When doctors become vectors

As Russian medical staff catch and spread COVID-19, entire hospitals and treatment wings are going on lockdown

The face of the pandemic

On March 31, Denis Protsenko tested positive for COVID-19. Protsenko, by now a well-known figure, is the lead doctor for Moscow’s City Hospital No. 40 — more commonly known by its location, the Kommunarka neighborhood. In early March, the Moscow government set aside the Kommunarka hospital for patients who had either tested positive for the novel coronavirus or who had potentially been exposed to it. Vladimir Putin visited the facility a week before Protsenko got back his positive test. When asked to comment on the news that Putin had shaken hands with a now-confirmed patient, the president’s press secretary said Putin is regularly tested for the virus. “Everything’s okay,” he assured journalists. The press secretary for Moscow Mayor Sergey Sobyanin, who was also present during the visit, likewise said her employer was keeping a watchful eye on his health.

Protsenko self-isolated in his office and continued his well-established habit of updating the public on the COVID-19 pandemic via Facebook. On April 2, he wrote a post emphasizing that he felt fine and was still working — for example, by holding telemedicine appointments and attending remote meetings with Italian colleagues.

Other hospital employees and the institution as a whole kept working as usual even though the majority of the staff had been in contact with Protsenko. Standard protocol would dictate that anyone who had interacted with a confirmed patient should be isolated, but no strict isolation measures were taken at Kommunarka. Staff said there was no need because the hospital’s doctors receive regular coronavirus tests.

Still, one COVID-19 patient undergoing treatment at the Kommunarka hospital told Meduza that not all of the medical personnel there follow safety rules. For example, they don’t always wear protective suits, he asserted. “It gets super hot in those. Your goggles fog up, your hands get sweaty. Feeling for a vein through a double layer of gloves is impossible,” the patient said. Two other patients, however, did not back up those claims of safety violations. They did say the hospital’s operations do not appear to have changed at all since the chief doctor was diagnosed with COVID-19.

Denis Protsenko and Moscow’s Healthcare Department did not respond to requests for comment.

Whole hospitals on lockdown

In Moscow, another COVID-19 test came back positive for an employee of the Blokhin National Oncological Research Center’s childhood cancer institute. When exactly she received her diagnosis isn’t clear. Representatives for the institute have said the doctor started sick leave on March 25, but the Blokhin Center stopped hospitalizing patients in her division only on April 2. The doctor works in the institute’s Chemotherapy Department No. 3; all her coworkers are now quarantined and undergoing tests for the novel coronavirus.

The department’s patients, meanwhile, have been isolated in their wards and placed under special observation. Because the Blokhin Center conducts chemotherapy in several different departments, a temporary quarantine in one does not affect the center’s operations overall, an aide to Russia’s Health Minister told the newspaper RBC. The aide, Alexey Kuznetsov, added that six patients had been in contact with the doctor who was infected, and their treatment has been suspended. “Fifteen patients who were not in contact with the doctor will be temporarily released to their homes to complete a two-week quarantine. After that, they will be re-hospitalized to complete their course of treatment,” Kuznetsov explained. The Health Ministry indicated that none of the patients in Department No. 3 require nonstop chemotherapy, and their treatment can be stopped and renewed without any dangerous consequences.

In St. Petersburg and the Leningrad region, four general hospitals and one maternity hospital have all been quarantined. That includes St. Petersburg’s Alexandrovskaya, Vvedenskaya, and St. George Hospitals. More than 1,000 people in total are now isolated in the three facilities. However, both St. George and Vvedensakaya are hospitals set aside in recent weeks to accommodate a wave of patients with pneumonia and acute respiratory viral infections. Some patients in those categories may actually have COVID-19.

At first, at least 20 patients at the St. Petersburg hospitals were found to have contracted the new virus, and the resulting isolation measures were extended to hospital staff. Still, the local news outlet Fontanka published an as-yet-unconfirmed report that the patients had already infected several doctors. All three hospitals stopped accepting new patients. Releasing patients has also been banned unless a delayed release would endanger their life or health. All of the facilities’ patients and medical staff will be tested for COVID-19, and anyone who tests positive will be treated in an inpatient infectious disease wing. Some of the hospital staffers undergoing testing have self-isolated at their workplaces, while others are staying home. One source at St. George told the St. Petersburg outlet Bumaga that while the hospital has been on lockdown, concerns about personal protective equipment (PPE) shortages have escalated. Staff have enough supplies left for two weeks, but only if they use some disposable protective equipment multiple times.

The trauma bay at the Leningrad region’s Gatchina Hospital was also placed under quarantine after the doctor who leads that department tested positive for COVID-19. The department head returned from a trip abroad, requested a coronavirus test, and tested negative. However, two weeks later, tests results came back positive. Other trauma department employees at Gatchina are now quarantined and awaiting test results.

In the Komi Republic, meanwhile, a rapid coronavirus outbreak has led officials to lock down the Ezhvinsky District Hospital, which is in the regional capital of Syktyvkar. COVID-19 became so prevalent at the hospital that Komi’s overall case count surpassed 50, making the northern republic the most highly impacted region in Russia’s coronavirus pandemic aside from St. Petersburg, Moscow, and the Moscow region. A doctor at the hospital is suspected of passing on the virus to numerous patients. In a reversal of that situation, another medical employee tested positive in Crimea after examining a man who returned from abroad and broke self-isolation rules by coming to a clinic in person. The patient now faces criminal charges.

Andrey Konoval, who co-chairs the healthcare union Action, told Meduza that a few regions of Russia have been sending ambulance crews into quarantine after they make contact with coronavirus patients. In some regions, all ambulance teams serving certain small towns and villages with COVID-19 outbreaks have been quarantined. According to Konoval, hospital workers who do not have ambulance experience have been asked to fill in for the missing crews.

Too much work, not enough PPE

In an interview with Meduza, Konovalov emphasized that with Russia under a nationwide self-isolation regime, there’s a risk that the medical community could become one of the primary vectors of COVID-19. He claimed that many doctors have had to hold office hours in simple gauze masks, while ambulance crews are only putting on special protective suits before a case if their patient has recently returned from abroad or been in contact with someone known to have COVID-19. Despite these conditions, more than 30 medical workers in various Russian regions say most Russian hospitals are not testing their doctors for the new coronavirus.

Meanwhile, Prime Minister Mikhail Mishustin has ordered hospitals to develop plans for isolating workers involved in fighting COVID-19. Medical staff may be isolated in hospitals outside work hours. If necessary, they may otherwise be housed in hotels set aside especially for them.

As increasing numbers of hospital workers get sick and whole divisions or facilities go on lockdown, Russian authorities are designating more and more clinics for coronavirus treatment. For example, this month, Moscow’s Spasokukotsky City Clinical Hospital will begin accepting COVID-19 patients, and eight different inpatient institutions in Russia’s capital already do so.

In St. Petersburg, the Pokrovskaya Hospital was assigned on April 2 to work with pneumonia patients who do not have the new coronavirus. The hospital’s staff, concerned that the opposite might be the case, issued a public call for help, recording a group video to highlight their shortages of PPE and other supplies.

“We are not refusing to work. We love our patients, and we want all of them to get well. But working in these defenseless conditions is impossible. Nobody is immune from infection, and being in medicine is no protection: the virus does not discriminate. It spares nobody — not doctors, not the young, not the elderly,” the hospital’s employees said. St. Petersburg’s healthcare committee later acknowledged that the facility’s PPE supplies really were lacking.

Russian hospitals are also working to establish a reserve of doctors from various departments who can help infectious disease specialists, primary care doctors, and pulmonologists at the peak of the epidemic, medical workers told Meduza. With concerns about understaffing on the rise, medical residents are also being asked, albeit rather forcibly, to take on full-time jobs immediately in fields related to COVID-19.

The Russian government’s task force for the pandemic did not respond to a request for comment on this story.

Text by Pavel Merzlikin

Translation by Hilah Kohen