The coronavirus situation in Moscow is growing worse every day. The incidence rate is increasing, and Moscow hospitals are admitting about 1,000 patients daily. Temporary hospitals have been opened to treat patients with COVID-19 to ensure that people get medical care when they need it. One of such hospitals is located at the Sokolniki Conference and Exhibition Centre. The hospital is an extension of the Inozemtsev City Hospital.
The hospital has over 1,000 beds, advanced equipment and a laboratory. An observation centre is located in the adjacent pavilions for patients who do not need hospitalisation but cannot be treated at home.
What is special about this hospital and how are the doctors supporting their patients? What do the doctors think about working with COVID-19? Alexander Mitichkin, Chief Physician at the Inozemtsev City Hospital, answers these and other questions.
Question: When was the temporary hospital in Sokolniki finished? What equipment does it have?
Alexander Mitichkin: The hospital was put together in 35 days at the Sokolniki exhibition centre. It has 1,200 beds in total. The beds have everything they need: oxygen supply systems, staff call buttons, individual lighting and IV stands. There are separate wards for men and women. An observation section was also opened for asymptomatic COVID-19 patients.
When we were equipping this facility back in the spring, the aim was to build a proper hospital. Despite it being temporary, we made sure it is up to standards. The diagnostics facilities are fully functional: there are X-ray, CT and ultrasound machines (stationary or portable). There is a laboratory equipped like a hospital’s. All tests can be run in 20 to 40 minutes. There is no need to carry biomaterial to the main laboratory.
In addition, there are 18 intensive care beds. This is what we call them, although they comply with the standards of a resuscitation unit. We have ventilators, mobile ultrasound equipment, oxygen supply and an X-ray machine. .There is a nurse station for every three beds and one doctor for every six beds. In total, there are 516 staff members for 550 patients in the hospital, including 70 doctors and 150 nurses.
Question: So there are no big differences between a temporary and a proper hospital?
Alexander Mitichkin: No, in terms of equipment and medical technology available, this facility is just like other hospitals. Common space instead of separate wards is the only difference but we try to encourage and support our patients as much as possible. We provide personal hygiene kits and tablets with movies and games. We hope it helps patients relax. Moreover, there are small recreation zones where patients can sit down with their tablets or talk to each other.
Question: What kind of patients is the hospital designed for?
Alexander Mitichkin: We admit patients in moderately severe condition. Before coming here, all patients go through outpatient CT centres, where the degree of lung tissue damage is determined. If it is minimal, outpatient treatment is prescribed; they are brought here with mid-level damage; those in more critical condition are sent to regular hospitals.
Question: What is the process like for a patient, from admittance to release?
Alexander Mitichkin: We take a conventional approach to treatment. Patients arrive at the admissions unit where they are examined by a nurse on duty who records their body temperature, blood pressure and saturation. The nurse also takes blood tests, performs ECG and CT. Software on the nurse’s tablet automatically evaluates the patient’s condition and determines the level of intoxication. If the level is high and there is a risk of complications, the nurse calls for a doctor immediately. If there is no such danger, the patient waits their turn to be admitted.
Then an electronic hospital record is created. Once admitted to the appropriate department, the patient is met by a nurse. As soon as she enters the patient’s data into her tablet, doctors receive this information and prescribe additional diagnostics and treatment.
Patients are examined by their doctor daily. Three times a day the nurse on duty checks their indicators and adds the data to the system. The doctor and the department head will see it on the medical record. If necessary, they can adjust the treatment. In addition, we have CT and an ECG machines that help promptly predict the risk of complications.
When patients begin to recover, we do not wait for their full recovery. Of course the hospital tries to make the patient’s stay more comfortable but it is not the same as being home. So as soon as patients are able to continue treatment outside the hospital, we release them. Patients are then taken home in a medical vehicle. The patient’s records are transferred to an outpatient clinic, which sends a doctor to continue the treatment. If a patient cannot be treated at home, there are also observation wards.
Question: What are the specifics of treating the coronavirus?
Alexander Mitichkin: I should perhaps calm our patients down: the standards for COVID-19 diagnostics and treatment are constantly being adjusted based on the new information we get and the new drugs that become available.
Recently, the Moscow Healthcare Department approved a new coronavirus diagnostics and treatment standard both for outpatient and inpatient treatment. We follow this standard down to a letter when prescribing treatment.
Of course each case is unique. Doctors can adjust the treatment but it is still based on the approved standard.
Question: What has changed in doctors’ work since the spring?
Alexander Mitichkin: The strategy is different. In the spring, when we were working with COVID-19, it was extremely stressful. We had to reinvent everything we know. We repurposed our beds. It was difficult, but everything had to be done quickly.
By establishing centres like this in Sokolniki and Krylatskoye we helped to keep other medical facilities functional for non-urgent hospitalisations and surgeries, which also means saving lives. This is the main idea; we opened new COVID-19 facilities in order to take some of the workload off the other hospitals.
Question: What did you think of the repurposing of hospitals back in spring?
Alexander Mitichkin: I am a doctor. We are all “reserve medical soldiers.” There is not a single doctor who is not a soldier. We all know what a massive influx of injured and infected people may be like. All of us were trained in organising medical services in emergencies and extreme conditions. This was an emergency, so there were no questions; you just get to work like you were taught. And our wonderful maxillofacial surgeons, traumatologists and dermatologists became respiratory infection experts in a week; they were brilliant.
Question: Does your family support your choice? Some doctors moved to hotels to keep their families safe.
Alexander Mitichkin: They did the right thing. We have to thank the city administration that made it possible to keep medical workers’ families safe (not not doctors but also nurses and hospital attendants).
I have adult children; they don’t live with me. I live with my wife, and there was no need for isolation. However, many have little children and elderly parents and, of course, it was great to have this opportunity.
Question: How are medical workers kept safe?
Alexander Mitichkin: The main difference between the spring and now is that you probably won’t hear that there isn’t enough personal protection equipment such as mask or gloves. We have enough (and even more than enough in stock) of everything.
I go around the department every day, examine all new patients, talk with the staff and demand that everyone strictly comply with the safety requirements. Moreover, the senior sanitary inspection nurse is the main decision-maker now. She decides whether to let someone into the red zone or not, even if it is a department head.
Moreover, our staff gets tested weekly. Everybody is used to this by now.
Question: How is the experience of the pandemic unique for doctors? How will this influence the healthcare system?
Alexander Mitichkin: I think we had a unique experience in the spring. After that, several temporary hospitals were established. As someone who has dedicated his entire life to healthcare and surgery, I think metropolitan areas like Moscow and multi-million cities must have reserves for emergencies like this. It is essential so that there is no need to immediately drop everything and heroically build them from scratch.
When the autumn came and we received an order to open in five days, we didn’t have to do anything out of the ordinary. We just washed and disinfected everything. All the equipment is in place, our personnel are trained. There were preliminary food service, cleaning and maintenance agreements for medical equipment, buildings and structures. Everything was prepared. So we could start working immediately. This is how it should be.
Question: Why should everyone wear masks and gloves in public places?
Alexander Mitichkin: I think it shows that people are socially responsible. If they neglect this rule, they are neglecting everyone around them. This is consideration: if you care, you wear a mask.
When people with a runny nose go to work there is nothing heroic about it. They are just helping their colleagues to get sick. This is where the risk is. If you have any symptoms, call a doctor.