “The office is large, under federal jurisdiction – it has been a week since the tenders were carried out. If the test results had arrived earlier, we could have separated the healthy from the sick. But the tests arrived after 10 days – when everyone had already mixed together,” Sorokin explained.
Only after April 27 (19 days after the announcement of the quarantine), according to the register of government contracts, the clinic purchased a thousand respirators (285 thousand rubles), 500 protective suits (1.3 million rubles), two thousand pairs of goggles (560 thousand rubles), 50 overalls (196 thousand rubles), and 50 thousand disposable masks (1.3 million rubles). Information about the payment and delivery of protective hoods for surgical teams (1.2 million rubles), ordered on April 7, is not available in the register.
Neurosurgeon Viktor Rudenko says that in the early days, friends helped the doctors. The department he heads received FFP3 masks, and the institute’s pharmacy provided a supply of antiviral and immunostimulant drugs for all employees. Dmitry Nakonechny thanked on April 17 for the “valuable delivery from the capital” – face shields. “Now it will be easier to fight,” he wrote. Nevertheless, according to Sorokin, all employees of his department were infected. It was impossible to protect oneself in a closed room where the infection had already spread, even if one was constantly washing one’s hands and sleeping with a mask, the doctor says. Even the center’s administrative and technical staff, who had no contact with patients, became ill.
In all these 35 days, it was possible to leave the center of Vreden only once – in the direction of the infectious hospital. The director of the clinic went there almost immediately with a temperature of almost 40 degrees. “There was very little chance of getting infected. In the end, almost everyone got through it asymptomatically or with symptoms,” recalls Vyacheslav Kalinin, a resident of Moscow. He arrived at the center on April 5. Shortly before, the man had injured himself while chopping firewood during a self-isolation in his country house near St. Petersburg. Surgeons managed to save his hand a few days before he was quarantined.
In the department where Nadezhda was staying, one of the patients had a high temperature during the first week. They couldn’t get it down, and he was sent to the infectious disease clinic. A week later the patients learned that the man had died. Nadezhda’s first coronavirus test was negative, although she began to feel unwell within the first week. According to her, a therapist came when she developed a fever and her temperature rose to 38 degrees Celsius. She was wearing a regular medical mask and robe. “We have a breeding ground for the coronavirus here, brace yourself,” the doctor said. Nadezhda’s subsequent tests for COVID were positive.
“The doctors in Vredena are wonderful, smart, just great. It’s not their fault that they were locked up with us,” Nadezhda told the BBC. “They are narrow specialists, traumatologists-orthopedists, they do not know how to treat this virus. The head of the department was reading books: how to help us, what antibiotics to give… They gave us pills, injected ‘Fragmin’ in the abdomen. They were sick themselves and they treated us, tried to do something, saved whoever they could. On the first day, the clinic’s clinical pharmacist developed treatment instructions for colleagues for coronavirus. We started with Arbidol and Tamiflu, and after a week we bought other drugs. In Sorokin’s department, elderly patients were not prescribed powerful drugs: orthopedists were afraid they would not be able to cope with complications, the doctor said. In other departments, he said, they used Plaquenil. Orthopedists even had to treat patients with aggravated diabetes.
“I didn’t think that stories about heroism existed in ordinary life,” described the life of Vreden Center, a patient in quarantine at the clinic.
According to Vyacheslav Kalinin, the medical staff “performed their usual work and the work of the infectious hospital staff”. “The number of symptoms is huge. Almost everyone coughs. There can be an immediate deterioration, and in 5-6 hours a person can be lost,” Sorokin said. Many were transferred to mechanical ventilation (MV) and oxygen-supported wards: the intensive care unit at the Vreden clinic continued to function. But more than 10% of the patients, according to the doctor, “got worse in a short period of time. As a result, about 15-20% of the patients from Vreden were sent to infectious hospitals, where “they would be under the care of a therapist, not an orthopedic surgeon. At that time, St. Petersburg hospitals were already overcrowded, and the transfer of severely injured patients had to be arranged on a personal basis. Sorokin says he once spent 24 hours looking for a hospital bed for his patient.
Medical personnel had the highest viral load. According to Sorokin, during the first two days the doctors visited the patients wearing a regular mask and cap. During the first week there were no protective suits for doctors, only masks, confirms patient Nadezhda. Those who remained on their feet tried to carry out regular sanitary treatment of the premises. On April 14, Dmitry Nakonechny photographed subordinates with mops and buckets after the “Quidditch Cup”. On April 15, he announced that he himself had contracted the virus. According to the documents published by “Fontanka”, out of 113 tests of doctors who arrived from the Vreden center that day, 60 turned out positive. “The nurses and the cleaning lady got sick – she cleaned our ward, windowsills and bedside tables. She was coughing, but she said she felt fine. She turned 60 and I congratulated her. She got worse. She died,” Nadezhda said.
Tatyana Kankia had an anniversary. On April 17, she and a nurse from another department, Yuliya Yasyulevich, who also cared for patients with fever and cough, were sent to an infectious hospital, but they couldn’t be saved there. Tatyana Kankia’s relatives planned to file a complaint with the Prosecutor’s Office about her premature hospitalization.
“We are so close to each other, but we can only communicate, like the rest of the world, by phone. And sometimes I really want to say words of support to those who are nearby in the corridor, on the neighboring floors, to those who are now just like you,” Dmitry Nakonechny wrote on his social media page on April 19 (the 11th day of quarantine). On the 12th day, the head of the spinal surgery department, Dmitry Ptashnikov, said that he himself had fallen ill, along with all the staff and 32 patients in his department. Nine out of ten employees and twelve patients were diagnosed with pneumonia. “Unfortunately, to this day no personal protective equipment, even modern ones, has worked, because we are closed in the same department with the sick. We cannot organize internal control within the department. We are stewing in our own juice,” Ptashnikov said.
Viktor Rudenko fell ill with pneumonia, according to Irina Efremova, whom he operated on at the end of March. He did not go to the infectious hospital, saying that he would not leave his department. The patients noticed that the doctors who had been treating them began to disappear. According to Vyacheslav Kalinin, the doctors resumed their work after recovering a bit: “We were idle in the wards, they were suffering from fever on their feet. They continued to provide the department with everything it needed. Exhausted, having slept only a few hours, the nurses woke up at night to give me intravenous fluids to fight the damn virus. Even the laundry of the patients’ clothes was taken care of. Despite the seriousness of the situation, we saw only smiles and cheerfulness from the doctors and nurses. Not for a second did any of them allow themselves to be lethargic, rude, or harsh. I have never seen such selflessness. “Doctors are just gold,” says Irina Efremova. She recalls that patients and doctors lived in the hospital like a family: the medical staff washed the patients’ clothes in a washing machine they bought themselves, and the patients helped with the cleaning. In the hospital, masks were immediately distributed to patients and they were allowed to walk in the corridor “by the ward”. Those who developed a fever or cough were isolated in available rooms. Irina, who also had a fever, was transferred to the isolation ward, but when her temperature dropped and there were no other symptoms, she was returned to the general ward. And just a few days later, she was taken away in an ambulance with coronavirus pneumonia. “Almost everyone got sick – there were elderly people, asthmatics, diabetics among the patients,” she says. Only on the way to the infectious disease hospital did Irina learn from the accompanying documents that her first analysis, taken at the beginning of the quarantine, was negative. Even the doctors at the Vreden clinic, she says, did not know the initial results of her tests. If in the first week the patients understood the quarantine, in the second week they began to resent the fact that they were being held illegally.
According to Sorokin, the doctors explained that those who would jump out of the window and leave would be caught. Such precedents occurred in the city of Vreden. On April 24, a patient from the Lipetsk region escaped from the traumatology hospital. He was followed by a 29-year-old man from Makhachkala. Both were infected with the coronavirus. Refugees from Dagestan were alarmed by cases of coronavirus patients dying in hospitals, including a 40-year-old woman from the same republic. She also came to St. Petersburg for a planned operation at the Vreden National Medical Research Center, became infected and was admitted to the War Veterans Hospital, where she died on April 24. “When zinc coffins are sent from St. Petersburg to Dagestan, no one wants to find themselves in them, especially after they are opened,” friends of the fugitive from Makhachkala were quoted by “Fontanka”. Three days later, local police found the refugees who had returned home.
According to TASS, a man from the Lipetsk region explained that he left the hospital because they did not perform a scheduled operation for him. The man from Dagestan decided that he had already completed the two-week quarantine. “I told him myself, run away while you’re still alive. A healthy person will definitely get sick in this hospital,” his mother said.
On April 25, the first patient was discharged from Dmitry Nakonechny’s department. “I myself accompanied her to the “clean” ward. It was the first time during this period that I went anywhere outside our territory. Of course, being close, I couldn’t resist and looked into the buffer zone to see my friends,” he wrote. “That day, I became curious: will handshakes return after the end of the epidemic?”
The artist Kuzma Petrov-Vodkin’s majolica on the facade of the historical building of the Vreden Orthopedic Institute. On April 26, the 18th day of the quarantine, a subtitled video entitled “A Plea for Help” by nurse Valentina Naumova of the Vreden Center appeared online. She claimed that supposedly all the medical staff and patients of her quarantined 21st department had already been “dispersed to hospitals”. The heroine of the video complained that allegedly no one was taking care of her condition: “I have taken the coronavirus test five times – no results. I don’t understand if I’m infected or not. I have a cough, chest pains, and no one cares about me – there is no one”. The woman promised to start a hunger strike and asked to “contact the authorities”. Later, in an interview with “Sever. Realities” (a publication recognized in Russia as a foreign agent) that she had started the hunger strike. For the moment, she has deleted the video from the Internet, but the BBC sent a link to the video to Rospotrebnadzor for comment on the day it appeared online. The video also remains on the VKontakte social media platform.
The St. Petersburg branch of Rospotrebnadzor shared a link to an article on “Fontanka” with an urgently recorded video message from nurse and acting director of the National Medical Research Center, Andrey Cherny, addressed to “patients and staff.” “We continue to actively monitor and treat patients and employees who fall into this category,” Cherney said. At this time, more than one hundred patients have been evacuated to infectious disease hospitals and twenty have been discharged with negative test results for home quarantine,” he said. He didn’t comment on the subordinate’s performance. However, he admitted that the difficulties were related to the initial delay in receiving the test results. According to the clinic director, on the 18th day of the quarantine, they were still installing the badge system (without it, it was not possible to rotate employees) and procuring personal protective equipment (PPE). The next day, April 27, TASS, citing the director of the Vreden Tikhilov Center, who had previously been hospitalized with coronavirus in Botkin Hospital, reported that the number of infected people within its walls was about 300. This figure has not been officially announced anywhere.
On April 29, St. Petersburg State Duma deputy Mikhail Amosov and eight of his colleagues complained to Russian Deputy Prime Minister Tatyana Golikova about the situation at the Vredena clinic. In an open letter, they said that as a result of “unplanned isolation” there was “almost 100% infection of staff and patients” at the clinic. The Deputy Prime Minister forwarded the letter to Rospotrebnadzor. After the scandal with the nurse’s video, on April 30, Governor Alexander Beglov for the first time on air presented the version of 78 TV channel that the source of the coronavirus in the Vreden Center was an employee who came from Turkey and violated self-isolation. BBC could not find any information about this employee and the consequences for him. According to the clinic workers who spoke with “Meduza”, someone among the patients brought in the virus.
On May 3 (the 25th day of quarantine), the center’s director, Rashid Tikhilov, who has recovered from the coronavirus, announced that the clinic had purchased personal protective equipment, necessary medications, and organized checkpoints. “We have rotated our staff and prepared health cards for the transition to regular work,” he said. According to Tikhilov, there were still 136 patients and 93 employees in the institute, the number of quarantine departments decreased from 19 to five. “Before the arrival of Rospotrebnadzor disinfectors, the employees themselves had to clean the beds after vacating them,” the nurse said in an interview with “Sever. Realities”. Patients were transferred to other wards, confirmed by BBC Nadia, who visited three of them during her quarantine. The last unit where she waited for confirmation of negative test results was already a “clean zone” and patients were taken in protective suits for CT scans. Orthopedics, unlike the coronavirus, was fine during the quarantine, as Dr. Sorokin later explained: “It’s surprising, but no one got infected, no one dislocated anything, there were no orthopedic complications.” Basically, everyone recovered from their specific ailments in the first week; patients with joint replacements spent the quarantine on crutches and went home on their own. On the one hand, confining so many people in one place without express tests is wrong, but for the patients it was still better, argues Irina Efremova: it is not known who was already infected at that moment. “We did not spread the virus across the country. If we had gone to the countryside, some grandmother might have died without timely help. Here, everyone was monitored by doctors, and we were helped immediately at any sign of illness. Also, the post-operative stitches were under control and there was no need to go to the clinic for bandages,” she says.
On May 15, BBC sent questions to the St. Petersburg branch of Rospotrebnadzor about the advisability of closing the hospital for quarantine in view of the subsequent mass infection, as well as the specific reason for this decision: whether the first infected person was a patient or an employee of NMIC. The BBC also requested the results of the sanitary and epidemiological investigation of the mass infection in the Vreden center, data on the number of infected and deceased patients and medical staff. At the time of publication, the agency had not responded to the request. Payments to the sick medical personnel of the Federal Research and Clinical Center of Vreden by the authorities of St. Petersburg and to the families of their deceased colleagues are not officially provided. It is unknown how this problem will be solved, according to doctors. Adult children (if they are not disabled or students) of deceased medical workers cannot expect federal payments either, as this category of recipients is not specified in the presidential decree. “This is extremely unfair and even surprised employees of the Social Insurance Fund, which is responsible for payments. However, challenging the decree will not be easy, as the legislator has the right to establish a list of those who are entitled to payments,” said Olga Zinovyeva, managing partner of the law firm “Onegin,” BBC reported. The BBC asked the Ministry of Health to comment on the payments made to Vredena Center employees who were in quarantine and to relatives of deceased medical workers. On May 13, the center of Vreden was completely cleared of “quarantine prisoners”: doctors who tested positive for coronavirus were allowed to continue their treatment at home. On May 19, Rospotrebnadzor allowed traumatologists to resume work to provide emergency assistance. But the clinic is still under quarantine.
Doctors and patients were discharged from the Vreden Center after 35 days. Patients from all over Russia who have received a quota for surgery at the center do not yet know what will happen to them. On the website of the institute there is no information about the prospects of the planned treatment. Patients exchange information on social networks, some write that they were able to find out through medical institutions in their regions and from doctors of the Vreden Institute that surgeries will begin in September. “We are forced to beg for help, grovel before the authorities, look for corrupt schemes and kneel down. The Vreden clinic will open, but we do not know who will get in and when,” Dmitry Yermakov, a patient, wrote on Facebook on May 17. Earlier, he complained that the urgently needed surgery can be performed only at the Vreden Center and the St. Petersburg Scientific Research Institute of Phthisiopulmonology, but both are under quarantine: “They let me go quietly. I called an ambulance 4 times, and each time I returned home. The coronavirus blocks everything! I can no longer walk”. The BBC contacted the Department of Health for comment. The surgeon who was supposed to operate on Nadezhda was sent from quarantine to the Botkin Hospital with pneumonia. Now he is healthy, says a BBC correspondent, but he is already afraid to return to the former “breeding ground”. Nadezhda was discharged 36 days after her hospitalization: without surgery, having recovered from Covid-19 in a “mild form” and with aggravated bronchitis. Speaking to the BBC, Nadezhda coughs constantly. She doesn’t know how to treat the cough: “I’m self-employed and don’t need sick leave, but I have a child. Someone brought us a paper prescribing self-isolation. But no one from the clinic called or came. Everyone is afraid. As soon as I stop coughing, I will try to do an antibody test and help people who are getting sick,” she says. A week after this conversation, the woman wrote on her Internet page: “A few days were good. I thought the nightmare of staying in St. Petersburg was over. But that was not the case… Nerves on edge, afraid of something and wanting to cry at night. And the cough got worse and the right side of my back hurts… And a fever that wasn’t there… A lot of thoughts swirling in my head”.