Which countries and why are cope with the Covid-19 epidemic is better: report

Nobody was waiting for the coronavirus epidemic, and they were not ready for it, perhaps, in any country in the world. However, some countries managed to take control of the situation, and in some a real disaster unfolded. We analyzed the data on several large cities of the world and found out what are the factors of success in the fight against pandemia. The data show that Moscow has every chance of passing the testing of pandemia with dignity. However, a lot depends on how people will behave.

The authors of the report

Yaroslav Ashshin , Ph.D., therapist, adviser to the General Director of the International Medical Cluster Fund. The attendant doctor "New" and its author.

Faina Filina , Director of External Communications of the Fund of the International Medical Cluster.

An analysis of developed countries and capitals in the fight against coronavirus allows you to identify the most effective ways to counteract the virus. Until the medicines and vaccines from coronavirus have been invented, the main issue is the search for the optimal degree of “hardness” of quarantine.

Full quarantine, on the one hand, allows you to preserve more human lives, but, on the other, it can extremely negatively affect the economy, and also contribute to the second wave of the epidemic.

We have identified several key solutions that allowed the countries to effectively cope with the COVID-19 and not overload the healthcare systems. However, while the pandemic is far from the final, it is too early to say that certain measures are 100% effective.

We analyzed the situation in the following countries and cities: China, Germany (Berlin and Munich), Sweden (Stockholm), Korea (Seoul), Great Britain (London), USA (New York).

Early taking quarantine measures

Quarantine limits the rate of spread of infection, and the more effective it is, the more effective. The slower pace of development of infection allow healthcare systems not to choke at the peak of an epidemic.

Of the countries and cities considered by us, strict quarantine was used only by China, but it was thanks to him that the country with the huge population, in which the epidemic was the first to break out, made it possible to prepare, was able to limit the number of people infected up to 100.85 per 100 thousand people. At least, according to the data that we have at the disposal. For comparison:

In the UK, where quarantine measures were introduced relatively late, this number is 35 times larger, in Spain - 81.

At the same time, the whole world adheres to Sweden intently, in which strict isolation was not introduced, even restaurants continue to work . But to talk about the success of the Swedish strategy is still premature, the number of cases is growing.

Monitoring the quarantine (in self -isolation) and

Violation of quarantine can be dangerous not only for the offender himself. The meeting of the asymptomatic medium with random passers -by or neighbors is especially dangerous. According to the operational headquarters to combat the coronavirus of Moscow, more than 40% are sick of coronavirus asymptomatic.

That is, in principle, leaving the house, you need to proceed from the fact that everyone is sick.

Quarantine is an effective measure to restrain the growth of sick, but it is important to observe all the rules - in the countries considered (except Korea and Sweden), for this purpose, special systems for gaps, cameras, fines are used, the police checks the documents of people and the purpose of their access to the street.

• In the United States, quarantine measures are within the competence of both federal and local authorities. If a person has violated mandatory self -isolation and infected others, he faces a fine of 100 thousand dollars or a year in prison. In the case of death - a fine of 250 thousand dollars or a year of imprisonment. For legal entities - 200 and 500 thousand dollars, respectively.

• For leaving the house in Spain without good reason, the amount of fines varies from 600 to 10.4 thousand euros - for citizens and up to 600 thousand euros - for enterprises.

• In Italy, the fine varies from 400 to 3000 euros. The most severe punishment - from 1 to 12 years in prison - threatens those who were diagnosed with Koronavirus, and who, without cured, was caught outside the house.

• In France, a quarantine violation will cost 135 euros for the first time, repeated - 200 euros, a systematic rejection of the rules - arrest of up to six months and a fine of 3.7 thousand euros.

• In the UK, a penalty penalty for violation of quarantine is 60 pounds (about 75 US dollars), for repeated violation - 120 pounds and then doubles for each next violation. These figures are comparable to fines in Russia .

• The most severe punishment, as you know, was introduced in China.

For those who know about their diagnosis and continue to visit public places, the death penalty is provided.

At the entrance to the country, persons who refuse to undergo quarantine control measures or resisting sanitary supervision services can be fined by 5,000 yuan (about 700 US dollars).

At the same time, in a small number of countries, the effectiveness of measures to contain infection is ensured by high social responsibility, initially characteristic of the nation.

So, in the absence of the official self -isolation regime, the Swedes behave very disciplined and observe the social distance. Those employees who can work remotely went to distance work. In Korea, the population has even more commitment to measures to counteract the spread of infection. So, from the very beginning of the pandemic, even when the number of cases did not exceed 100 people, all Koreans began to wear masks, gloves, and observe the distance. Restaurants work in the country, but there are not many visitors in them, and those who come are located at a sufficient distance.

Strategic planning and transformation of the medical network

The allocation of individual centers for taking COVID-19 patients, re-profiling hospitals, deploying several levels of "defense" from infection

One of the factors of success in the fight against pandemia was the centralization of the healthcare system and the willingness to quickly reproduce hospitals or departments.

The decentralized healthcare system, apparently, is less effective in the fight against the epidemic.

In the USA, for example, most hospitals are private and are not dependent on each other. In the conditions of pandemia, each institution takes care of its reserves: the largest centers receive the necessary personal protective equipment and equipment, while small clinics cannot afford and close this. This makes the problem of access to medicine in such countries even more acute. And in Germany with a centralized system, even every Ivl (whether it is in the hospital or in a private dental office) in a single information system. In crisis situations, all Ivl is transferred to the use of the state. For example, some patient in the ambulance happens in the distance from Berlin or Munich, the paramedic can see in a single reference to see how faster the patient to the Ivl apparatus is faster.

The register of “heavy” equipment (including Ivl and Extracorporeal membrane oxygenation apparatus, ECMO) was created by France. The past epidemics of coronaviruses SARS and Mers pushed them to this measure.

In many countries, typical infectious hospitals and departments have become quickly missing due to the increasing number of infected ones. The decision to reprofile some hospitals, expand the intensive care units or build field hospitals allowed to provide the necessary assistance to a larger number of infected, as well as save life.

Particular efficiency is shown by the preparation of hospitals for taking the diseases before the need for additional capacities - when such a need arises, it will already be able to satisfy it. Almost all of the considered countries, except for South Korea, were forced to increase the number of beds, as well as seek help from volunteers, military, students and, in some cases, pensioners. Some re -profiled by coronavirus not only of medical facilities, but also ex -centers (Sweden). So, a new hospital was built in the exhibition hall in Stockholm, the resuscitation center with Ivl and other equipment.

The success of Germany was largely determined by the presence of a special plan in case of an epidemic.

For the first time in the history of Germany, laws on the emergency adopted on June 24, 1968 were applied.

Recommendations on countering coronavirus are also produced in Germany centrally by the Robert Koch Institute. They include measures to protect the population, and, very importantly, strategic and tactical, which need to be undertaken by the healthcare system. The recommendations of the authoritative institute are followed by all the clinics of the country.

Sufficient amounts of funds

Personal protective equipment play a critical role in maintaining the health of medical personnel, therefore, for a successful fight against the virus, the SIZ supply should be sufficient.

Among the considered countries, there is a lack of personal protective equipment in the USA and Italy - countries where the infection rate is extremely high.

According to doctors themselves from these countries, the medical staff even had to sew PPE for themselves. Cases of the disease of doctors and the further spread of the virus are found in both countries, for example, the percentage of medical workers infected in Italy almost doubled the number of registered during the epidemic in China.

The disease of doctors and nurses is fraught not only with an increase in the number of infected ones, but also by overloading the healthcare system - sick workers will not be able to provide medical assistance and will be forced to take place.

The mass infection of doctors in New York led to the fact that in some clinics the number of medical staff fell to a critically low level, and even infected doctors began to go to work (as much possible protection).

Sufficiently Ivl and D

The apparatus of artificial ventilation of the lungs can save patients in serious condition and give them the opportunity to continue a full life after recovery.

Here we must note that the information widely distributed in the media that patients should not be transferred to Ivl is not entirely correct.

Transfer to the ELS is always an extreme measure, when there is no other opportunity to save life.

The hasty (when it is possible to “keep the patient” on mask ventilation or high-flow oxygen) switching to Ivl worsens the prognosis of patients with almost any diseases, and not only with COVID-19.

Unfortunately, in many countries they were not ready for increased need for such devices. In the USA, Italy, which are in the forefront in the number of patients, there is a lack of Ivl, and doctors are forced to decide who they will save their lives and whom they will leave without the necessary help. Again, a centralized system, where there is data on free equipment in real time, is more effective. This is what Germany can boast, which manages to pass the pandemic relatively calmly, and what has become a problem in Italy and Spain.

Connection of patients with coronavirus to Ecmo (enriches blood with oxygen in conditions of severe lesion of the lung tissue, when the possibilities of Ivl were exhausted), for a number of reasons, it was not necessary as often as with other severe respiratory viral infections. In this case, the lack of ECMO was observed in Sweden. Due to the “optimization” of the healthcare system at one moment in Stockholm there were only 3 functioning devices, including a device from cardiac surgery for newborns (for comparison, in Moscow there are more than 17). Doctors had to choose who to connect to ECMO and who not. Preference was given to those patients who had a higher chance to survive.

Creation of centralized channels for informing citizens

Of particular importance in the fight against coronavirus is the informing of citizens about the situation and measures to contain infection. Upon receipt of insufficient or wrong information from the media, people tend to panic and buy the same PPE, creating a shortage of necessary goods. They can be not serious about the self -isolation regime adopted to protect the population, and violate it. Both types of behavior threaten an effective process of combating the epidemic, so it is very important to convey to everyone why it is important to stay at home, not to visit older relatives, to comply with hygiene and social distances, people, realizing why they refuse the usual things, and trusting the city or country, more serious about established rules.

The principles of creating centralized channels for informing citizens adhere to in many countries, including Germany, South Korea and, of course, China.

Compliance with hygiene measures

Hygiene is the most important measure to counteract the spread of infection both inside the hospital and in public spaces. So, in Paris, special attention is paid to observing the rules of hygiene, tough protocols for using the PPE are created to which doctors follow, and the population of South Korea actively promotes the rules of effective wash of the hands and uses sanitizers next to the entrance to stores. In Germany, blessings are now introduced in quarantine measures, but they have introduced a mandatory mask regime in transport and public places.

Timely deployment of wide testing and identification of contacts of infected

The most striking example of timely wide testing was demonstrated by South Korea. The country for a long time occupied the second place in the world in terms of the number of cases, but the rate of spread of the virus was so reduced that today in South Korea the incidence rate has decreased to 20.7 cases per 100 thousand people, and in Seoul it is at all a case per 100 thousand population.

The mortality rate in the country is also impressively low - 0.4 per 100 thousand people. In Seoul, only a few people died from coronavirus.

Such results were achieved due to mass testing - one of the methods of early diagnosis of the disease, which reduces the possibility of complications and reduces the number of contact persons.

In South Korea, chains of citizens who contacted infected were tracked in great detail. The authorities collaborated with the police and worked to identify the first and second circles almost like in a detective series. Perhaps it was this circumstance that led to the recordly low among megacities, the number of infected and dead in Seoul.

Considering the experience of the EU, where countries actively interact with each other and thereby allow the virus to spread instantly, you can pay attention to the approach to testing Germany and Sweden.

In Germany, a test to identify coronavirus began to be developed even before the first infected ones appeared in the country. Such prudence allowed to create the first test in January. The own tests of tests allowed Germany to expand the extensive testing of citizens - now the country takes third place (after Russia and the USA) in the number of tests carried out (more than 1.3 million has been held). Doctors undergo regular testing for coronavirus.

Testing allows not only to isolate the sick and prevent the spread of the virus, but also to identify potential patients who do not yet appear symptoms, but which can already be contagious.

In Sweden, they relied on testing on antibodies against coronavirus, considering the tests on the coronavirus itself relatively useless due to a large share of asymptomatic patients. According to experts, doctors of the Swedish hospitals, about 30% of the trusted hospitals of hospitals have antibodies to COV-19.

And what do we have?

What is happening in Moscow

An analysis of international practices to combat coronavirus allows the Russian capital to use methods that proved their effectiveness around the world. Moscow is trying to take into account the best world experience, including at the site of the international medical cluster between the most authoritative Russian and foreign doctors, knowledge is constantly being exchangeed.

The successes of Moscow in counteracting the spread of coronavirus infection are noted both in other cities of Russia and abroad.

In Moscow, quarantine measures, a system of digital passes were introduced in a timely manner, and plans for encouraging doctors working with coronavirus were developed. In a record compressed time, literally in a month, a new large infectious complex for 800 beds with 770 Ivl devices was built in Moscow. Moscow doctors, medical sisters and builders of a modern hospital are today a real civil feat.

Also, in Moscow, a number of hospitals are re -profiled, the creation and expansion of ORI departments in emergency hospitals. We can say about the effective echeloning system - the creation of several protection lines: the hospitals of the “first echelon”, which from the very beginning on the “advanced”, hospitals of the “second echelon” in which there are OIT branches, but they are expanded and strengthened by appropriate equipment, and general profile hospitals that reproduce. It is such systems that are used in Germany and Sweden.

Now even WHO admits that Russia copes well with pandemia. The number of cases of coronavirus in Russia is growing so far, but this growth is without a surge, not vertically, today the representative of the WHO Melit Vuinovich said. По ее оценке, российская система здравоохранения справляется с пандемией и в состоянии обеспечить лечение тяжелых случаев, когда больные занимают койки в реанимации в течение нескольких недель.

The situation with the Covid-19 in the megacities of the world. Аналитическая справка к докладу (скачать .pdf)

Авторы доклада благодарят зарубежных коллег за помощь с подготовкой материала: Профессора Жильбера Массара (Франция), врачей-реаниматологов из Германии — Дмитрия Зубовского, Алексея Фомина, врача-инфекциониста Дина Авербух (Израиль), врача-реаниматолога Михаила Неклюдова (Швеция), профессора Сергея Кима (Корея), Сергея Майера, и др. Отдельное спасибо за подготовку аналитического материала Мариям Акбаевой, эксперту Фонда Международного медицинского кластера, а также Юрию Сафронову, спецкорреспонденту «Новой Газеты» в Париже.