Leonid Pechatnikov – Advisor to the Mayor of Moscow on Social Development and former Head of the City Health Department. Moscow authorities have declared that the coronavirus epidemic is putting a strain on the capital’s healthcare system, and they are reserving thousands of new beds in the city’s hospitals. Will Moscow’s healthcare system be able to cope with the growing number of infected people? How has the “optimization” carried out by the Moscow authorities in the 2010s affected the availability of hospital beds, and when might the epidemic peak?
BBC correspondent Oleg Boldyrev interviewed Leonid Pechatnikov, Honorary Doctor of the Russian Federation, former Head of the Moscow Health Department, Deputy Mayor of Moscow, currently Advisor to the Mayor of Moscow on Social Development and Dean of the Faculty of Health Management and Medicine at RANEPA.
BBC: At the end of last week, Moscow authorities announced that the capital’s health care system was working at its limits in terms of receiving COVID-19 patients. Earlier this week, they warned of a possible shortage of hospital beds in two to three weeks. Do you agree that the system is beginning to be overloaded?
Leonid Pechatnikov: The system is beginning to be overloaded, mainly due to the fact that a very large number of acute pneumonias are being admitted to hospitals at the same time. The problem is not a lack of beds or resources. When this happens suddenly and a large number of patients arrive, any system begins to experience difficulties. In this regard, it is possible to agree with the Moscow authorities. As for the problems related to the lack of beds or equipment – such problems should not exist in the Moscow health care system now.
BBC: Recently there was another order from the head of the Moscow Health Department saying that they are ready to receive patients in departments with a total of over 10,000 beds. I understand that this is in addition to the 20,000 beds that Health Minister Murashko reported to Sobyanin’s headquarters at the end of March. What percentage of the hospital bed capacity do these 30,000 beds represent?
LP: Moscow hospitals – the concept is broad. There are hospitals that belong to the Ministry of Health. There are about 55,000 beds in such hospitals. And about the same number of beds in federal centers and departmental hospitals. Only the Russian Railways hospitals in Moscow are four large hospitals. Several hospitals of the Ministry of Defense. Civil aviation hospital. The total bed capacity of Moscow hospitals – and they all operate under the OMS system today – I think is no less than 80,000 beds.
BBC: But these tens of thousands of beds are not for pneumonia. How reasonable is it to put people in these places to fight pneumonia?
LP: That is a very important question. Today, after all the reorganization that has taken place in Moscow, we have multi-profile hospitals that are very well equipped. All hospitals have multiple CT scanners and huge intensive care units. We have created multi-profile centers, so it is not difficult to reprofile any department of a multi-profile hospital for the treatment of pneumonia patients, and they will not need anything new to treat them, everything is already available in the hospital.
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BBC: But have the infectious beds been reduced during the optimization? In the early 2010s, the number of beds in infectious diseases hospitals was almost halved, from 4800 to 2200 places – if we believe a recent article in “Vedomosti”…
L.P.: That is not true. Not a single bed in the infectious hospitals has been reduced. Moreover, as part of the preparations for the World Cup, a new building was built in the 2nd infectious hospital, and one of the buildings of the former 12th psychiatric hospital was transferred to the 1st infectious hospital. Thus, in all these years, the number of infectious beds not only did not decrease, but even increased.
BBC: But even before the severity of the epidemic became apparent in Moscow, authorities began building this 900-bed hospital…
LP: First of all, not 900, but 500 (that was the original project, now the authorities are talking about a capacity of 900 places – ed). Half of them are intensive care units. It will be built with easy-to-erect structures, following the experience of China. What happened to the hospital in China? It was dismantled as soon as the epidemic was over.
BBC: By the way, they promise not to dissect it.
L.P.: While it will be a branch of the 68th City Hospital, only time will tell what lies ahead.
BBC: In any case, these decisions were made before the severity of the epidemic in Moscow became apparent. Doesn’t this show that the optimization of health care in Moscow has revealed a shortage of hospital beds?
LP: Let me tell you again – at the beginning of 2020, the Ministry of Health had about 55,000 beds. Almost the same number was available in Moscow from federal and departmental institutions. These new 500 beds are meaningless. But all these beds in all hospitals together began to operate under the OMS system. This was due to the federal reform. All these beds and hospitals were included in the compulsory health insurance system. And they started to be financed in the same way as the municipal beds. If before we counted municipal and departmental beds separately, because only selected people could go there, now we have to count the whole set of these beds. In municipal health care, not only did the number of beds not decrease after the reform, it actually increased.
BBC: And what about doctors? Does their number correspond to the number of beds? Or does the fact that Moscow is now trying to find new doctors and offering very good salaries indicate that there was a shortage of them even before the epidemic?
Oleg, in the history of mankind, only one mortal knew in advance about a natural disaster. His name was Noah. An epidemic is a natural calamity. When a natural disaster occurs, it creates an exclusive situation.
BBC: But some systems are better prepared for it, like the German ones, while others are worse off, like the British ones…
Translation:
Q: What did the Moscow health system lack in comparison to the German system during the epidemic? Do we put beds in train stations like in Spain, or do we put beds in compartment cars like in France?
BBC: Doctors are already fainting at work – this is happening in Russia.
LP: And according to you, people don’t faint in Germany? Today, no matter where doctors work, they faint. Because it’s very difficult to work in these protective suits. It’s not because there are so few doctors. By the way, today, when beds are converted, both neurologists and gynecologists – everyone starts working on the epidemic.
BBC: Is that normal? They don’t really understand how to work with it. I have an acquaintance who is a surgeon, and she is not at all enthusiastic about the fact that she might have to do this. Dear Secretary: Do you think it is necessary to maintain a regiment of pulmonologists? In times when there is no epidemic, what should this regiment do if there is no work? They will lose their qualifications within a month and won’t know what to do. Vascular surgeons, gynecologists and urologists should know how to treat pulmonary inflammation. All the treatment protocols already exist and are available to doctors.
BBC: Special shortage after health reform – of nurses. It’s the one profession that doesn’t need retraining…
LP: The problem with nurses is different. There are enough of them, but the nurses do not take the Hippocratic oath. And some nurses, I see, are forced to leave because they are afraid. The fact that people are afraid, including medical professionals, is a great credit to your profession. The fact that you, journalists, have created such a ninth wave, the fact that there is such panic…
BBC: Today we are publishing a survey of regional doctors – every second person does not understand what is happening. And it’s not our fault that they’re scared, but they have very little medical protection.
L.P.: Today not only our doctors and not only our people are afraid. The whole world is afraid. I don’t know what kind of protection they have over there. In Moscow there is enough protection, although I know that this is an epidemic – a natural disaster, and the situation in Germany is not easy either. Although the Germans are probably more disciplined than we are, they observe quarantine and their epidemic does not have an exponential character.
BBC: Let’s go back to the health care reform. If you had known about this epidemic eight years ago, when you were in charge of the Health Ministry, would you have continued with the reform?
LP: Sure. We would do the same thing. The Moscow system proved to be ready to work during the epidemic. The health care system cannot be reduced to the number of beds. It is about the quality of the beds. What did we create? Large multi-profile hospitals with large, well-equipped intensive care units. The main diagnostic tool in the epidemic is not the PCR test, but the computer tomograph. There are CT scanners in all clinics, and each hospital has several of them.
BBC: But the number of clinics has decreased and the number of hospitals has also decreased…
L.P: And how many tomographs were there? 50 for all of Moscow. And the number of clinics physically did not decrease, clinics were merged, several clinics were turned into one outpatient center. But in this clinic, which used to be independent, it was impossible to put even one tomograph into operation! Have you seen these clinics? Today, every clinic has a CT scanner and a MRI scanner. Every hospital has large intensive care units and large diagnostic departments. The department is called “gynecological”, but if you change the sign to “pulmonological”, there is no need to buy anything additional for this hospital, everything is already there. After the transition to multi-profile hospitals and outpatient centers, even with the reduction of these beds, which were actually scrap metal, the system is better prepared even for such spontaneous disasters as this epidemic.
BBC: But do you understand the calculations on which the authorities base their statements that there may soon be a shortage of places for COVID-19 patients?
L.P.: No, I don’t understand those calculations. I think there should be enough beds anyway. Today the federal centers have started to re-profile. And in federal, departmental and private clinics there are almost as many places as in municipal ones. I don’t think there will be a shortage of beds if the criteria for hospitalization are properly followed.
BBC: So you mean not to take them all in a row?
L.P.: If we consider only those who should be hospitalized. For example, during flu epidemics. We do not hospitalize everyone who has the flu, and we do not even hospitalize those who have some minor complications. We hospitalize when there are serious complications. In this case we are talking about severe pneumonia with respiratory failure.
BBC: Every morning we look at two figures – the number of infected and the number of deaths. But for some reason they never report the number of people hospitalized per day, even though it is clear that there are far fewer of them than there are infected. The majority of people get sick with symptoms that do not require hospitalization…
L.P.: It’s hard for me to say. As far as I know, these numbers are not hidden, and more and more departments in multi-profile hospitals are specializing and re-profiling to fight coronavirus infection. It’s difficult for me to answer why these numbers are not in the statistics, but as far as I know they have never been hidden.
BBC: Now that the authorities have admitted that there is no time for testing and any patient with pneumonia symptoms is automatically assumed to have coronavirus, the tomograph is becoming almost the main means of diagnosis.
L.P.: Yes, that is absolutely true. Computed tomography allows earlier and more reliable suspicion of pneumonia and possibly coronavirus-associated pneumonia in individuals than PCR diagnostics. And there are certainly no problems with computed tomography.
BBC: How many tests or scans per day are possible with the CT scanners purchased under your leadership? This is not just a simple smear – it takes about 20 minutes in total to do a scan on a CT scanner… That still does not cover the lack of testing…
L.P.: Epidemic is a natural disaster, do you agree with that? You cannot keep a boat in every house for a possible flood. And a fire engine in every backyard.
BBC: You were talking about Moscow and its hospital equipment. What will happen if the virus spreads to the provinces on such a scale? Will the picture of infection and recovery be different?
L.P.: I can’t say. I have always dealt only with Moscow. I don’t want to comment on everything that happens outside the city.
BBC: Everyone is trying to understand when the epidemic will peak and when the infection curve will plateau. Do you have any thoughts on that?
L.P.: Nobody can predict that. All quarantine measures, including those taken by the Moscow authorities, are very important. But they are designed to slow down the exponential growth. But until there is a vaccine (and whether it will exist is still unknown), until there is a medicine that directly affects the coronavirus, we must understand that the epidemic will stop when almost half of the population is passively immunized, has had the infection to some extent and has developed antibodies. Only then can we talk about reaching the peak and going downhill. Fortunately, 80-85% of the people who contract the infection recover quite easily. They are our best hope.
BBC: Did you get the feeling that the authorities did not take the threat very seriously at first, and that there was a camp of “coronaskpetics” who delayed making tough isolation decisions?
L.P.: I don’t know those people. I know that when the first footage from China appeared, the first to sound the alarm was surprisingly not the doctors, but Mayor Sobyanin, who intuitively felt it. He even convinced me that it was serious. And you have to give him credit for his intuition. As for the “corona skeptics”, I do not consider myself one of them, and I would not consider myself a “corona hysteric” either. In my opinion, the hysteria still exceeds the actual threat.
BBC: And what does that lead to?
L.P.: What can hysteria lead to? Panic. This is a serious problem. Medical professionals start to panic.
They are also human beings with families. They start thinking about themselves, even though they have no right to do so in such a situation. It can undoubtedly begin to affect the functioning of the health care system. Therefore, such hysterical stories and panic can seriously affect the resources of the health system.
BBC: We’re talking to volunteers who are buying masks and protective suits with their own money and delivering them to hospitals, and here’s what they’re hearing from the doctor: “I’m scared for the second time in my life.” It seems that fear is forgivable in such conditions…
Translation:
P.S.: Everyone has the right to be afraid. However, doctors and medical personnel generally do not have the right to show that fear to their patients.
BBC: And yet such behavior suggests that there is already a lack of safeguards? L.P.: I haven’t heard of that. I also communicate with doctors, with the chief physicians of hospitals. As of now, I don’t see any shortage of protective equipment in hospitals.
BBC: You recently said, “The most important thing is that the quarantine is not more harmful than the virus itself”. In what case might that happen? LP: Economists should judge that. If the pandemic and oil prices are so synchronous, it seems to me that the quarantine should make economic sense.
BBC: Russia is following other countries. But in Russia there is an important difference: citizens have very little trust in officials, and there is a widespread feeling that the figures are unreliable and the picture is hidden. From Chernobyl to fires, from floods to mercenaries in Syria and Libya. What do the authorities need to do to win people’s trust, and can it be done now, or is trust something that takes a long time to build? L.P: This is a difficult question for me to answer. I will come back to Moscow. When Sobyanin “digitalized” the city, huge resources were spent on it. And today Moscow is one of the most intelligent cities in the world. Today it costs nothing to check the numbers that exist in Moscow. As for Russia as a whole, trust has to be earned, and it will not come overnight.
BBC: Will the epidemic lead to significant changes in Russian health care? And what are the weakest and strongest aspects that the crisis has already revealed? L.P.: Again, different countries, different economies, different well-being of people. And the problems turned out to be very similar. I was never enthusiastic about the British model of health organization, it reminded me too much of the Soviet one, but the French, Italian, Spanish models – the problems are the same. We shouldn’t be asking how the Russian healthcare system will react. We should ask how the global health system will react. “I think there will be some consequences, but life shows that with God’s help everything will be forgotten after some time and we will wait for the next epidemics. In the 14th century there was the Great Plague, which coincided with a period of cooling, a small ice age. Now there is a warming in Europe, and African mosquitoes can fly to us, especially to the southern regions, and bring with them a lot of infections that will make the coronavirus seem like child’s play to us.