Anastasia Vladimirovna! On Sunday, the country celebrated the Day of medical worker. Physicians of the capital, felt their professional holiday, or they are now still not to the holidays?
Anastasia Rakova: I’m glad the system load began to subside and we were able just to congratulate health workers. Moscow healthcare system went through a tough test. But our system survived. For all months, even in days the peak load, slid into a collapse, was not critically overloaded. It was very hard work of all departments and specific people. Outpatient clinics, hospitals, ambulance service, laboratory service work as a single organism.
the institutions employ more than 180 thousand specialists. We are very grateful that during the epidemic we were supported by colleagues from the Federal and private clinics. Their merit is that in the course of the entire pandemic in the city has always lacked beds. Doctors departmental, commercial, Federal agencies, despite the rank and insignia became these days in “ordinary” physicians and worked to the same standards. Really helped that the city has a convenient tool, able to ensure continuity of treatment: electronic medical records. It is available to all, including Federal and private institutions. Thanks to all the doctors can assess the condition of the patient, his medical history and act in the General information field.
I Want to thank the medical staff for the great work and to congratulate. I wish them and their families health, happiness, more calm moments. I think, these words with joy will join the Muscovites.
– the City stimulated the work of doctors of coronationstreet significant cash payments. Put them in hotels near clinics and ensure their comfortable accommodation: free breakfasts and dinners, free taxis to work and back. As a result, Moscow coped with the disease on their own or attracted doctors from other regions?
Anastasia Rakova: Coronavirus has become a serious challenge for the world. The separation between “us” and “them” here is just inappropriate. Early in the epidemic came to us more than 2 thousand medical workers from other regions. In a complex capital for the period they supported our physicians. I think, and for them the experience is not in vain, they return home with the real specialists on work with covida. In turn, Moscow more than 100 physicians in the 15 brigades now help in the treatment of patients with coronavirus in the regions. They went to North Ossetia – Alania, Ingushetia, Dagestan, Kamchatka, Zabaykalsky Krai, Khanty-Mansi Autonomous district Pskov and Vladimir region. Multidisciplenarie team of pulmonologists, infectious disease specialists, anesthesiologists and resuscitation specialists, radiologists, nurse anesthetists lead by experienced doctors leading Moscow hospitals.
They participate in the reshaping of hospitals and astronoomiaring aid, offer medical schemes, established in the capital.
– Enough protected in the coronavirus doctors themselves?
Anastasia Rakova: the Safety of health care workers for the city most important. Means of individual protection they are provided in full. For this to hospitals weekly shipped about 4 million units of personal protection with a new warehouse open in the South-East of the capital: masks, gloves, protective suits and glasses, respirators, Shoe covers, disinfectants and others. Is there a minimum stock of PPE in the calculation of 2-4 weeks. In addition, doctors and nurses of hospitals, which treat patients with COVID-19, regularly tested for coronavirus.
– According to the requirements of Rospotrebnadzor recently employers had every two weeks to organize the testing of 15% of the employees working offline. This rule is stored?
Anastasia Rakova: Yes, it persists. Most businesses in the city have already resumed work. It is important not just to keep the pace and increase the volume of testing. To this end all the citizens created the opportunity to take the test for antibodies to the coronavirus. This can be done on the basis of 30 outpatient clinics for the pre-recording option. The result will come in electronic medical records and show sick man now, had been ill previously and had developed antibodies or even until faced with the virus.
in Addition, organized a service for enterprises. In the framework of public-private partnership, employers can organize employees testing for antibodies. They just need to pay for blood sampling and the study itself passes through the city.
testing working Muscovites can in the clinic and in the workplace. We are ready at the request of the employer to organize a mobile team which is convenient for employees and saves time of the staff. Employers is sufficient to conclude a contract for the provision of services with one of the city’s medical organizations. More than 3,5 thousand enterprises agesanctuary to participate. With almost 100 organizationality contracts. Expressed a desire to participate and 20 private medical organizations.
Massive testing of the population of Moscow began the country’s first…
Anastasia Rakova: the test mass and free was our ultimate dream from the very beginning of the pandemic. But it was necessary to organize the work of the laboratories. Studies in Moscow, conducted in 45 laboratories. In addition, we set up a convenient��yy service electronic records for the delivery of the analysis. Organized algorithm of reception in clinics: allocated in each building specific zones, divided the flows of patients, distributed receiving slots so as not to create crowds of people. Prepared and trained doctors and nurses. Provided information about the results in electronic medical records. In addition, after delivery of the analysis by PCR or IFA, the Muscovites sent a TEXT message that the test result can be seen in the EHR with a link to the page.
In the end testing and in the early stages, and at the peak of the epidemic, Moscow has become one of the best not only in Russia but in the world. Test for coronavirus in the mandatory we have taken all of the townspeople with symptoms of SARS, pneumonia and those who live with a patient with confirmed diagnosis of COVID. Also organized the screening of medical and social workers, transportation, utilities, police. In short, all who are in contact with residents. Later began testing and all patients non-infectious hospitals of the city.
Realizing that no test is perfectly accurate 100%, we use all quality initiatives in the world. In addition to diagnostic PCR, which detects the presence of the virus, conduct mass IFA(CLIA) testing blood from a vein in the presence of antibodies to coronavirus infection. Already conducted more than 3.2 million PCR tests and more than 800 thousand ELISA tests.
How Muscovites responded to the invitation of the city authorities is free to test for coronavirus? The first results showed that 12.5% of Muscovites have antibodies against it. Now the level has increased to 17.4%. The study immunity lasts?
Anastasia Rakova: Yes, the study of population immunity to coronavirus among Muscovites held for nearly two months. The figure for this period increased almost 5%.According to preliminary results, the average titre of immunoglobulin also increased, by almost 10 points – from 63,8 to 72.2. Increased the number of people with high titers (>50) – they are already more than half. Two weeks ago these people was 43%. This speaks to a greater probability of formation of immunity. In addition to identifying emerging immune to COVID-19, we identify citizens who currently suffer from coronavirus. Share cares and analyzed by PCR analysis, and CLIA testing. According to the obtained results it is obvious that the proportion of ill Muscovites reduced. The results of CLIA testing: from 3.9% to 3.6%, according to PCR studies from 2.4% to 1.8%.
Screening helps to install other features of the disease. Daily of the total number of people who have diagnosed coronavirus, more than 40% carry the virus without symptoms. Prolonged monitoring of patients atsuggests that in the future the symptoms appear only 14-15% of the cases. The results will present this week.
is generally coped well with the coronavirus. This is acknowledged by foreign experts. But more importantly, in my opinion that it significantly changed the attitude of even the skeptics to the Russian medicine. What in your opinion has helped the city to survive in a critical situation? The professionalism of the Moscow doctors? Or correctly built strategy of the city authorities?
Anastasia Rakova: of Course, it’s the synergy of the professionalism and dedication of the Moscow doctors and the complex management decisions at all levels. We are grateful to the doctors who were and remain at the forefront of the fight against coronavirus infection. And it is important that our actions were adequate to the current situation. In the city in time, measures were taken on the basis of recurring lesions in different parts of the world. At first it was a hotbed of China, then to Europe. We have delayed the arrival of a new virus in Moscow. The first case was registered in Moscow at the end of February, and the full force of the epidemic began to flare up in the middle of April. We were able to take maximum advantage of the resulting delay, make a decision ahead of the curve.
for Example, have started to provide patients with chronic diseases drugs for long-term treatment – up to 6 months. This helped to protect them from unnecessary contact and to minimize the risk of infection.
At the suggestion of the Clinical Committee in mid-April, it was decided all the cases of SARS can be regarded as a suspected coronavirus. These patients began to be observed as potential carriers of the virus. Issued the writ instructing them to follow a policy of self-isolation. For the metropolis it is very important to break the chain of spread of the virus.
For patients with symptoms arranged for the treatment at home. For constant communication with them was established the Center for telemedicine. In the case of deterioration of the patient to him immediately sent doctors from the hospitals, which enhanced exit services. In addition, patients with confirmed SARS coronavirus organized and free medicines.
Another important decision is the creation of a special CT scan centres clinics where patients with suspected coronavirus performs CT scan, ultrasound and other studies for accurate diagnosis. In addition to CT scan for patients with suspected COVID-19 in these centres carried out by other tests: General blood analysis, ECG, intake strokes on novel coronavirus infection, if necessary, conduct ultrasound examination. This approach enables not only the timely diagnostirovannaya, but also to determine its character. Over 177 thousand diagnostics that were before possible��s only hospital, conducted on the basis of CT centers. Careful attention to such patients are allowed to take control of the disease and timely correct treatment, avoid severe cases.
CT centers during a pandemic worked around the clock. Not going to abandon this practice in “peace time”. If there is a need and demand from residents, that CT diagnosis will continue to be available 24 hours in clinics. Appropriate equipment while there is not everywhere. But in the course of the overhaul program clinics CT and MRI machines will be installed in each office building of the clinic.
– Imagine that the government of Moscow the previous 11 years did not deal with the health of the city as it was. And Moscow would have met without new pandemic are prepared to accept patients at the first signal Kommunarka, without a CT scan and an MRI in every hospital. A pandemic would be the same? What do you think?
Anastasia Rakova: Indeed, the positive changes that have occurred in the city in recent years, have not gone unnoticed. For example, our hospitals have a powerful material and technical base and constantly updated infrastructure. Institutions of the city have more than 5.3 thousand of the ventilator 34 and ecmo machines.
Base to launch telemedicine Center was preparing for several years. But the pandemic, which is particularly valuable were the time and the safety of patients and doctors, proved how popular the telemedicine technology. After internal examination, a telemedicine doctor dynamically, in the course of disease, watching the patient, corrects the treatment. Spending on average 13-15 minutes for a consultation, it is having access to electronic medical records and other data from the SYSTEM, manages the day to explore up to 60 people.
there were projects implemented “from scratch” with colleagues from other complexes of municipal economy of Moscow. For example, the infectious diseases hospital in the New areas in the settlement Voronovskoe area of about 80 thousand square meters was practically built in a month. Moreover, it is the capital clinic, which will serve for decades. When the epidemic ends, in the Voronovo will operate modern and well-equipped infectious diseases hospital.
Generally one is a warrior. Social sector and health care work together, for example, with the CPS. Carried out operational and epidemiological investigations helped to create algorithms with contact persons, develop a sanitary standards for establishments and monitored the test execution. They are the key experts, with their constant advice to support the city managed to function properly and in many ways ahead of the curve.
the housing and utilities sector was able in a short period to make Moskov��cue bedspace suitable for the treatment of kovida. To more than 10 thousand points were summed up and connected to the oxygen. Economists quickly began the mass production of means of protection and fully meet the needs of medical institutions. Moscow transport, in addition to the functions for the transport of patients, helped our doctors and ensure comfortable movement around the city.The international unit even in difficult market conditions, managed to organize the delivery to Moscow of more than 100 test systems CLIA and the required amount of reagents.
– During the pandemic appeared in Moscow on the new clinical Committee. What problems were solved with the feed?
Anastasia Rakova: All the world, and Moscow in particular had to deal with an unknown enemy. Coronavirus infection of a new type of experts from many countries of the world stumped. Not to say that we already know everything about this disease, but we are successfully moving in this direction, are at the forefront of the study of infection. Confirmation of this can be that more than 60% of all Muscovites, infected with a coronavirus, treated successfully, including the most severe cases.
Clinical Committee treatment to combat coronavirus infection was established in the beginning of April. Its membership is composed of chief freelance specialists of the Department of health and senior doctors of kolenichenko. During the whole period of the epidemic they are constantly in contact with each other, with foreign colleagues, working together to find optimal solutions.
the First initiative is to refuse the separation of hospitals for coronavirus and hospitals for the treatment of pneumonia. The lung disease of bacterial nature to continue to treat in the centers of pneumonia. Clinical Committee proposed to change the routing of patients. When the evacuation to the hospital the patient is still no test results, but when examined in the emergency Department identified CT signs of pneumonia-COVID 19 with a characteristic clinical manifestations, he will be hospitalized at the hospital and being sick with COVID infection.
In Moscow, the world’s first massively applied the technology of automatic data processing and artificial intelligence to analyze a CT-scan. It works like this. All studies are automatically entered in a single of the radiological system. Artificial intelligence processes the data, and radiologist in the experiment receives the image labeling and text description. In a tense epidemic situation this allows the doctor not to miss even the smallest details of the study.
It was at the suggestion of the Clinical Committee were open CT centers, launched a screening study of the population immunity.
we should also remind that in Moscow ��rowdata deep morphological studies of coronavirus infection. Based on the obtained data, a detailed classification of causes of death during the coronavirus. Moscow specialists were the first in the world compiled and published the Atlas of severe pathological changes in the organs of the dead from kovida. These studies gave an opportunity for our experts to better understand the disease. For example, it is established that the basis of a large part of deaths lies with increased blood clots. The doctors decided to prescribe anticoagulants is not in the preventive and medicinal doses. And it yielded results.
in the treatment of COVID-19 applied many innovative techniques to combat COVID-19. It is the experience of foreign countries, or in most of our Moscow development?
Anastasia Rakova: of Course, we watched the situation in other countries and cities and adapted from the practices that gave good results abroad. They all – both Russian and foreign, are still experimental. For example, we know that the blood recovered from the coronavirus of patients contains antibodies to it, so it can be used for the treatment of patients with a new infection. The transfusion of donor plasma approved for use by our clinical Committee. Already more than 1 thousand people, had been ill with a virus, become donors for others. We are very grateful for the donation and hand them a gift set with nice Souvenirs and a certificate from the health Department.
In the research Institute. N. In. Sklifosovsky use of experimental treatment in the early stages with hyperbaric oxygenation. The method is based on the blood oxygen saturation by delivery through the plasma at an elevated atmospheric pressure. It’s more effective than the flow of oxygen through the mask – so can do 100% of oxygen. In Sklife this technique to treat patients with the coronavirus have introduced for the first time in Russia.
Tested and an experimental treatment with helium on the basis of Sklifa and GKB 52. According to experts, helium can prevent hypoxia, normalizes blood gas composition. Gives good results in the recovery of even heavy patients.
on Sunday in Moscow first identified less than a thousand new infected per day – 968 . Compared with the previous 6 thousand at the peak of the pandemic, of course, a little bit. But by and large, and a lot. Doctors give a prognosis: when the process can still stop? Or the first wave will go smoothly in the second, which experts now say as the matter is resolved?
Anastasia Rakova: We take account of the different predictions, since our goal is to have a margin of safety for the health care system under any scenario.
Now the city is one of the smallest gains in the country. Nevertheless, the virus is still with us. Therefore, the work continues. In clinics in identifying each new case call center immediately reported by telephone about the test results, asks to remain in isolation and expect the arrival of the doctor. The doctor will provide medication and be observed to full recovery.
the Pandemic recedes, and 16 hospitals with a total capacity of 8.8 thousand beds, converted at coved, gradually returning to normal operation. Seven of them have already started the planned and emergency admission and took about two thousand patients. And 12 hospitals did not stop the reception and worked in the same volume. Headed people in need of emergency medical care.
re-Purposing – it is organizationally difficult. So, before you start the reverse process, we have provided a reserve stock of hospital bed capacity on the basis of temporary hospitals. Now in the city about 10 thousand hospital beds in reserve, more than 500 of them – resuscitation. 100% of beds are provided with medical gases, i.e. specially adapted for needing oxygen support.
the Temporary structures will be preserved and stored in case of change in the epidemiological situation. In case of unfavorable development of the situation they will contribute and provide a margin of safety for the health care system. Will allow us to take the necessary measures, without touching the hospitals.
of Course, with the onset of hot days it is tempting to throw all precautions to remove the mask, start safely to meet with friends and acquaintances. But I hope that citizens understand the responsibility that falls to each of us as members of society. So it is better to accept that the new rules of social behaviour that has brought the virus, should we still stay for some time, to prevent return of the infection.
learned a coronavirus? New born health? What should, in your opinion, taking into account school coronavirus izmenitsa in our Moscow hospitals?
Anastasia Rakova: of Course, the coronavirus had an impact on our plans and projects, but no one was sitting idly by waiting for the end of the epidemic. Much could be done for her. For example, we prepared for the opening of two new centre. In the pulmonology center at city clinical hospital No. 67, which was opened by the mayor of Moscow Sergey Semenovich Sobyanin, the relevant patients are people suffering from bronchial asthma and lung disease. Get it help in rehabilitation and the Muscovites who have suffered coronavirus.
In the near future will start to accept patients, and the Center of the brush and purulent surgery at the hospital named after Yudina. There will be high-tech and minimally invasive surgery. Did this direction in the city full-times demand, we do not have many clinics that can provide such assistance. The opening of this center will make it more accessible.
back in October we launched a large-scale project on equipping the expert pathological laboratories in six anchor cancer hospitals. In December began to receive the first equipment for different types of tests. In March came the last delivery – I dosnateli laboratory high-precision microscopes, and apparatus for carrying out immunohistochemical and molecular genetic studies of tumors. This allowed us to reach a new level and new capacity in the diagnosis of malignant tumors. Now doctors can as accurately as possible to appoint the latest targeted and immune drugs for treatment. So, in these laboratories from the beginning of molecular genetic and immunohistochemical studies were conducted almost 12 thousand patients, representing 90% of such studies in Moscow.
Continue intensive work on life-cycle contracts. We started doing it first in Russia. Let me remind you that this is actually a new format for the purchase of equipment, when purchased more than just equipment, but also its maintenance over the life of the contract. This reduces costs and minimizes risks. In the two years through the procurement of medical equipment contract life cycle total savings of the budget of Moscow amounted to 15 billion rubles. By the end of summer will Rastorguev some more contracts.
And, of course, special attention will continue to pay clinics. It is important to space them comfortable and navigation – friendly. To need experts and equipment were close to home, and for carrying out diagnostic tests and examination by a doctor-specialist did not need to go to the other end of the city. All this is provided in the new standard of the Moscow clinics, in accordance with which the city has already begun the repair of the 12 clinics, until the end of June the repair will take another 25 out of 135 buildings of clinics. Despite the epidemic of coronavirus, the project will complete in time before the end of 2023.
