Russia is experiencing a record increase in Covid-19 infections. On Wednesday, for the first time since the pandemic began, more than 300 coronavirus patients died in the country in one day. And the day before, the number of newly confirmed cases per day exceeded 16,000 for the first time since the epidemic began.
Moscow hospital No. 52 was reprofiled for the treatment of COVID-19 patients in March 2020 as one of the first in Moscow. Currently, the hospital has 888 beds for COVID-19 patients, including 100 intensive care beds. Almost all of them are occupied. The Russian service of the BBC spoke with the head physician of GKB No. 52, Mariyana Lysenko, about whether the new wave will be more frightening than the previous one, whether doctors have learned how to better deal with the epidemic, and who will suffer most from the disease in the fall of 2020.
BBC: Has the number of patients with Covid-19 increased significantly recently?
Marianna Lysenko: Of course. We currently have an increase of about 30% compared to last year.
BBC: Is there any difference from the first wave in terms of severity or age criteria?
M.L.: I don’t like to call it the second wave – the virus didn’t go anywhere. There was a lull because people went into vacation mode, left Moscow. Everybody went to their dachas. Older people, in general, were not actively socializing. But now all this is over.
We explain quickly, simply, and comprehensively what happened, why it matters, and what’s next. The number of offers should remain: episodes. End of story: Podcast Advertising.
We have an epidemic every year at this time: it depends on the weather, but somewhere around mid-September it is always influenza and acute respiratory infections and so on. Right now it is the coronavirus. This is normal because it is the dominant virus of the season. Everyone is back to work, back from vacation, and all adults have been cleared for movement and communication with family members.
Of course, there is the same imbalance now as there was at the beginning of spring. At that time we received the adult population, who were the first to bear the brunt, they were the first to get actively sick. Then everyone stayed home [for the older generation], it was so quiet. Younger people got sick through contact. Now adults are getting sick again. Of course, they are getting sicker because of the presence of concomitant diseases, age, and so on.
BBC: “Meduza” recently published a large piece, among other things their doctors say that the percentage of young people who have fallen ill has increased (in Meduza’s publication on October 8, a source from the publication in one of the hospitals said: “The trend is such: in the last week we have received young people and they are in a very critical condition”).
M.L.: A lot of young people are getting sick. We thought there would be a clear correlation: any viral infection is dangerous for adults, especially those with underlying health problems. Of course, we expected the same with the coronavirus, but it turned out differently. Currently, the total number of patients is dominated by adults, but it cannot be said that “older” people are significantly sicker than the young because of accompanying somatic conditions. There is a fairly large category of young, healthy people who live healthy lifestyles, take care of themselves, and have never had any illnesses in the past. However, they can suffer very badly from infections, sometimes with tragic consequences. And we cannot always deal with that.
BBC: Can you say that in these seven months you have learned more about this disease and have a better understanding of the logic of its course?
M.L.: In my opinion, we have studied the logic of the disease thoroughly during this time and have learned to deal with it well. Some more time is needed, not for us, but for people who are engaged in serious scientific research.
Right now no sane person can give you a prognosis – this one will be difficult to deal with, while this one will be easy. It is clear that there are somatic factors, some peculiarities. We see some national correlations. This may have something to do with genetics, because small populations – relative to the world – have their own genetic characteristics and diseases that are specific to certain nationalities… Somewhere here there may be some points where genetics and the blood coagulation system are intertwined. But, of course, we have not studied this in detail yet, it is not our job at all, these are just our thoughts on the subject. Our job is to treat. As for the protocols and developments that produce results, we have succeeded and understood them quite well. Everything is already stabilized both organizationally and ideologically. Of course, there are still some new approaches. But now we are dealing with more severely ill patients – categories of patients on mechanical ventilation (Bi-Bi-Ci), on ECMO (extracorporeal membrane oxygenation – Bi-Bi-Ci), who have severe lung damage leading to fibrosis. And this is where we are trying to find some ways and some solutions. In some cases these are very young people and it is incredibly sad to lose them.
HI BBC: I just wanted to ask, have the treatment recommendations changed?
M.L.: The recommendations change regularly. In fact, no recommendations have ever changed so dynamically, and that’s a good thing. Everyone rolls their eyes and says: “Oh my God, there’s already the 12th version…” But that’s normal: the infection appeared at the beginning of this year, if we don’t count China. The fact that we find solutions and publish them immediately, implement them and discuss them with colleagues is absolutely great.
BBC: How much freedom do doctors have in choosing treatments? Is there an approved protocol and can they deviate from it?
M.L.: Yes, it is possible! A doctor can always deviate from a treatment plan if there is good reason to do so. There are no absolute dogmas in any disease, including Covid-19. However, it should be noted that there are established treatment protocols that we share and approve in the clinical committee. These protocols are either recommended or optional, but they provide a framework for individuals who lack personal experience or have limited medical experience to navigate the nuances. So everything else is the doctor’s right, the doctor’s choice. It only needs to be justified and, considering that some drugs are off-label (when the drug is used differently than indicated in the instructions – BBC), it should be appropriately confirmed by the Council.
BBC: In Russia there are three drugs registered for the treatment of coronavirus – all belong to the international non-patented name favipiravir. Do you use them?
M.L.: We use one of the drugs called favipiravir.
BBC: There have been a lot of concerns about these drugs because the general knowledge is that it is based on a Japanese source and has some potentially dangerous consequences. Is it really dangerous?
M.L.: Considering that we just started living together, no one can talk about such serious, long-term consequences. Of course, the drug has been tested, in all phases. And all that is happening is exactly a teratogenic effect (i.e. a possible disruption of fetal development due to the mother taking medication – BBC). Therefore, we must be very careful when prescribing this drug to women of reproductive age. Other treatment options can also be used and they will also be effective.
BBC: How do patients respond to the drug? Have many of them used it?
M.L.: The drugs work very well in the early stages of the disease. However, we are the first level, and the first level hospital takes the most severe patients or transfers patients from other clinics that for some reason cannot handle the severity of these patients.
BBC: So these are the ones who have already missed the initial stage?
M.L.: Most of the time these patients are already very sick. [But] the virus is not infinite, sooner or later it becomes ineffective in the body itself. That’s why all the scary things happen against the background of carrying this virus – cytokine reactions, lung damage, damage to the coagulation system… Then there are consequences and we treat the consequences because the virus is not as active. That’s why in some cases this drug just doesn’t make sense. Every therapy has a certain window of opportunity. Of course, the ideal is to hit the right window and then you get an effect.
BBC: Am I right in understanding that there has been an overall change in the approach to when to hospitalize a person? And are more people getting sick at home than in the spring?
M.L.: Actually, we made a quick decision about routing. And we realized very early on that if we took everybody with a positive PCR test and no symptoms or a mild form to the hospital, the hospitals would run out of space very quickly, and people would continue to get sick. And then we would be treating [people] in tents and schools and auditoriums. There is nothing scarier in medicine because it is a war in a way, but it still happens in peacetime. And this inability to provide proper help in the 21st century is a very frightening choice for doctors, nurses. So the fact that we have moved, at least in Moscow, to monitoring mild and asymptomatic patients through telemedicine, through teams that have gone out and consulted with these patients, has greatly shifted the focus to those who really need help at the hospital level. Considering that all this was new, everything was just being set up, there were some imbalances somewhere, but now there are none – there are enough beds, and temporary hospitals have been opened to avoid damage to specialized care.
BBC: Have you come across cases of reinfection?
M.L.: No, we have not encountered cases of true reinfection. But we have categories of patients – those who receive high-dose chemotherapy for certain diseases, patients with primary or secondary immunodeficiency, severe patients with systemic diseases who receive immunosuppressive therapy, which is severe and serious. They have a problem, but it is related to any viral infection: these patients do not produce antibodies against any virus – not against COVID, not against influenza, not against herpes, and so on. The virus is alive, well, maybe it is slightly suppressed by drugs and therapy. As soon as the patient is in a situation of repetition of either chemotherapy or some other treatment, the virus is activated again, starts to revive and causes some manifestations. This is what we have seen.
BBC: Maybe I’m asking a stupid question. How do you know it’s the same virus and not a new one?
M.L.: Because we understand the mechanisms of the appearance of these recurrent clinical phenomena: a person’s immune system is completely suppressed. How do we defeat the virus? Through the antibodies that recognize it and kill it. If we suppress the production of everything that the immune system consciously produces in order to save ourselves from another disease, then there is nothing to do with it, simply nothing. Then some time goes by after chemotherapy. Of course, the immune response starts to grow and develop at least a little bit of an antibody response. And then there is the treatment. The virus subsides. Then we do the chemotherapy again and the virus can become active again. This is not always the case and not for everyone. But, for example, there are people with primary immunodeficiency – unfortunately there is such an orphan disease, very rare. They simply do not develop antibodies and it is absolutely irrelevant what they are sick with: measles or COVID-19 virus and so on. If this patient has a herpes virus, for example, it progresses differently and sometimes very severely – we treat him with certain medications. As long as you give the medication, everything is fine. The drugs are stopped and the person has nothing to deal with.
BBC: So does that mean he has coronavirus forever?
M.L.: No, it will eventually die in the body if the patient is treated, but it will be too late, not too early. And secondly, about the possibility of relapses caused by the patient’s own virus, sleeping somewhere, or by the fact that the patient has encountered it again somewhere – we cannot say right now [how it works], there are very few observations, these are limited groups. Ultimately, we will probably be able to answer that one day.
Everything related to the study of coronavirus infection is a path into the distant future. The virus has just appeared, and we will be studying it for a long time. We know nothing about it now, except that we have learned how to mitigate its frighteningly deadly manifestations. Time will tell what will happen next. How effective is immunity against it, for how long and in what way. The whole story takes 7-9 months. Nine months are like pregnancy. We are just at the beginning of the journey, just giving birth.
BBC: How did your doctors deal with those seven months? Are there any psychological conclusions? It is understandable that this is a huge burden, especially at the peak. Was there any turnover, maybe someone couldn’t take it and left?
M.L.: Our people left at the very beginning. I mean the medical staff. When we talk about the medical team, three people left at the very beginning. But they were people who were either new or part-time. They got scared. It was their right. The whole team that has been working in the hospital for a long time, both nurses and doctors, stayed, everybody is working. Maybe psychological help would have been helpful in this situation. But we didn’t really have time for that. And secondly, the team has been working together for a long time, they are young enough and used to relying on each other. Perhaps this sense of support prevented a psycho-emotional breakdown that could have occurred in this situation. Yes, everyone was scared, but no one had a panicky fear, horror, or desire to leave the facility quickly.
BBC: And how many people have recovered?
M.L.: We probably had about 40% of the entire staff get sick. Of course, they didn’t all get it at once, and some got it here, some got it at home, and some got it in transit. But we hardly had any serious cases, thank God. A lot of people went through it asymptomatically, and that was discovered later when [tests for] antibodies came out and we started getting tested.
We’re tested every week, but this analysis didn’t appear right from the beginning. And when the IFA diagnostics came out, to our surprise, it was discovered that people had antibodies. You know, when there is intense emotional work, quite tense and especially unfamiliar, if you feel a little bit choked in your throat, no one will pay attention to it during such work. But then the antibodies come. We really had colleagues who were seriously ill. Thank God, almost all of them recovered. We have a tragic story with our medical sister that we lost. But that is the only loss, and we are living with it now.
BBC: How are you doing with vaccinations? M.L.: With the vaccine, we are currently in the third phase of post-approval clinical trials.
BBC: Do many people participate? M.L.: A lot of people participate with us, but [some of the employees] have not yet realized their participation due to the fact that we had a flu shot. We all get flu shots, all the medical staff, every year at the right time. The next vaccination should be scheduled for the month following the previous one. More than a hundred people somewhere have participated in the [coronavirus vaccine] research. Some people are finishing the 30-day interval from the time they got the flu shot. Therefore, we will now have a greater increase in volunteers.
BBC: And how do you feel, have there been any manifestations for anyone… M.L.: Well, I was vaccinated, I feel absolutely fine after the vaccination, and I didn’t have any side effects during the vaccination. Some people had a fever, some aches and pains – this is very common after flu shots, it all depends on the reactivity of the immune system. Now that the vaccine is in circulation, I think we will all be vaccinated. What the positive experience of dealing with COVID-19 gives us is the understanding that we should not neglect sanitary and epidemiological measures that annoy everyone, even doctors. This is a story that we cannot get into our heads and we consider it an attack on our rights, our individuality. When we live in society, sometimes we have to think about someone else.
Here’s a way to sneeze and cough into the environment… It’s not about COVID. This happens every fall and winter. And in public transportation there are people who are sick and infect others. And no one knows if these people will survive or not, because they can grow up, they can have serious diseases, with transplanted organs. For them, acute respiratory viral infection can be fatal. Viral pneumonia can be caused by a common respiratory virus, various forms of influenza. But we never think about it. One person does a heroic act – he goes to work. He’s sick, but he doesn’t really care what happens to other people who are completely innocent, they just have to go. If such an attitude towards others can change COVID, then it will be good, despite all the tragedies, because we are losing and fighting for a large number of patients, also because of this. The summer with COVID showed our absolute unpreparedness for independent decisions. As soon as they said “well, let’s go on living”… Well, “living” doesn’t mean getting completely naked and running around in public, does it? For some reason, democracy in our country is perceived as permissiveness or chaos. They ask us to keep social distance, to wear masks, especially in public places – and we will be able to live with it normally, visit theaters, cinemas, but under certain conditions. The virus has not gone away. Until there is a total immunological layer of about 60-70 percent, which will be achieved through vaccination, it will not go away and this chain of transmission will not be broken. We are starting all over again. We really feel like Groundhog Day. That is all that has happened. We appealed, we begged. [In the spring, we were in a situation where] you don’t know what it is, you have to figure out how to give proper help right now and here. And when we see people going beyond the fence during the quarantine, this life beyond the fence irritates us, because we know they will come here later. And the fact that now adults are getting sick, and even people who, unfortunately, can end their lives in the fight against COVID, in this, among other things, the fault lies more with younger people who didn’t think that maybe it’s not worth hugging and kissing so actively if you work in a place where there are a lot of people.
BBC: Do you see a change in people’s consciousness that they have to wear masks again and stop coughing in the subway? M.L.: Well, probably yes, because some strict measures were taken. Before this started, everyone successfully took off their masks or wore them as a scarf, in their pocket, and got irritated when they were criticized. The same goes for the shops. Maybe things have gotten stricter now, and people just don’t do it because they don’t like people coming up to them and pointing out their mistakes. But overall, I think the situation is generally worse now. It is clear that no one wants a quarantine. And everyone understands that it may be an excessive measure. It was effective, it was successful, and it gave us the opportunity to solve something and not to suffocate in the provision of medical care. We would have gotten what our colleagues have gotten in Spain, in Italy, where they have experienced an absolutely monstrous overload – and not so much related to the fact that there were few of them, but to the fact that they simply lost patients that they had to choose between. That’s terrible. There is nothing more terrifying for a doctor. But at the same time we understand that there is an economy, there is a state, there are people, there is life in general. It is impossible to stop all this, it has to continue somehow. So, of course, I would like the attention to be more focused on what is being asked, and people still need to realize what they are doing. That they are not asked to wear a mask just for the sake of wearing it, and that this mask is worn in their pocket for two weeks, and it is no longer a mask, it is just a source of infection; that they have listened to what is being suggested, how it needs to be worn, that it needs to be changed every two hours, and so on.
BBC: As a doctor, would you like to introduce a quarantine on the same principle as in the spring, to get some rest? M.L.: We don’t need a break. We have enough of everything, we have everything we need. Maybe we want this whole story to end. We want to go back to normal practice, treating patients according to our professions. We want to be surgeons, gynecologists, nephrologists, hematologists. Right now we are all dealing with the same disease. But if we talk about the fact that there is a need to introduce and stop strict quarantine measures now – there is no such wave. There is normal work with normal capacity, and it does not require any stoic effort at all, when everything is clear, worked out, and the working environment is quite functional.
BBC: You said no one can make predictions, but I’ll try. Maybe fall will be scarier than spring? M.L.: In terms of volume? BBC: By volume, by severity, by number of fatalities. M.L.: I don’t think it will be like that. It’s hard for me to speak on behalf of the Russian Federation, I can only speak about the institution entrusted to me. I don’t think that the number of results, including deaths, will be the same as in the spring, because we know what to do, how to do it, who should do it, and everything is being done. Unfortunately, fatal outcomes are inevitable in medicine, and have always been, whether it’s infections, non-infections, or diseases. Unfortunately, nurses and doctors are not gods. But it is certain that the therapeutic results will be better because there are protocols, understanding, approaches, and drugs. Everything is already there.
