stories

‘Get sick or get vaccinated’ Heading into the coronavirus pandemic’s second wave, St. Petersburg’s hospitals are facing cuts

Source: Meduza

Rising infection rates and the most coronavirus deaths per capita

During the peak of the pandemic’s first wave in mid-May, St. Petersburg was recording more than 500 new coronavirus cases per day, according to official statistics. But these numbers started to decline steadily from the beginning of June onwards.

At the time, Meduza wrote about this strange, uniform decline, which was recorded in a number of regions in the weeks leading up to the nationwide vote on constitutional amendments. At the same time, St. Petersburg began to lift lockdown restrictions. City residents were allowed to be on the streets without masks or gloves, and non-essential businesses, like hair salons and summer patios, opened up again. 

St. Petersburg has seen the incidence of the coronavirus decline throughout the summer — with the exception of a two-week period in late June and early July, which saw the nationwide vote, the Victory Day parade, and widespread disregard for quarantine restrictions. By August 8, it had fallen to 155 new cases per day. After that, this indicator began to rise once again, reaching more than 200 new cases daily as of September 23. Other regions began to experience a similar spike — on September 19, 6,065 people in Russia were diagnosed with COVID-19 in a single day; the highest number recorded since July 20. This rise continued in the days that followed — 6,431 new cases were confirmed on September 23. 

At the same time, there hasn’t been a significant increase in the number of tests being conducted in St. Petersburg. In the past week, 12–24 thousand people have been tested per day. In the first week of August, this number ranged from 9 to 19 thousand people. That said, according to data from the sorting center at the Berezina Medical Institute, an increased number of people are being checked for pneumonia. Patients at the sorting center undergo medical examinations and CT scans, and are sent to a hospital or for at-home treatment accordingly. Since September 1, the clinic has examined between 170 and 194 people daily — from mid to late August, this figure hovered around 110.

According to official data, in Russia, St. Petersburg is second only to Moscow in terms of its total number of coronavirus deaths — 2,817 compared to the capital’s 5,100. However, St. Petersburg is leading in terms of the number of deaths per capita with 52.6 per 100,000 people (Moscow is in second place with 40.8 coronavirus deaths per 100,000). And the city’s overall mortality rate for the past seven months has increased by 14 percent compared to the same period last year.

The head of St. Petersburg’s working group for countering the coronavirus, the director of the Almazov National Medical Research Center, Evgeny Shlyakhto, emphasized that there are a lot of young people among the dead. “We thought that young people get sick less, [but it turns out] they get sick often,” Shlyakhto said, without naming any figures.

The city authorities have also acknowledged the spike in the number of cases, regardless of the fact that they lifted all restrictions in mid-September. However, St. Petersburg’s Deputy Governor Evgeny Elin underscores that the rise in the incidence of the virus was expected and isn’t critical. The transmission rate, known as Rt, has already exceeded one. In the past, the authorities used this value as the basis for lifting restrictions.

Hospitals at capacity leave ambulances waiting outside

By mid-September, against the backdrop of the rising number of infections, just 15 percent of St. Petersburg’s hospital beds remained available. What’s more, compared to the peak of the first wave in May–June, the total number of beds had been reduced nearly threefold — to approximately 3,500. 

One week on, the situation has gotten even worse. By September 22, the number of free beds available to COVID-19 patients in St. Petersburg’s specialized clinics decreased to six percent. In response, the authorities have begun rolling out new beds once again — healthcare facilities that had returned to normal work after the spring peak were converted back to coronavirus treatment centers. Specifically, they’ve already opened a new, temporary infectious disease hospital with 300 beds at the Zarya Guest House in Repino, on the outskirts of St. Petersburg — in the spring, it admitted patients with moderate cases of COVID-19.

The rise in the number of cases means other facilities will be reprofiled, as well: during the summer, some coronavirus hospitals had begun offering routine appointments. On September 23, the St. Petersburg Healthcare Committee reported that the number of free beds had been raised from 6 to 20 percent. The total number of beds available to COVID-19 patients grew to 4,000. 

Meduza spoke to four medical workers from various St. Petersburg hospitals. They all noted a marked increase in the in-flow of patients in September — but it still hasn’t reached the level seen in the spring. The St. Petersburg-based news outlets Bumaga (Paper) and Fontanka have made similar reports. For example, employees at St. Petersburg’s Pokrovskaya Hospital told Fontanka that they’re admitting 40 to 60 people everyday, whereas in August they were admitting 10 to 20 people. 

Speaking anonymously, a doctor at the Pokrovskaya Hospital told Bumaga that in September, ambulances with patients have had to wait in line outside of the hospital once again. Fontanka wrote about this too. Moreover, there were no free beds inside the wards; spare cots have been set up in the hallways. Medical workers from two other hospitals in St. Petersburg confirmed for Meduza that patients there are being forced to stay in hallways, as well. 

At the same time, doctors underscore that they’ve been preparing for this situation in advance: employees at many St. Petersburg hospitals were told in the spring that they would have to work with coronavirus patients until October or November at the very least. “This [increase in morbidity] is predictable. You’ll either have to get sick or get vaccinated,” a Pokrovskaya Hospital employee told Meduza. 

In a previous conversation with Meduza, epidemiologist Anton Barchuk explained that St. Petersburg was expecting a second wave in the fall — an influx of people coming back to the city from their summer cottages, in combination with students heading back to schools and universities, would mean increased contact between people. 

At the same time, healthcare workers who spoke to Meduza noted that the majority of hospitals are no longer having problems securing personal protective equipment (PPE) — they even have stockpiles. As a result, there have been fewer large-scale outbreaks at medical facilities. There is only one known recent outbreak in St. Petersburg — at the Mariinsky Hospital. As one of the hospital’s employees told Bumaga, at the beginning of September a girl who had tested negative was admitted with coronavirus symptoms. During this time, she managed to infect her neighboring patients and several doctors. How many people became infected remains unknown. The authorities reported that between late July and early September, more than 200 people fell ill at the Mariinsky Hospital. 

In addition, St. Petersburg doctors say that the majority of hospital employees have already had the coronavirus — many of them had it at the very start of the pandemic, when the city had problems providing PPE. According to them, at least two-thirds of hospital employees were infected at their institutions. 

According to official statistics, more than 7,000 medical workers in Russia have fallen ill over the course of the pandemic. The unofficial “Memory List” — where healthcare workers record the names of their colleagues who have died so far — includes the names of 69 medical workers from St. Petersburg and 15 from the Leningrad Region.

Second wave met with funding cuts rather than quarantine restrictions

The St. Petersburg City Administration says it’s not planning to introduce any new bans or restrictions. Deputy Governor Evgeny Elin has emphasized that the administration doesn’t even have an estimate of the level the morbidity rate would have to reach to warrant a lockdown. 

Meduza’s source in the St. Petersburg City Administration explained that the authorities are “completely focused” on containing the second wave without shutting down food services or taking any other radical measures. This is largely due to the fact that the economy has suffered during the pandemic. St. Petersburg Governor Alexander Beglov said back in May that in 2020, the city would see about 100 billion rubles in lost revenue because of the pandemic (approximately $1.3 billion). 

In this context, hospitals are being forced to economize — including those facilities treating coronavirus patients. Fontanka reported that this will even impact the Botkin Infectious Disease Hospital — St. Petersburg’s leading hospital in the fight against COVID-19. Among other things, it will have to cut employee salaries and save on public procurement. The hospital confirmed that they are “optimizing” costs — including through “incentive” payments for staff. Doctors are set to see a potential shortfall of 86 million rubles ($1.2 million) by the end of the year — about 110,00 rubles ($1,428) per person on average. 

Three doctors from other city hospitals told Meduza about similar cost-saving policies. They said that currently, hospitals are trying to accommodate as many patients as possible, so they’ll receive payments under the compulsory health insurance system. “Right now my hospital is trying to make money so that it won’t be left with a bare bottom. They’re paying in pennies,” one of the medical workers said.

The doctors are convinced that they won’t be paid the bonuses they are due for their work during the second wave (hospital administrators deny this). Moreover, according to Meduza’s information, not all St. Petersburg doctors have received the bonus payments they’re entitled to for working during the first wave. “Doctors, nurses, cleaners, and nurses aides worked [with the coronavirus in the spring] specifically because of the [increased] salaries. Only workaholics and those who have nothing to lose would work in such conditions for pennies,” one St. Petersburg doctor stressed.

According to the medical workers Meduza interviewed, they’re expecting “the real second wave” a little later: staff at some hospitals that haven’t been treating coronavirus patients have been told that their facilities will be re-profiled as of October 1. The employees at hospitals where work with coronavirus patients has been limited to their infectious disease departments have received similar information.