Chief physician of city clinical hospital named. S. P. Botkin, chief surgeon of Moscow Alexei Shabunin was infected with coronavirus new. Since the disease, that is, from April 30, he leaves his office and runs the hospital in the isolation mode. Observer “MK” talked with Alexey Vasilyevich about how he was helped by the treatment with plasma from recovered patient and how the Botkin hospital in the epidemic.
Alexei Vasilievich, how do you feel now?
– Better. I do not have the mindset to talk about your situation with the mass media, though leadership, of course, I reported and isolated themselves. But, unfortunately, all secret becomes obvious. And two days ago the media found out.
Your hospital today treats patients with coronavirus?
– of Course, engaged. The second month, the hospital, all our doctors, like many of our colleagues from other institutions that provide specialized medical emergency, and COVID cancer patients.
In Europe and the United States, as everyone rushed to do COVID-19 in emergency care and Oncology, with heart attacks, strokes, etc. have become worse. And city management, and the Department of health has tried to consider this experience. Therefore in Moscow it was immediately decided that the larger clinics, having all of the profiles of the treatment in the first place, Botkin hospital will continue to provide assistance for emergency pathology, Oncology, Hematology – in all diseases where it is impossible to stop the healing process. For example, if a patient with blood cancer have chemotherapy, he will die.
of Course, the number of patients with emergency cases with cancer diagnoses, from heart attacks and strokes in our institution increased. Indeed, more than half of the hospitals in the capital were reorganized completely under the coronavirus, and they stopped taking other patients. And these patient flows have been routed primarily to the Botkin hospital.
now, However, every patient may be a potential source of infection …
– of Course! The main priority of the Botkin hospital has been and remains the safety of patients and staff. Statistics show that 45-50% of people carry the infection without symptoms, so all incoming patients, and our staff can theoretically be infected. And we have to deal with such situations, when we receive a patient with cancer, and a few days later he played COVID pneumonia. Therefore, at the Botkin hospital was developed by a rigid program of safety of patients and employees.
What steps have you taken?
– First of all, we realized that the input necessary to distribute the flows of patients. You need to carefully watch for any incoming symptoms COVID, even if they themselves do not understand. So we introduced a triaging patients from emergency vehicles. In admitting we made a box chamber and a dedicated CT unit, which have all submitted surveys are conducted COVID-pneumonia.
it was Found that in some patients on CT scan there are signs of coronavirus pneumonia, despite the fact that they come to us for a totally different reason, for example, exacerbation of pancreatitis, and the symptoms of lung disease from them at all. Therefore, a thorough examination of all incoming patients for signs of coronavirus infection has become a law.
the Next step was the creation of the hospital observation and quarantine departments. If we suspect COVID-pneumonia, we see CT on a suspicious picture if the patient had contact with coronavirus patients, and the results of the tests yet, we will hospitalitythe and treat patients, but in an isolated unit.
– do you have Enough beds for isolation of such patients?
– For the day to our hospital receives somewhere in the 150-200 patients. Bed capacity hospital with about 1,700 beds. So that number of beds is sufficient.
And most importantly. One of the points of our safety program was the fact that we have carefully studied the lists of patients with a planned nosologies, in which hospitalization and surgery can be safely transferred to a few months. For example, patients with gallstone disease, hernia of the anterior abdominal wall, with cataracts. They wear their disease for many years. Cataracts generally developed for decades. And transfer surgery on a few months will not affect their health and quality of life.
We talked to these patients, asked them now, in the period of the epidemic, to wait 2-3 months. Explained that any operation reduces the body’s defenses. Then we all hospitalization and operate. This measure also helped us to free up bedspace and frames to throw resources at the direction of emergency care, Oncology, and coronavirus pathology.
we All live in the city, take public transportation, walk to shops. And physicians, plus on the front. And the chance of infection in patients and employees is still there. Therefore, despite the security measures periodically appear infected.
Inside the hospital also took drastic measures. When a patient with a coronavirus, he quickly isolated to prevent the spread of infection. Patients with confirmed COVID-pathology and contact patients in observation we isolate and quarantine zonesOh, and all contact employees, taking their pre-tests, to go home with pay. The steps taken previously to the release of hospital beds is allowed to us. Every day I get a summary from HR today the number of employees who are on sick leave, does not exceed the number of employees who in the summer are in the selling mode. Therefore, the Botkin hospital is in a healthy state.
Two weeks ago in Botkin appeared full COVID center?
Yes, came the moment when we realized – only box chambers and observational areas is not sufficient to resolve the situation. The number of patients increases, and to transfer the patient with confirmed coronavirus infection in some of the city’s specialized centers that take time. And we proved to management DZM that the individual center should appear on the territory of our General hospital. Anyway, we already treat these patients, why waste the time to transport them to other hospitals?
city leaders approved our initiative, and now more than two weeks we have a COVID center. Of course, security measures had to increase. The entrance is more stringent sorting of patients. If the results of their studies, the patient is “clean”, we are merely his hospitalization in specialized departments, and then operate, treat, put the stents. If the patient has comorbidity coronavirus infection, we his hospitalization in COVID center. And thereby keep continuity in the treatment process.
Previously, there were situations when, for example, hematologists came and said sorry to give our patient to another hospital, this young man with blood cancer, we only started his treatment. Now such a patient is transferred to COVID centre in our territory, where it can be observed and treated by the same specialists.
of Course, in our COVID center patients heavy. The common COVID centers observed people with viral pneumonia, we have concentrated covenyi patients with pneumonia on a background of emergency and oncological pathologies.
intensive care beds are enough?
– IN COVID center 125 beds. They are all equipped with oxygen supply, and all airlocks and decontamination stations, where the staff dresses up with a system of high pressure and sterilization of the air. Of the 125 beds, 25 intensive care. In two weeks we have treated at the center more than 200 patients. And another plus of this case: here a successfully treated quite a lot of hard our employees.
– do your medical PPE?
– One of the first steps of our program is ensuring that not only all our employees and patients, security personnel and cleaning masks and gloves. All zones COVID center entrance area (emergency room), resuscitation, anti-shock chamber, where doctors are working in full gear, the personal protective equipment.
How do you have time to conduct such large-scale testing of all incoming?
– This is another step Botkin hospital – strengthening of laboratory services. We set a goal: one hundred percent of patients and one hundred percent of employees to be tested. Today our laboratory operates around the clock. Next week we will test all employees of the hospital. Today, about 3 thousand employees passed the tests, others in the process.
– Now the diagnosis is made by PCR?
– in addition to PCR, we have begun to test for antibodies. 2700 people took the survey the rapid tests, in addition, we conducted more than 1,800 tests quantitative way (they are more accurate). And made about 2 thousand PCR tests. Patients we are doing research by PCR.
– Many doctors point to the low accuracy of the PCR testing. Some even believe that their accuracy does not exceed 30%…
– not True. PCR involves a fence of brush stroke, and there is a very important quality fence material. If the nurse tickle in the nose, of course, the result can be negative. But if the fence is in compliance with all rules, samples are taken and in the nose and mouth, the reliability of this test is very high.
Now we have carried out a new phase of our program: urgently assembled the tent before the entrance to the emergency room. It will be infectious emergency room with the box chambers, the so-called Roder. That is, we move the sorting of patients from a hospital at all. We realized that we should do it.
the Patient will arrive to this tent, there will be rapid diagnosis by PCR (we also have implemented it) – not 5-6 hours and 40 minutes – an hour to prepare the test. And further away from roader, the patient is routed or coveny center with a positive test, or other “clean” the medical building, where they will be provided with an emergency cancer and infectious medical help.
Is so fast you do PCR?! Today, many patients say that waiting for test results for weeks!
– Indeed, there are cases when the results of diagnostic test in reference centers, and, of course, the process may be delayed. But we do the research yourself and get results until 5-6 hours later. And will be even faster.
Our program delivers results. I repeat: we all live in the metropolis and the probability of infection is. However, we conducted sequential steps allowed us to reverse the situation. Today, the number oOdesa with sick leave of employees exceeds the number of cases. In the recent past has been clearly formed in this trend. This confirms the effectiveness of the work performed.
And more. Our staff were not alone with the disease, we organized the clinical research Committee – I recall that on the basis of the Botkin hospital are 24 departments 4 Moscow medical universities we employ over 150 professors, 250 candidates of medical Sciences. We have created a group overseeing treatment of employees at home. And every employee call and talk to him, learn about the state, designate or corrigiruut treatment, if necessary, arrange CT. If you require medication, we provide their staff completely free of charge.
– Because you have already gained some experience, can you say: is there effective therapy for COVID?
– We have received experience of treatment of more than 200 coronavirus of patients with urgent cancer. Today, MBT has a special research group which accumulates all the most recent results against new infection in the form of methodological recommendations for treatment of patients with COVID-abnormalities.
We understand that you need to use the full Protocol as early as possible. And we see good and even very good effect (I can tell) from the use of plasma ill patients with a high concentration of antibodies. In addition, we see a good effect from the use of biological agents monoclonal antibodies. The experience of our Russian and foreign colleagues is already quite large, it amounts to hundreds of thousands of satisfied patients. We will continue the use of the latest recommendations.
– So you have experienced a method of treatment with plasma? How was it?
– Yes. In the early stages I started to give all medications and antiviral, and antibacterial. Unfortunately, the positive effect was not. And I could not stop the management of the hospital.
the doctors took the decision to continue treatment according to Protocol. As a Professor, and a practicing physician who believes in the efficacy of the transfusion of plasma with antibodies, I have insisted on the use of this treatment method. Picked up by blood plasma in a volume of 300 milliliters and had a transfusion. The next day the temperature decreased from 39-38 to subfebrile values, and the turning point in the disease. And cough, and other symptoms remained, but there was a clear positive trend, which allowed me in the office to continue working.
whether in the office conditions for life?
– Everything you need in order to survive, the surgeon who spent his life on duty in the operating room is. I of the special conditions is not required. Bring food. Wait, kogYes, there will be two consecutive negative test.
we sincerely wish you good health and a speedy recovery!
Thank you! The situation is certainly complex, but the second month of the fight against coronavirus confirms that, as 75 years ago, and today the collective of the great Botkin hospital is working on all fronts: for the treatment of emergency patients, Oncology patients, and now in the care of patients with the new coronavirus pathology. And he fully performed before hospital tasks.
