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‘The morgue is full’ Medical workers offer an inside look at how the second coronavirus wave is impacting Russia’s hospitals

Source: Meduza

In Russia, the second wave of the coronavirus epidemic has already begun. Every day, the country is registering approximately 500 more cases than the day before. The majority of Russia’s regions are experiencing similar increases, including in Moscow — on October 2, the capital recorded 2,704 new cases of COVID-19. Many doctors have returned to working in “red zones” in hospitals — including those who went back to providing routine medical care after the end of the first wave. In their own words, healthcare workers treating coronavirus patients tell “Meduza” what’s happening inside Russia’s hospitals amid the pandemic’s second wave.

Please note. The following interviews have been edited and abridged for length and clarity.

Mikhail

Doctor, Krasnodar Krai 

We’ve had a backlog at our hospital for the last five days. The day before around 80 people were admitted, the day before — 115. There’s no lines of ambulances, patients are accumulating in the emergency room. It takes three to four hours to get from the door of the department to the hospital’s wards — we only have one CT machine, which performs more than 80 scans per day.

We have 88 hospital beds in the department — yesterday they were completely full. There’s no couches on our floor, so no one is lying in the hallways, but there are many [lying in the hallways] in other departments. Intensive care is full, the morgue is full. Work piles up over the weekends. 

One of the main problems is a lack of personnel. According to the Health Ministry’s standards, we should have twice as many of us: it says there should be 20 beds per doctor, but we have 45. Many are getting sick among the staff. Our department has kept its specialists on for a long time, but since [the beginning] of October we have a hodgepodge of cardiologists, surgeons, endocrinologists, and others. This slows things down.

We’re burnt out. Patient deaths aren’t felt as acutely. For me the worst was on Medical Workers’ Day [June 21]: a patient died at the end of my shift. We [tried to] resuscitate her for a long time, [working in a protective] suit is very difficult and hot. We took her to the intensive care unit, intubated her. All according to protocol, but it had no effect. Later, I took her to the morgue: there’s a ramp there, the nurses can’t cope alone. That’s how the holiday turned out.

We expected to get back to normal work in the summer. In August, I got sick — there was no normal life anyway, of course, it didn’t happen.

We’ve already gone through a wave and a half: there was an outbreak in Krasnodar during the holiday season. Quite often the patients lie [there] and wait for two negative swab [tests], when their treatment has already ended. They take up a bed and bother us with questions about getting discharged and [tested]. The swabs are taken according to Rospotrebnadzor’s standards, and it takes a long time. [Besides] we aren’t involved in discharging, [it’s] the doctors in the “clean” zone. It turns out that we’re like robots. [Only] we follow the instructions, but at the same time, we’re the ones coming in contact with the patients. It’s hard.

The second wave is in full swing: people are calling from everywhere with questions about “corona,” there’s a lot of patients. I’ve had enough of covid. It’s clear that everyone will get sick. Perhaps the vaccine will save [us], but this isn’t a quick matter and we need to work now. I really want to do my job and [challenge] my intellect more. I went from being a cardiologist to being a covidologist. 

Alexander Marakhovsky 

Paramedic at a coronavirus hospital, Ulyanovsk

Our healthcare system wasn’t prepared to undergo the first wave, for such mass infection. Many heads of medical facilities acted incompetently, the funding flows from Moscow were diverted for other purposes, bonus payments for [working with coronavirus patients] were withheld, and there was a lack of PPE [personal protective equipment] and masks. Over time, many leaders began to help their subordinates, they started purchasing ventilators, medicines, and paying [salaries] according to legal orders. Although some of them are ‘ripping off’ [embezzling public funds], just like last time — they’re simply in a frenzy over the cash flow.

Initially none of us believed in covid, but when many of our friends and relatives started to get sick, the situation began to change. I didn’t believe in it myself until I started working at the covid hospital in May. When I saw everything that was happening with my own eyes, including many deaths, I had a feeling of fearlessness and a lack of self-preservation instinct. Many medical workers started joining special departments and brigades, and saving people’s lives.

In the hospital it was like a war: 100 people in each ward, who were just choking and coughing. Lack of medical workers, lack of essential drugs, and medical equipment. Sometimes we had to spend 20 hours in the “red zone” in a day. 

I think the second wave is more dangerous than the first. Many [of my] young colleagues from [other] clinics and hospitals have started to get sick with viral pneumonia, as if the virus has started mowing down everyone indiscriminately, including young people. 

Now we’re waiting for the vaccine. But we’re still very worried because we don’t know what surprises await us in the future. Overall, everyone is very tired and [you] basically just want this virus to bypass your loved ones. 

Valentina Beletskikh 

Paramedic, Novgorod Region

When the first wave began to march across the country, we were faced with the fact that the leadership of our emergency department didn’t want to take care of protective equipment for the paramedics, who continued to go out in masks and gloves that had been used many times. We brought up this issue and the chief physician replied that there wasn’t any money for respirators.

Then one day they sent me on a call without protection — and the patient turned out to have bilateral pneumonia. I think that this case influenced the fact that literally the next day they brought us all the personal protective equipment. 

When the first wave began, at first it was scary, of course. I went through distance medical training, I read everything very carefully. After one of the cases — the patient with bilateral pneumonia — I sat for three days, processing the situation, thinking about what might happen. I wasn’t afraid I might get sick myself, but that I would bring it to my children.

But once we got PPE, in part thanks to the help of volunteers, it wasn’t so scary. If you put on PPE correctly it’s difficult to pick something up — but you have to follow safety precautions.

I think the second wave is swinging [in] now. Our work [already] looks exactly the same as it did in the spring. [But] now the coronavirus tests are only done on those with obvious symptoms. They’re not [testing] those who have respiratory infections or bronchitis; probably the hospitals have no money or they were told not to [test]. 

Pyotr 

Doctor, St. Petersburg

The first wave was full of horrors for me. At first I ended up in observation: I was in contact with a covid-positive patient for nine days. They paid us very little money, the treatment tactics were constantly changing, there was no clear treatment for the infection. There wasn’t enough staff per shift, we worked 12 hours every day. We were completely in the dark, we had to work in accordance with the Health Ministry’s methods only. 

There were a lot of deaths. It was scary for me, when people came in on their own two feet, ended up in intensive care the next day, and died a few days later. My colleagues and I experienced a crazy change — many of us [are experiencing] psychological problems. I personally see a psychotherapist. After two months of summer I got back to regular life a bit, but this only worsened my condition — I was alone with myself, my health went downhill.

The second wave has already begun to accelerate — like it did in April. I don’t think the authorities and our leadership will step on the same rake a second time — now they are more prepared. I hope that this time it will be easier. There will be a clear plan, some orders and clauses that can be referred to, rights. Working in such conditions is easier and more understandable. In the spring we worked like blind kittens. 

Hopefully the vaccinations will start as quickly as possible. Hopefully there will be fewer patients. In general, there’s a slightly different attitude towards the coronavirus among medical workers who worked in the “red” zone. Many people [who have not encountered it] simply don’t care about the coronavirus, many people still think that there’s no covid. I saw how people “burned out” in two days — I treat it differently. I’m tired of this tense epidemiological situation and the constant talk about it. But you can’t take the coronavirus lightly. This carelessness brought us into the second wave.

Igor

Emergency care physician, Moscow 

The first wave went badly. Many of our colleagues were dying, and everything was bad for the patients too. The healthcare system wasn’t ready. The worst thing in practice was when the patients refused hospitalization — they were afraid that covid was everywhere in the hospitals.

Over the summer I managed to return to more or less normal life, but I still follow the safety measures. My attitude towards covid hasn’t changed, I still take precautions. Although, of course, I’m tired of it. Tired of putting on a [protective] suit, constantly working in it. It’s hard to breathe in it, you sweat in it. You go to the next patient all damp — now we’re working without entering [the substation], there’s call after call and no opportunity to change.

Now the calls for covid have increased — we’ve had to start going out more often, compared to the summer. In that period there were 2–4 calls [per day], now nearly half our calls are about covid [cases], that is, about 7–8 calls per day out of 15. The growth shown in the statistics is noticeable. 

Now there are a lot of hospitals in Moscow, they admit [patients] promptly, so there’s no lines of ambulances. But there’s a feeling that problems with hospitalization are about to begin: the headquarters for coordinating the hospitalization of each patient recently refused to give [someone] a place [in a hospital], even though it was a serious case. The head of our hospital told me that perhaps this is a new trend from senior management — they want to lower the number of hospitalizations for pneumonia. Maybe it’s related to the fact that they want to lower the statistics, or to some other factor.

I think that everything will be worse now than during the first wave, since the growth has already begun, and they haven’t introduced restrictive measures yet. Now young people have begun to fall ill already too, many of them aren’t taking any precautions.