“The coronavirus will decline by August, and then the second wave”

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Today, due to the lack of personal protective equipment in the country, more than 300 doctors have already died from coronavirus. How did it happen?

The main reason for the problems with medicine is its total underfunding, the open poverty of state medical institutions, and the authorities did not even think about the possibility of epidemics requiring a mobilization regime of medicine, so COVID-19 fell headlong. However, Professor Altstein reassures, the worst is over: Russia has finally reached a plateau of morbidity, and the virus is mutating towards harmlessness, so the second wave will not be too dangerous.

The production of Russian respirators, protective suits and medical gloves cannot fully cover the need for these products. The production of Russian respirators, protective suits and medical gloves cannot fully cover the need for these products.

“HOW CAN THE RUSSIAN MEDICINE BE BROUGHT TO SUCH CONDITION? ..”

The other day, a group of doctors, medical experts and heads of charity foundations sent Deputy Prime Minister Tatyana Golikova and Health Minister Mikhail Murashko a letter in which they drew attention to organizational and resource problems in medical institutions. Particular attention in the letter was drawn to the existing shortage of personal protective equipment for doctors in hospitals.

This appeal was signed by 28 activists, including doctors Yaroslav Ashikhmin and Pavel Brand, president of the Association of Personal Protective Equipment Manufacturers Vladimir Kotov, director of the Institute of Health Economics at the Higher School of Economics HSE Larisa Popovich, president of the Volunteers for Orphans Charitable Foundation Elena Alshanskaya, Ekaterina Shergova, director of the Foundation for Assistance to Children with Oncohematological and Other Diseases “Give Life” and Aleksey Maschan, Corresponding Member of the Russian Academy of Sciences.

The basis for such a letter was the results of an interview conducted by the above experts with managers and ordinary employees of 30 medical organizations in 12 regions of the country, as well as an anonymous survey of 84 health workers from 24 regions of Russia and an analysis of appeals to charitable foundations.

As a result of these measures, it turned out that, firstly, in almost half (49%) of cases, medical organizations do not use a clear algorithm for calculating the needs of employees in personal protective equipment. Such an algorithm is also not spelled out in the latest version of temporary methodological recommendations of the Ministry of Health.

Secondly, the requirements for remedies for institutions redesigned for coronavirus and those that accept patients with other potentially coronavirus diagnoses are not divorced. As a result, experts say, the vast majority of heads of medical institutions are deprived of the opportunity to clearly calculate the need for remedies.

According to experts, the production of Russian respirators, protective suits and medical gloves cannot fully cover the need for these products. The need for respirators was satisfied by 27%, gloves – by 17%, and the domestic production of antiplague suits suits the needs of hospitals by only 11%. However, they argue that the vast majority of hospital workers surveyed are frankly afraid to speak openly about the problem of a lack of personal protective equipment.

“The situation is also aggravated by the ban on the dissemination of false information in the Code of Administrative Offenses, used to limit the statements on the subject of COVID-19, which only strengthens the atmosphere of fear and forces the transfer of information to open sources anonymously and through third parties, which leads to distortion of information,” he quotes an excerpt from treatment, in particular, RBC.

It is imperative, the authors of the appeal claim, to solve the problem of the lack of personal protective equipment for physicians before the second wave of coronavirus, which is expected this fall.

And in their words they see not just a specific reason, but a reinforced concrete resonator – to date, more than 300 doctors have died from coronavirus due to a lack of personal protective equipment. And the list of victims continues to grow.

“How could Russian medicine be brought to a state where doctors who were called upon to save people from fatal diseases themselves had to beg officials to save if the coronavirus pandemic began to embrace the world last year?” Asked the joint venture and addressed for a response to our own experts.

“THE FEDERAL CENTER LATER RECOGNIZED ALL THE SERIOUSNESS OF THE SITUATION”

“Recently, the situation with the provision of personal protective equipment to physicians has, of course, improved somewhat,” said Andrei Konoval, co-chair and secretary of the Inter-regional Health Workers’ Union “Action”. – However, not least of all this happened because the doctors themselves did not hide the problems and raised this issue, often at the risk of not only their relationships with the bosses, but even the workplace itself.

– That is, what, the problem, it turns out, resolved by itself, and the doctors really became “all right”?

– From the regions, there are still a lot of complaints about the lack of personal protective equipment among doctors. For example, from Dagestan. Let them, of course, and noticeably less than, say, a month and a half ago, but nevertheless the situation is actually far from ideal. So the experts’ concerns are well founded, and their letter to the ministers asking them to take appropriate measures is quite appropriate. In my opinion, there is nothing wrong with it, and the Ministry of Health should not react to it and talk about some achievements, because achievements do not remove the presence of problems in the healthcare sector or the likelihood of their recurrence in the future.

– What, in your opinion, are the main reasons for the emergence of this problem, because of which, sadly, dozens and hundreds of Russian doctors?

– There are several reasons, and one of the main ones is the total underfunding of healthcare and the open poverty of state medical institutions. After all, the point here is not simply the absence of specific masks, gloves and costumes against the background of a specific coronavirus infection, but the fact that people, for example, have not been given work clothes for years, and if they are given, they are of the wrong quality, of the wrong size or not at all by season.

Because of this underfunding, the administration of state institutions constantly has a difficult choice – either to direct the available money to maintain the level of salaries so that the latest specialists do not run away, or to buy medicines, or to carry out ongoing repairs of equipment, or to purchase masks with dressing gowns, or pay off debt.

– And where are the payables from state hospitals? For what?

– For example, for the same utilities. Moreover, this debt can reach tens, or even hundreds of millions of rubles. This is quite common. I’m not talking about the fact that some medical institutions now justify the reduction in the provision of incentive payments to physicians working with coeval patients with the fact that this money was spent on the purchase of personal protective equipment.

– Does everything rest only in the absence of proper funding, or are there any other serious reasons for this problem?

– There is still a problem of strategic, if you like, unpredictability of occurrence of situations like today. The organizers of the current health care system are unaware of the likelihood that a difficult epidemiological situation may one day arise, or of the fact that in this case it is necessary to create strategic reserves of protective equipment.

Of course, in a sense, this is a new challenge, but, according to my estimates, the federal center realized the seriousness of the situation only in the second half of March, and only after that at least some actions began to be taken to increase the corresponding purchases and increase production. In a good way, this should have been done ahead of time, in my opinion, certainly not later than mid-January 2020. If so, according to our estimates, mass infection of health workers could have been avoided.

– Will it be possible to solve the problem of providing physicians with the necessary number of masks, suits, gloves and other personal protective equipment before the onset of the second wave of coronavirus infection?

“I suppose it’s generally possible.” However, locally, locally, due to the poor quality of healthcare management, such problems will continue. Especially if the current system of financing state medical institutions through the current pseudo-insurance system is preserved, when hospitals are forced to earn their livelihood, and not be financed directly from the budget as necessary in accordance with norms and standards.

– The conclusion from your words suggests itself. To solve the problem of the security of Russian hospitals, it is necessary, firstly, to pay close attention to the quality of managerial training in local health care, and, secondly, to change the funding. Correctly?

“Why only locally?” On the whole, the healthcare management system needs not only personnel changes, but also reform in general.

This last replica of Andrei Konoval hits, as they say, not in the eyebrow, but in the eye. Only now, taking into account the peculiarities of the distribution of state and other leadership positions adopted in the vertical of power built in Russia, one gets the feeling that no one is going to reform the current Russian health care system until 2036. But if the reform does happen, then, most likely, it will be similar to retirement.

Apparently, if Russian doctors hope for anything in the fight against coronavirus infection, it’s not for the current officials and functionaries, but only for mother nature.

“RUSSIA SAME GOES OUT ON THE MOST FAMOUS“ PLATO ”

– I think it’s too early for us to think about the second wave of coronavirus infection. For the simple reason that the first one is still quite far from completion, ”said JV Doctor of Medical Sciences, professor at the Gamaleya Research Institute of Epidemiology and Microbiology, and virologist Anatoly Altstein. – The incidence rate for almost a whole month is almost in one place, without increasing. That is, Russia nevertheless reached the same notorious “plateau”, albeit a little jagged. However, at the same time, a tendency to a decrease in the incidence rate has not yet been observed, although in the last days of May a slight drop in the infection rate was still recorded.

– When can we see a more or less stable decline?

– Most likely, we will receive a reduction in what is now in a month or even two. Then for some time we will live in peace, but the virus will not go anywhere, and the incidence will continue, albeit at a low level.

– If the recession, in your words, ends around the middle of August, it turns out that the very “second wave” that everyone is anxiously waiting for will not cover us in September, but later? Or will she not be at all?

– Almost without any doubt it will be, and will happen within the fall. But I expect and very much hope that it will be much easier than the first.

– What are your assumptions based on?

– Coronavirus has a tendency to reduce its pathogenic effect. This can be easily seen by comparing the two daily curves – the global incidence and global mortality. If the first creeps up, then the second falls down. This is, of course, caused by a number of factors, but one of them is the spread in the world of less pathogenic variants of the virus, which have a definite advantage, at least in some countries. Therefore, I hope that the second wave of the disease will be easier.

– And how likely is it that in the second wave, COVID-19 will be replaced by some other, more lethal coronavirus?

– Such events occur very rarely, so the replacement of one coronavirus by another is extremely unlikely. Most likely, those versions of COVID-19 that are more adapted to reproduction, but much less pathogenic, will simply be distributed. Figuratively speaking, the human body is in some way a filter for a pathogenic virus. Once in a person from an animal, the virus can have high pathogenicity, at first it, roughly speaking, vomits and mosques. So it was, for example, with the “Spaniard” in the 18-19 years of the XX century. But since the virus is alive, it is gradually changing.

– Could this coronavirus suddenly take and go the other way, along the path of increasing its pathogenicity?

– For a long time, 70–80 years ago, it was found that changes usually go in the direction of weakening pathogenicity. We do not know the reverse examples. Yes, this is a living virus and is not beneficial, because if a person falls ill seriously, he lays down and is isolated from society, and if the disease is mild, the person remains in society and thus the virus enters the body of other people. Although in rare cases, the virus may retain its original pathogenicity. How this happened, for example, with unremitting smallpox for millennia.

Andrey Zakharchenko
“Free press”06/02/2020



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