The Russian healthcare system is urgently being adapted to combat coronaviruses. At a meeting of the State Council’s working group on combating Covid-19, the regions were recommended to adapt new buildings of medical institutions with different profiles for infectious departments.
As the Russian service of the BBC found out, Moscow medical institutions are already working under new rules: preventive medical examinations and planned hospitalizations are being canceled. “The user of the site Baby Blog, Alexandra, was planning to give birth in Moscow Maternity Hospital No. 8. “They called in the morning and “delighted” me! The hospital I had a contract with is closed due to quarantine, they are not accepting new [mothers-to-be -BBC], and they have transferred the existing ones to other hospitals,” she wrote in the Baby Blog forum. “I had a contract with a particular doctor who agreed to supervise a vaginal delivery. And now there is confusion about which maternity hospital to go to with such a bouquet and how the delivery will take place. I want to give birth today, if possible”.
The website of Maternity Hospital No. 8 (part of Demikhov City Clinical Hospital) says that it is closed. However, it will continue to operate, but not as a maternity hospital. On March 14, it was announced that the building would be used to house patients with coronavirus. According to the TASS news agency, this proposal was made by doctors and supported by the Moscow Health Department.
On March 20, a meeting of the State Council working group on coronavirus control was held under the chairmanship of Sergei Sobyanin. At the meeting, the Ministry of Health was instructed to fully mobilize all health care systems within 10 days. The regions were advised to take into account Moscow’s experience in reprofiling hospital beds, including adapting new buildings of health institutions of different profiles for infectious departments. According to the order of the Ministry of Health dated March 19, seen by the Russian service of the BBC, federal centers will be created in the country to combat the new virus. New rules for the work of emergency services and regulations for doctors treating patients with acute respiratory viral infections (ARVI) at home will be introduced. Patients with ARVI in polyclinics are planned to be examined through “reception-inspection boxes”. However, preventive check-ups and medical examinations will be suspended, according to the document: doctors will have to “consider the possibility” of postponing scheduled medical care. Patients will be able to receive a prescription for medication remotely and have it delivered to their home. Moscow hospitals are already working under the new rules. The website of the Veresaev hospital states that preventive medical examinations in the outpatient clinic will be cancelled. Access to the hospital and maternity ward for visitors will be limited, and their belongings will be accepted in the halls.
The 81st Hospital has confirmed to the BBC the cancellation of planned hospitalizations. A doctor at City Clinical Hospital No. 29 gave the same information anonymously. Calling the 13th hospital, the answering machine announces the postponement of scheduled hospitalizations. At the 67th hospital, the BBC was told that they initially received a citywide order to cancel scheduled hospitalizations, but it was later revoked and now each medical institution makes the decision independently.
These measures are necessary to protect healthy people by separating them from the sick, as explained by a source in the Moscow Health Department, BBC reported. He added that only planned operations that can be postponed will be cancelled, while urgent ones will continue to be performed. Therefore, it will still be possible to receive chemotherapy and vaccinations. But the focus of medical institutions on coronavirus can harm other patients, like Alexandra, who was not accepted by a re-profiled maternity hospital. Or Natalia, who complained on Facebook about the closure of the Special Hospital No. 45 in Zvenigorod for people with asthma and lung diseases. “Yesterday there were some commissions, and today they announced that the hospital will be closed, and by 12 o’clock all sick people (regardless of the stage of their treatment) must leave the premises,” she worries. “They explained that the hospital will be re-profiled for infectious diseases due to the coronavirus epidemic, but everyone who is treated there, I repeat, is at risk.”
On March 23, a message appeared on the Facebook page of Hospital No. 45 stating that a quarantine had been imposed there: visits to patients were forbidden, and the patients themselves were not allowed to leave the area. However, “scheduled hospitalizations will be carried out on time, according to plan and in full,” the post said.
“This is a useful precaution,” said BBC virologist Anatoly Alstein of the Gamaleya Epidemiology and Microbiology Research Institute. “Of course, sometimes there is an overreaction, but in this case it’s better to err on the side of caution than to fall short.” He agrees that this could harm patients who do not have coronavirus and are not now a priority: “The epidemic has its own laws. This is a catastrophe that does not pass by harmlessly for anyone, and a blow to the economy is worth what”.
In St. Petersburg, the medical community even had to protest against the harsh measures. On March 23, the city’s chief sanitary doctor canceled all planned hospitalizations and outpatient visits until April 30, as well as vaccinations – despite the fact that the Health Ministry’s order only advises governors and chief medical officers to decide for themselves what can and cannot be postponed. The Association of Clinical Research Organizations did not agree with such strict measures. This NGO wrote a letter to the Chief Medical Officer, pointing out that the denial of planned assistance could pose a threat to the lives of patients no less than a coronavirus infection, for example, to oncology patients or patients on hemodialysis. They also reminded participants in clinical trials that if they miss visits to receive an experimental treatment, they will lose a vital innovative therapy that could save their lives. After that, the measures were watered down. On March 26, just three days after the doctor’s decision, the document was amended. Now, if a delay in treatment can lead to a deterioration of the patient’s condition and threaten his life and health, he will still be admitted to the hospital and treated in the outpatient clinic. And those who are undergoing treatment in the day hospital will be allowed to complete it.