Branch 3 of the Balashikha Regional Hospital is a multidisciplinary hospital in the Zheleznodorozhny microdistrict. At the beginning of April this year, it was clearly unprepared for the coronavirus pandemic that reached Russia. Doctors complained about the lack of dirty and clean zones and the lack of protective equipment. Officially, the hospital was not supposed to receive patients with coronavirus. It was re-profiled to treat patients with pneumonia. However, by mid-April, patients with pneumonia in Moscow were being treated as if they were infected with coronavirus, even if their test results were negative.
In the second half of April, doctors at the Balashikha hospital began to fall ill. Among them was anesthesiologist Inna Demekhina. She returned to work on April 8 after her vacation. On that day, according to her, there were already seven people with pneumonia in the intensive care unit of Balashikha hospital. In total, 24 people in Balashikha were diagnosed with coronavirus that day. Officially, none of the patients at the hospital in Zheleznodorozhny could have been infected. Two weeks later, Demekhina was forced to take sick leave due to an acute respiratory infection. The symptoms of her illness were similar to those of a coronavirus, although this diagnosis was not officially confirmed for her.
Demikhina initially attributed the first symptoms of the disease to exhaustion and the large amount of antiseptics the doctors used to disinfect the premises themselves. “In principle, we took care of everything ourselves as best we could, so we saw symptoms like sneezing and sore throats – before the temperature rose – as possibly related to the constant use of disinfectants (BBC) and quartz lamps, antiseptic treatment of hands and skin
surfaces, and also the fact that we treated coats with antiseptics,” she explains. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: episodes. End of story. Podcast Advertising.
Then the woman began to feel a burning sensation in her mucous membranes, weakness, and a high temperature. She experienced severe muscle and head aches, dry cough, “in other words, it was difficult to perform the duties for 24-hour shifts in such a condition,” she describes. As a result, she went on sick leave. She underwent two CT scans, which did not reveal pneumonia. They took a swab from her on April 30, the 11th day of her sick leave, for a coronavirus infection, the doctor said. According to her, she had previously been denied a coronavirus test. She had to wait almost two weeks for the test result: on May 11, she was informed that her test was negative.
At the same time, it became known in April that the percentage of false-negative tests for coronavirus is quite high. Doctors claimed that the accuracy of the tests was 70-80%. Patients often complained that the coronavirus was not confirmed in them until the second or even third test. During the interview with the BBC correspondent, Inna coughed heavily and took frequent breaks. She found it difficult to speak even though she had been ill for over a week.
Demekhina’s sick leave ended only in mid-May. At the doctor’s office, her chronic condition worsened against the backdrop of an acute respiratory infection that she had to treat. She was on sick leave for several weeks. Inna Demekhina is not the only doctor at the Balashikha regional hospital to fall ill in April.
Two other doctors told the BBC that they were also on sick leave in April with symptoms of acute respiratory infection. Both doctors claim they were diagnosed with bilateral pneumonia based on CT results. Unlike Demekhina, they have not been able to get tested for coronavirus, although all three doctors are confident that they have Covid-19. They all associate their illness with the situation in the hospital and complain that the hospital was not prepared to receive infected patients.
On May 6 this year, President Vladimir Putin signed a decree on insurance payments to doctors affected by work with Covid-19. According to the decree, medical workers who contracted Covid-19 have the right to receive compensation of 68,811 rubles.
However, the doctors do not expect to receive any compensation for their illness, as they have not officially worked with the coronavirus. The Russian service of the BBC tells how doctors can be infected in the hospital and what payments they can expect. Most of the doctors agreed to speak anonymously for fear of possible problems at work and conflicts with their superiors.
On April 3, the hospital staff in Zheleznodorozhny was informed of important changes: from April 6, the hospital will be re-profiled for the treatment of pneumonia. Patients who did not have pneumonia and whose treatment needed to be completed were transferred to other branches of the Balashikha hospital. According to hospital employees, on April 6, patients with pneumonia began to be admitted to the hospital, reports the BBC. Officially, the hospital could not accept patients with Covid-19 during this period.
Therefore, according to the doctors, there was no zoning, i.e. there were no “clean zones” where one could work without special protective equipment, and “dirty” zones for working with infected patients. Such zoning is used to ensure the safety of hospital staff. “We did our best to protect ourselves with interferons, with Arbidol, with all the means of prevention in order not to get sick. Maximally, gloves, everything. We tried to use all the protective measures we had. But without zoning, it turned out to be, let’s say, not quite effective,” Demekhina says.
The doctor believes that one of the possible ways the infection could have been transmitted was through interaction with patients in the intensive care unit where she works. “All of our patients receive oxygen therapy. Those who are not on mechanical ventilation receive oxygen through a mask or nasal catheters. Patients cough, they take off their masks, they are still agitated because everyone has symptoms of respiratory failure. And this aerosol mixture goes into the air. And in the air, due to the fact that the room is not separated, it has the property of spreading. The hospital ward is next to the residents’ room, and across from it is the head nurse’s office. The nursing station is also right here. Basically, we are all in one room,” she says, describing the hospital in April before she went on sick leave.
Another issue that has become a concern is the lack of protective equipment. The doctor, who agreed to speak to the BBC’s Russian service but requested anonymity for fear of repercussions at work, explains that he and his colleagues are literally asking management every day for the necessary protective equipment to work in pandemic conditions. According to his words, they ended up receiving only disposable suits made of thin fabric that can tear and several antichemical suits.
“They provided us with disposable caps, regular masks, about 12-15 construction respirators, not more than twenty, disposable gowns, and some anti-plague suits, green ones that supposedly provide protection. But the question is, how old are they? And, of course, they were the wrong size. Only one out of eight suits fit me, for example. We didn’t use the suits because they didn’t fit, but hats and masks – of course we had to protect ourselves somehow,” says an anesthesiologist-intensivist from the same hospital.
But doctors say that even if the suits fit everyone properly, they are unlikely to solve the problem. In hospitals with segregated zones, doctors can wear sterile suits and take them off after leaving the “dirty zone”. “We don’t have a clean zone, we’re constantly in a dirty zone, and that’s where our dining area is, our living room. In other words, it is practically impossible to put these suits on and protect ourselves,” explains one of the doctors.
An anesthesiologist-reanimatologist says that in early April, the hospital was basically not ready to receive patients with pneumonia and possible Covid-19. “Multi-bed rooms, common corridors, common elevators, nothing was done to organize the red zone, the green zone. It was not done, and no one was particularly involved. The management explained this by the fact that we, our entire branch, do not work for receiving patients with confirmed coronavirus infection,” he says.
On April 22, the head of Balashikha, Sergey Yurov, announced that a special ward for patients with pneumonia confirmed with Covid-19 has been prepared on the territory of the third branch. According to Demekhina, the infectious ward is formally part of the third branch. The doctor claims that there is allegedly no intensive care unit in it, and critically ill patients are sent to the main hospital building. The BBC Russian Service called Yurov for clarification, but he did not answer the phone. The cell phone of the hospital’s deputy chief physician Viktor Goncharenko was not available.
According to doctors, some patients with pneumonia who were in the branch of the Balashikha regional hospital in April allegedly tested positive for Covid-19. This patient could be a resident of Balashikha, Dmitry Volov. On April 20, he felt unwell and called a doctor to his home. Volov was sent for a CT scan of the lungs, which showed that he had bilateral pneumonia with lung involvement resembling “ground-glass opacity” – a classic picture of lung damage in coronavirus infection, the man told the BBC in a conversation.
After the CT scan, Volov was taken to the Emergency Department of Branch No. 3 of Balashikha Regional Hospital as a patient with pneumonia. “The conditions there were very sad, it was a very old building, and they clearly did everything in a hurry and very quickly, without any protective measures. All the nurses, all the doctors were wearing masks at best. At one point, I saw a doctor who came down from the department for more serious patients because I asked for an explanation of what was happening to me and how they were going to treat me. She was wearing a hazmat suit and a respirator,” he recalls.
According to Volov, he walked from the street to the hospital in his usual clothes. “When I arrived at the branch, I entered the ward in my street clothes, there is a small wardrobe in the ward where everyone hangs their jackets and shoes,” he recalls. Volov actively describes the progress of his illness on social media. The day after he was admitted to the hospital, he was transferred to the Maternity Hospital in Savvine, which had just been re-profiled to receive patients with coronavirus at the end of April. According to him, the situation there is completely different: there are clean and dirty zones, his clothes were taken away for disinfection, and all doctors work with patients only in protective suits.
Volov says he saw several dozen people from the 3rd branch being transferred with him to the Savvine maternity hospital. Volov claims that he finally confirmed that he had coronavirus. He took the test independently through Rospotrebnadzor’s non-contact testing service before his first hospitalization. By the time the test arrived, he was already at the hospital in Savvino. Doctors at the Balashikha regional hospital explain that testing at the 3rd branch is carried out according to the following protocol: on the day of admission, the patient undergoes the first test, on the third day – the second test, and on the tenth day – the third test. Only after a positive test, the patient is referred to the Savvino Maternity Hospital, which has been reprofiled to receive patients with coronavirus.
In early April, the Moscow City Government changed the routing system for patients with pneumonia: in Moscow hospitals, medical staff began treating patients with confirmed pneumonia as if they had confirmed Covid-19, even if tests had not yet been performed or their results were not yet available. Coronavirus and pneumonia treatment facilities were merged into one system.
At the end of April, another doctor at the Zheleznodorozhny hospital went on sick leave. Speaking to the BBC, the woman said a CT scan showed she had bilateral pneumonia. She was prescribed strong antiviral medication and antibacterial therapy. The doctor said that she had allegedly not been swabbed for coronavirus, even though she had asked to be tested. According to her, messages were circulating among the hospital’s medical groups via messengers, stating that a swab could only be taken with the consent of the chief doctor of the Balashikha Regional Hospital.
A woman complains about the hospital administration: “Nobody cared about our bad health, we talked about having a fever and everything. And they decided that we just don’t want to work. And we are afraid that we will be fired. There is also the possibility that as long as we have to endure this epidemic, no matter what the losses are, the doctors have to stay. But no one knows what will happen after that. She still couldn’t get tested for the coronavirus.
A doctor, a resuscitation anesthesiologist, who complained about the lack of properly sized protective suits, also reports that the CT scan showed bilateral pneumonia. He tried to ignore the early symptoms because he had to work. But when his condition worsened, he called a doctor. When asked if he was afraid to work, knowing all the risks, he says he wasn’t: “We’ve worked in the ICU and dealt with worse cases, and you think you’re still young and maybe you’ll get lucky. There is no fear. It’s just a virus. Of course, sometimes you think about the possible consequences, but it seems like you’re young and a little bit immortal.
The doctor claims that while he was working, they allegedly refused to take a coronavirus test from him. He was only able to take the test when he was on sick leave with pneumonia. The first swab came back negative. He explains that according to the rules, a second swab should have been taken from him, but this has not yet happened. Two other doctors from the branch who managed to pass the coronavirus tests ended up at the maternity hospital in Savvin with confirmed coronavirus infections, doctors said. However, the BBC has been unable to contact these health workers.
Speaking to the BBC, doctors expressed two concerns. The first is that they tend to get sick at home with their families and are afraid of infecting them. Secondly, they discussed the additional payments promised by the President of Russia to doctors treating coronavirus patients.
They all believed that these payments for April are unlikely to be received by them, as their branch has not been reprofiled for the treatment of coronavirus infection. However, the day before the text was published, doctors were paid their April salaries. Two BBC interviewees said that they had received presidential bonuses. According to them, all doctors who worked at the branch in April received bonuses. At the same time, the hospital management’s position throughout April was that there was no coronavirus in the hospital. However, the question of compensation for doctors theoretically infected at work in April remains open. According to Vladimir Putin’s decree, compensation is due to medical workers who have confirmed coronavirus infection.
Alexey Goryainov, a lawyer and national representative of the European Association of Medical Law, confirmed that the May presidential decree on the introduction of additional insurance guarantees only works if the doctor’s illness is confirmed to be specifically a corona virus infection. If there is no evidence of coronavirus infection in the workplace, the doctor will not be paid anything other than regular sick leave.
On April 27, the Ministry of Construction Complex of the Moscow Region announced that the third building of the Balashikha Regional Hospital will be reconfigured for work with coronavirus patients. The hospital will be divided into “clean” and “dirty” zones. The hospital will organize 190 beds for coronavirus patients. Admission of coronavirus patients will begin in mid-May.
However, according to doctors, at the time of publication there is no zoning in the hospital, the only thing that has changed is the installation of oxygen in the wards. The doctors say that the hospital is under construction. One of the doctors believes that the hospital does not have the necessary number of special devices to deliver oxygen directly to patients. The BBC has also found no government procurement documents indicating that any reconstruction or zoning work is being carried out or planned at the hospital.
Inna Demekhina will have to return to work in her department after her release. The doctor is worried about reinfection if the premises are not divided into zones. “The virus is relatively new and poorly studied,” she worries.
The Russian service of the BBC sent questions about the organization of the work of the hospital to the Ministry of Health of Russia, the Ministry of Health of the Moscow region, as well as to the Balashikha regional hospital, but did not receive any answers by the time of publication of the material.
Illustrations by Denis Korolev