Forty volunteers, mostly students from Moscow universities, haven’t seen their families and friends for several months, live in rented apartments, and spend eight hours a day in “COVID” hospital laboratories. They are taking part in a large-scale blood study organized by 74-year-old Professor Fazil Ataullakhanov that could help save the lives of thousands of coronavirus patients.
Ivan Fedorov, an intern at the Skolkovo Institute of Science and Technology, recently tried to explain to a taxi driver that working in a coronavirus hospital laboratory is not as scary as it seems. I told him it was more dangerous to take a taxi now. And him? He looked skeptical and said nothing.
Ivan and four dozen other volunteers, mostly students, are taking part in a large-scale study of the blood of people infected with the coronavirus. Every day, as if they were going to work, senior students from Moscow State University, postgraduates from the Skolkovo Institute of Science and Technology (Skoltech), and medical school graduates go to the laboratories of eleven Moscow hospitals, where they are carefully called “covidiaries”. Many of them have not seen family and friends since April – this is a mandatory condition. They are also instructed to minimize other social contacts. Therefore, the students live in rented apartments near the hospitals, walk to the laboratories and back. They are provided with food in the hospitals and an additional 500 rubles per person per day for food – students prefer delivery.
All the participants in the study interviewed by the Russian service of the BBC have almost the same motivation. “It’s impossible to sit idly by when something like this happens.” “My grandchildren will ask me later: ‘Grandma, what did you do during the pandemic? I’ll have to have something to say.” “When you have the opportunity to be part of a great cause and help people, it’s always nice.
COVID-19: New Blood – How young scientists are saving humanity from the coronavirus. Each volunteer spends eight hours a day in the lab. Hospital nurses draw blood from patients for research purposes, insert plastic tubes into the ports, and volunteers collect them and begin the research.
“The main problem is that too many test tubes arrive in the morning, so it’s hard work,” says 20-year-old medical student Alexey Chernov. Each patient’s blood is tested several times – immediately upon admission, before blood-thinning medication is administered, and twice during treatment.
“We spin the test tubes in the centrifuge and collect the plasma. We observe how quickly and how strongly a particular patient’s plasma coagulates. In perspective, this provides a collection of material and the opportunity to see which anticoagulant therapy works better and which works worse,” Chernov explains. One of the most dangerous complications of coronavirus infection is associated with impaired blood clotting: blood clots in damaged blood vessels, leading to thrombosis, often resulting in death. The process can be reversed with anticoagulants, but it is important to identify the threat as early as possible.
The organizer and the main ideologist of the research, in which Moscow students participate, has been trying to solve this problem for over 25 years. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: Episodes The end of the story: Promotional Podcasts. Thrombosis is similar to a forest fire – the same pattern of spread, says 74-year-old Fazoyl Ataullahhan. He is a biophysicist and professor at Moscow State University and the University of Pennsylvania. His friends call him simply “Fazli. To combat “fire,” Ataullahanov and his colleagues have developed a blood coagulation test called “Thrombodinamics” that can detect coagulation disorders and help doctors determine the dosage of anticoagulants.
From the perspective of the test, it looks simple. A cuvette of blood plasma is inserted into a small rectangular box, and a test system – a special coating with a clotting activator (tissue factor) that mimics a damaged blood vessel wall – is also placed inside. The plasma interacts with the coagulation activator, and if something goes wrong with the blood, within half an hour you can see a clot growing in the artificial “vessel” on the screen of the computer connected to the device.
There are dozens of blood coagulation tests in the world. However, Ataullakhanov insists that it is his method that allows to detect blood coagulation disorders with very high accuracy at all stages – before, during and after thrombosis. Fazli was able to convince the state corporation “RUSNANO”, which in 2010 became the main investor in “Thrombodynamics” and invested several hundred million rubles in the project in 2010-2013. Since 2010, the company “Hemacor” has been producing tests and instruments called “Thrombodinamics” – initially the company was founded by Ataullakhanov and his associates, then “Rusnano” became its investor and co-owner, as well as the companies “Sberbank-Capital” and “VEB-Capital”. They invested in exchange for large shares in Hemacor. According to the Rosnano website, a total of 1.09 billion roubles have been invested in the project, of which 880 million roubles have been invested by the state corporation. Currently, the state corporation owns 80.8% of the project, while the remaining percentage belongs to companies affiliated with state banks.
But the business did not succeed: although from 2011 to 2018 (there are no more recent data) “Gemakor” revenue increased almost 25 times to 50 million rubles, the company has always been unprofitable. Thus, in 2018, the net loss of “Gemakor” was slightly less than the revenue – 40.4 million rubles. “We released the devices, started selling them, but they sold poorly. In 2013, “Rusnano” allocated us the last forty million rubles – they understood that we wouldn’t make any profit. I have to say, I am quite a businessman,” Ataullakhanov explains. According to the information in SPARK, throughout its history “Gemakor” has sold only a few devices called “Diagnostic Laboratory System “Thrombodynamics Recorder” (costing about 1 million rubles) to medical institutions, and has concluded several dozen contracts for the supply of consumables for blood research.
The head of “Gemakor”, Ilya Spiridonov, says that the devices were mostly purchased by private companies, and a total of 200 have been sold since its existence. According to the medical publication Vademecum in 2017, the buyers of “Gemacor” products were the Center for Theoretical Problems of Physico-Chemical Pharmacology (CTP PH) of the Russian Academy of Sciences, headed by Ataulakhanov, and the Dmitry Rogachev Center for Pediatric Hematology, Oncology, and Immunology, where Fazli was the head of the department. In an interview with Vademecum, Ataullakhanov expressed his frustration with the crisis and reorganization of Russian medicine and hoped that the founders of “Hemacor” would be able to keep their shares in the company. This did not happen: in 2017, “Rusnano” bought out the remaining shares of Fazli and his partners.
The large-scale clinical studies on blood coagulation that Ataullakhanov dreamed of were not conducted at Hemacore: “There was nothing, it just somehow existed without me.” “We are generally satisfied with the technology that our colleagues at “Hemakor” are developing,” said Yuri Udaltsov, a member of the “Rusnano” board of directors who has overseen the company since 2014. “Perhaps we underestimated the difficulty of entering the market, and as investors we are not very satisfied with how long it takes to enter the market – we wanted it to happen earlier and faster. However, objectively speaking, technologies in medicine progress very, very slowly, both for subjective and objective reasons,” Udal’tsov concluded.
Another project involving the same “Rusnano” and Fazli’s nephew, Rustam Ataullakhanov, ended very badly. The state corporation was supposed to invest up to 1.3 billion rubles in the company “NTPharma”, which planned to build a plant for the production of vaccines and other medicines. But the factory was never built, and in 2016 the Investigative Committee opened a criminal case against the managers of “NTFarm” for embezzlement of 424 million rubles. In January 2020, the founder of the company, Rustam Ataullakhanov, was sentenced to eight years in prison (he was also accused of laundering money obtained by criminal means), and the former CEO of the company was sentenced to five years.
The relationship between Fazli and “Rusnano” does not seem to have been spoiled by all these stories. After all, it was “Rusnano” through the “National Association of Experts in Primary Immunodeficiency” (NAEPID) that allocated a total of 6 million rubles to Ataullakhanov for new research on blood coagulation in 2020 – this money was used to rent apartments and protective suits for volunteers. The new coronavirus in Russia gave new hope to the old project. “When the virus appeared in China, and there was no virus in Russia, I had a hypothesis that thrombosis played a decisive role in this pathology. Doctors later saw that the coronavirus quickly clogged the lungs with blood clots, leading to respiratory failure,” Ataullakhanov explains.
With this thought in mind, he went to his former student, the head of “Hemakor” Ilya Spiridonov, and told him that it was necessary to stop all work now and “fight for survival”. Spiridonov recalls that he was skeptical about the teacher’s words – in early spring, the situation with the new virus did not seem so frightening. However, having grown accustomed to trusting Fazli’s scientific intuition, Spiridonov allocated 40 “Thrombodinamics” devices and 10 thousand test systems to the project.
In late April, Ataullohanov posted an open letter on the Internet. “I am looking for volunteers who are willing to participate in a multicenter study on blood clotting in patients suffering from COVID-19. The goal of the study is to develop a new treatment protocol for patients that will prevent their condition from worsening,” Fazli wrote. Volunteers had to meet several criteria: be no older than 35, have no chronic illnesses, and preferably have a chemical, biological, or medical education. The group was promised training in “thrombodinamics” and blood work, provided with protective equipment, and sent to work in clinics for coronavirus patients.
Ataullakhanov admits that many people told him that such research should not be initiated, asked how he would ensure the safety of the volunteers, and stated that the whole endeavor “goes beyond all reasonable limits. “I was very worried about the volunteers getting infected in the hospital – it was under my control and I could protect them. But if a person commutes to work by metro, if they live at home and one of their relatives gets sick, it would be a pity not only for the volunteer but also for the laboratory where they bring the infection. One clinic will be excluded from the study,” says Ataullahankhan. Therefore, it was decided to accommodate the volunteers in rented apartments near the hospitals – mostly in pairs.
Alexey Martyanov “There are people who refuse to rent their apartments to volunteers working with the coronavirus. Others say, ‘Oh, that’s great, I’ll give you a discount. There were people who outright refused to house our two girls, but when I explained that they were actually helping people, they apologized and offered a 15% discount. The first volunteers responded within hours of the open letter’s publication. Ataullokhans personally asked each of them if they were ready for all the risks and several months of self-isolation from friends and family. As a result, forty volunteers were selected, many of them seniors. When Alexey Chernov told his parents that he was going to volunteer and work with infected blood, they were horrified. “My mother was worried – working with biological fluids, the risk of infection was much higher. I told them I had made a decision, and my father said I had done the right thing,” he recalls.
Alexey says he will not regret taking part in the study, even if he is infected with coronavirus: “I’ll get through it, there’s nothing scary for my age. I’m 21 years old, I try to stay in shape even during quarantine. I’m willing to take the risk. Fifth-year medical student Daria Kopnenkova combines research work with nursing shifts at a hospital in Kommunarka. When Dasha went to her first shift, her friend’s father was brought to her ward. “Imagine, yesterday my friend and I were sitting, drinking coffee, laughing, and the next day she says – oh, I have a fever. They took her whole family to the hospital, and her father was admitted to my ward. Well, they all recovered. Kopnenkova herself is no longer afraid of getting sick because she doesn’t want to be afraid anymore: “If they ask me in 20 years – ‘Dash, how was it, you were in the epicenter,’ I don’t want to tell them that during that time I was sitting in quarantine next to the refrigerator, trembling with fear.”
The most difficult experience was the death of the first patient, recalls Dasha: the person came to the ward on his own feet and “burned out” within a few days. “I cried a lot afterwards. I go through the sick people myself – you see them, walking around at night, measuring their saturation every two hours. I still can’t get rid of myself: the patients don’t have the pills for their chronic diseases that they usually take, and there are no relatives, and I’m ready to run to buy these pills for them, just so they can take them.
It’s one thing to study at a university for five years, taking exams and doing internships, and it’s quite another to take part in real research, says Polina Laryonova, a 22-year-old chemistry student at Moscow State University (MGU) who works at the same Kommunarka facility. “Here you understand that it is scary to make a mistake, that there is a real person behind every analysis.” Polina recalls a 97-year-old veteran: “He had a bullet wound in his medical records, which he received during the Great Patriotic War. We were very worried about him, but he managed to recover. “There was another couple whose blood was often sent for testing,” says Polina. “At first their test results were bad, then they seemed to improve, but their blood continued to be sent. We thought, when will they be released? He was released, but she died unexpectedly. Some patients stay in the hospital for 30 days, and the lab assistants involuntarily start monitoring their condition. “When patients’ condition deteriorates, it’s difficult – at first I was worried that I wasn’t in the ward next to them, that I couldn’t do anything. Now, when the patient gets better, I unconsciously thank the nurses and doctors,” says 22-year-old Daria Morozova, a 5th year student at the MGU Faculty of Basic Medicine.
Another difficult part of participating in research is the self-isolation, says Daria. “I understand even more now how much I love to hug people. I keep thinking about what it will be like when I can hug my family, hug friends that I only see through Zoom. When I go out, I’ll just hug people, I won’t need anything else. Thromboembolic complications were the cause of death in 15% of patients participating in the study, says Dr. Alexandra Pisaryuk of Hospital No. 64. Similar data can be found in the atlas “Pathological Anatomy of COVID-19” published by the Moscow Health Department in May.
At the 64th hospital, 300 patients are currently being treated for coronavirus: “We see that such patients often develop thrombosis. One of the current hypotheses is that thrombosis is the pathogenesis of the disease,” says Pisaryuk. All patients admitted to Moscow clinics with a diagnosis of coronavirus immediately receive a therapeutic dose of anticoagulants – usually low-molecular-weight heparin. During the pandemic, doctors began administering this drug to patients even before the Ministry of Health included anticoagulants in the list of mandatory drugs for coronavirus treatment. According to Elena Vasilieva, chief physician of the City Clinical Hospital No. 23, since the end of March, when it became clear that thrombotic complications play a crucial role in the course of Covid-19, most patients diagnosed with coronavirus in Moscow hospitals began to receive anticoagulants, mostly low-molecular-weight heparins, in therapeutic doses.
“In the most severe patients, often in intensive care units, unfractionated heparin was often used. I think this led to a significant reduction in thrombosis among Covid-19 patients in Moscow,” says Vasilyeva. “In our clinic, the incidence of venous thrombosis did not exceed 17%, compared to the usual rate of about 70% in patients without anticoagulants, according to literature data.” The goal of Ataulakhanov’s research is to calculate an individualized dose for each patient, whereas hospitals typically follow an averaged protocol, explains Alexandra Pisaryuk.
“It is not the case that all patients respond to anticoagulants in the same way. Recently, doctors have come to the conclusion that general recommendations do not always work, and that patients need an individualized approach. Fazli’s study can be very helpful in this regard, and it is the first of its kind in the world,” says Pisaryuk. “A large-scale study of hemostasis organized by Fazli Avtullahanov in Moscow in several clinics may provide new approaches to the treatment of hypercoagulation in these patients. The method he developed for comprehensive assessment of thrombus formation may be the most accurate for such selection,” says Vasilieva. However, more research is needed before specific practical recommendations can be made, she adds.
“I am very much looking forward to the results of this study – I am skeptical by nature, but I am ready to consider a different point of view,” says Professor Dmitry Zatyezhnikov, Head of the Primary Vascular Department at City Clinical Hospital No. 51. “There is an important point – in our country, inventors are often unwilling to test their inventions the way they should be tested. And that automatically creates mistrust. And if someone is ready to test his invention properly, that is a big plus,” the professor concludes.
The entire family of 21-year-old Skoltech postgraduate student Anastasia Gorshkova is involved in the fight against the coronavirus: “I come from Chelyabinsk, from a family of doctors. My parents worked in the hospital and waited for me to follow their example. Gorshkova wears a protective suit even during Zoom conferences with teachers – she doesn’t have time to change after work. She works in the laboratory of the academic hospital in Troitsk – about thirty to forty blood samples come in every day. The whole world is now one big laboratory, and people are the subject of research, Anastasia believes: “This is happening a bit against our will, so I prefer not to think about the fact that we are at the forefront and pushing science forward.”
Asya Kazantseva, a science journalist and writer, worked in the same laboratory and is also involved in the research. “It should take no more than an hour from the time the blood is drawn from the patient’s vein to the time it is spun in the centrifuge. And you have to mark where each patient’s sample is without mixing them up. When 30 tubes come at once, it is like playing a high-level game of Tetris – only all the shapes are infected,” Kazantseva says.
Asya Kazantseva When the pandemic began, Asya was studying for a master’s degree in molecular biology in Bristol, England: “Then everything switched to distance learning and I was forced to come back. It was frustrating, especially since I had just started a romance in Bristol. That’s why Kazantseva has “personal scores” with the coronavirus, and she’s using all her skills to fight “this damned creature” by participating in the Ataullakhanov project. According to her, the first phase of the study has already been completed – more than a thousand patients participated in it. “We have collected enough statistics to be able to say that increased blood clotting in a patient is associated with a more severe course of the disease”. “In addition, it is possible to predict an unfavorable prognosis based on the clotting rate even before symptoms appear. This is perhaps the most important thing,” says Asya. Kazantseva worked in the laboratories of the City Clinical Hospital No. 51 and the Troitsk Academic Clinic. Currently, she is processing the data of study participants for the second phase of the study at the RZD Scientific and Clinical Center. However, it is unclear how the second phase will proceed – recently, Asya posted on Facebook that the funds for the research have run out.
“When we started working, it became clear almost immediately that we were right. We now know that 80-85% of patients who come to the clinic have increased blood clotting. It became clear that a larger sample of patients was needed for a more convincing study. The number of hospitals increased and we went into debt,” Ataullahanov explains. “Rusnano” initially allocated 4 million rubles, then covered a debt of 2 million rubles that arose due to the expansion of the research scale, but whether the corporation will allocate money for the second stage is still unclear. “I am not competent enough to comment on the course of the research – I do not see any data now, and I will see them when the data are processed and the results are presented,” says Udal’tsov, a member of the Rosnano Board. But he adds that he is “happy that they are doing this research in principle” and that the topic is very well chosen: “We hope that the sales of “Trombodinamika” will increase if the research is successful.” Udaltsov said that Rosnano will continue to support Gemacor, but he “does not know the answer” to the question of whether the state corporation will finance Fazli’s new research or attract investors. Money is needed for the second phase of the research, in which it is planned to calculate the dose of anticoagulants individually for each patient. Ataullakhanov does not yet know where he will get the money. “I was asked this question when I started the first phase: ‘What if you don’t raise enough money for the first phase? I will think of something, I cannot not do it,” says the scientist passionately. Now, due to the fact that some clinics that were temporarily reprofiled during the pandemic have closed their COVID-19 departments, four hospitals remained in the study – the Academic Hospital in Troitsk, Kommunarka, Hospital 52, and the Scientific Clinical Center of the Russian Railways. To keep the project going, the organizers announced a crowdfunding campaign to raise 3.5 million rubles. Within the first ten days, they managed to raise 1.1 million. But new volunteers are also needed. “The work at the checkpoints is difficult – I had to work in the defense, it’s very hard. Eight hours, everything gets foggy, you get tired – then you remember doctors who work 12 hours in the defense and you realize that you’re generally okay,” said volunteer coordinator Alexey Martynov. The organizers of the study try to make sure that volunteers work on the project for no more than two months, he says: “Then two weeks of quarantine, and then you can go. But the majority of volunteers do not want to leave and are now desperately hoping that it will be possible to raise money for a new stage of research. “If a person wants to continue, we do not refuse. And 70% do not want to leave, they want to stay,” says Martynov.
“It is difficult to combine exams with work, but the teachers understand my situation,” says 20-year-old MSU student Evgenia Belousova, who has been working on the project since May. “At first my parents tried to dissuade me, then they continued to worry quietly, with poorly concealed pride.”