‘I plan on working in diapers’ Doctors treating Russia’s coronavirus patients talk about their difficult job conditions, access to protective equipment, and the struggle to get tested
The number of Russians diagnosed with COVID-19 has already surpassed 62,000 people. In order to cope with this influx, more and more hospitals are being either partially or fully reassigned to handle coronavirus patients and are only admitting confirmed or suspected cases. The medics at these clinics, who are now working with COVID-19 patients every day, told Meduza about their working conditions, the availability of medical supplies, how they cope with the fear of getting sick, and what their administrators are telling them. As it turns out, the supply of personal protective equipment varies radically from clinic to clinic — but according to the medical workers who spoke to Meduza, the main problem for most hospitals is testing the doctors themselves.
Please note! This text has been edited and condensed for length and clarity. The names of the doctors interviewed have been changed at their request. Also, all Meduza content about the coronavirus pandemic is free to distribute according to Creative Commons CC BY 4.0. You can republish this stuff! (Except for any photographs featured in our stories.)
Coronavirus patients began coming to us around April 10. Around April 15, they told us that we would be fully transitioning to coronavirus [treatment]. The unit on the ground floor was converted into cubicles; they made a laboratory there. All of the patients needed to be discharged in two days — they were transferred to the districts. After the 17th, we stopped working with non-coronavirus patients. We only just started working so there are still free spaces. I work in cardiology; now we have patients with cardiological diseases, in conjunction with a coronavirus infection. On April 19, there were six people. Our [department] head told us that we will have 15 beds all total.
The administration here organized everything in such a way that the men went [to work] in the “contaminated zone” first. The women are working, but they are in the “clean zone,” doing paperwork. Nobody criticized this approach and it’s correct from my point of view, as well. In the “clean zone” we put on [protective] suits, respirators, caps, glasses, two pairs of shoe covers on our feet, and two pairs of gloves on our hands. Spaces that could open up are plugged with tape. After that we go to work in the department.
The shifts are different lengths for different personnel. In our department specifically, the doctors and nurses are working in pairs for 12 hours at a time. The shifts go day, then night, then a day off. We go into the “zone” in pairs and if there’s little work, then one [person] can go out and rest. We have organized meals and dedicated rooms for resting. They’ve organized dormitories for those who are living on hospital grounds.
The question [of how to go to the toilet during a shift] wasn’t even brought up here. I read some of the channels on Telegram and bought myself a pack of diapers. I plan on working in diapers.
After we have worked our shift we are treated with bleach on the outside, then we remove the protective gear. All of this has two dedicated rooms. In the first room we take everything off except for the respirators and the lower layer of gloves. Then we go to the next room and [take off] everything else. We only have two showers and everyone changes shifts at the same time, so there is a 20–30 minute lineup.
At the moment there is no information about infections among employees, but yesterday a nurse came to us from the intensive care unit who had been in contact with [COVID-19] patients. She arrived with a temperature and a dry cough. I don’t know her test results yet.
We have concerns regarding protection, from a legal point of view. We didn’t enter into any additional agreements in our employment contracts, saying that we agree to work in a quarantine environment. When I asked my manager about this, no one knew anything about it, not just in our department but in the others, too. Yesterday I brought this to the attention of the administration once again. They said everything should be [in place] this week, they will work on it. So far, silence. For me this is just unpleasant. It seems to me that this is an essential matter for our protection; additional pay and everything else. So far we have not been paid since we started working with these patients.
What’s more, a medical test is supposed to be run on the employees working in the “contaminated zone” once per week, or right away if symptoms occur. I was tested on [April 13]. Accordingly, they should have taken me for testing again on the 20th. I called the senior nurse and at first she said she knows nothing about it. Then she said that there would not be testing [until later], because the laboratory is overloaded. So there has already been a violation of the recommendations.
All of this impacts the medical side of [our] work, as well. For example, in Russia there are no clear recommendations as of yet [about] which treatment methods to choose for certain diseases, if the [person] is also a confirmed coronavirus patient. There is the experience of our Chinese and American colleagues, but in Russia there are no clear instructions so far.
Everything else here is not so bad. They’re feeding us, there’s PPE, the administration understands that protecting personnel is the priority. I can say immediately that we are not hiding anything [regarding the scale of the pandemic]. Everything is clear-cut here. We take tests and the analysis comes back. There are no orders not to write this or not to diagnose that.
We don’t have any military-style speeches in the hospital. But when our first guys went into the “zone,” the department head said that they were like Gagarin (this was around Cosmonauts Day). But she has this feeling of being lost, it’s palpable. Today we had a conversation about the procedure for discharging patients and nothing is clear yet. So there’s no military rhetoric. I’m calm enough. I was working and I realized that it’s quite possible to live in this suit.
For almost three weeks we have been working on adapting our hospital to receive patients with coronavirus. We created streams, there is the “clean” zone and “contaminated” zone, and the flow of people does not cross paths. Now we are completely dedicated to working with the coronavirus, because there’s no other way: we have one big building, not several blocks.
Before starting this work the doctors were offered [the option] to live in hotels temporarily, so as not to risk the health of those close to them. This question arose immediately — like in other countries, numbers among doctors are dismal. Many here are afraid of infecting their parents or children: 70 percent of our doctors expressed a desire to live somewhere [else] while [doing] this work.
They told us that we would be living in a hotel that was built in the ‘70s, which has not been renovated in a long time. We went there to check in and they began to place us in [groups] of five people in quadruple rooms, then we found out that there were not even four places, but rather two double beds. They gave us a simple answer to the question of where we will sleep: “You’re working in shifts. When you’ve left for your shift [and] removed your bedding, someone else will take your place with their own sheets. And so you switch!” Of course, this is brutal. We made a big fuss and we were relocated to a nicer hotel. We are living there in pairs.
In practice, we opened to coronavirus patients on April 16. Of course it was scary. The preparation for this was so dragged out that it completely exhausted us. It’s sort of like you accept the situation, resign yourself [to it], and then it all starts again: denial, anger, depression.
Overall we have 400 beds in the hospital, everyday we admit about 60 people. Now the hospital is half-full. Because of the lack of PPE we have reduced the number of people on shifts. Now it turns out that two nurses are working on 30 patients. These are absolutely different working conditions and it's a different specialty. For many, all of this is really a terrible shock.
We have 12-hour shifts. We spend 5.5 to 6 hours in the “contaminated zone,” then we exit the “zone,” wash ourselves completely, eat lunch and go back. But in general, a system has not been established and worked out yet.
In terms of protective equipment we have everything. At the beginning, I said to the department head “You provide me with PPE and I will provide you with good work. As soon as anything runs out, I will not work.” He told me: “Yes, we have an agreement.” So far we have everything, but not much of it.
Of course, working in this protective gear is really terrible. The worst thing is the glasses. They fog up and I don’t know how to deal with it. The work itself has also changed. Usually I am a scrub nurse, but now everyone has gone to work in the office. I went to the intensive care unit — I chose it myself. I know myself, I simply can’t work in the office. It doesn’t interest me.
Of course, now everyone is in complete shock. Nobody knows anything, nobody understands anything, nobody has any answers for questions. There are more and more questions [...] But obviously this is a very extraordinary situation. The employees themselves have very different feelings. When they told us about the hospital’s [infectious disease] future, they asked whoever wanted to leave to please [go]. From my department nine people left, they applied for three months unpaid leave. They made it clear to us that for those who leave now it will be difficult to return. They will have to analyze each case individually and look at the reasoning behind such a decision.
I had no such thoughts. From the beginning I understood that this is my profession and that I was somehow prepared for this. When this all started, I was ready for it. You are already struggling with yourself, trying to train yourself, in order to improve your emotional state. I can’t speak for everyone but I have these fears; I’m afraid of not coping [and] letting someone down. If this fails, if emotionally I can’t do it, it will be physically difficult for me. Because I am not afraid for myself. I consider myself a healthy, young, [and] able-bodied individual. I hope that even if I do become infected, it will not be difficult for me to carry on. For now all of our doctors are working, but they are not testing us. In general, they don’t say anything about this at all.
Our hospital takes people from nearly half of the Moscow Region. We have several buildings and at the end of March one of the three-story buildings was designated for the coronavirus — there were 250 [beds] there. They filled up quickly and since last Monday the hospital has been completely closed for intake admission, it’s only accepting COVID-19 [patients]. Only one building remains for other diseases. They are treating the seriously ill patients there, and they're being discharged.
At first everything here was very poorly organized. At the entrance the employees could record whatever temperature, disposable robes were worn multiple times and quickly fell apart. Now the “clean zone” has been done well — one department has been allocated for it, there’s enough reusable suits and respirator-masks, for now.
Around 40–70 patients come to us daily. In general, they said that 50 patients will be coming to us. When I was on duty, these 50 people arrived around 4 or 5 p.m., but afterwards [more] people were brought in anyway: some of them thanks to a personal arrangement, some simply because they were taken from somewhere in [the Moscow suburb] Lyubertsy — there’s no turning around.
I work with CT scans and all of the patients are sent to us immediately. Generally, the workload is high now, there’s one-and-a-half to two times the number of CT examinations. Nearly all of them have viral pneumonia. The workload is high: normally I am on 24-hour call every five [days] — now it’s every three [days].
There weren't any motivational speeches from the administration here. And so it’s clear that the responsibility for the patients is on our shoulders. You have to put up with it and do some work. It’s wrong to take sick days or take leave at your own expense. Another thing is that the management should provide us with everything we need — I am afraid that in 2–3 weeks the suits will be worn out, the masks will run out, and they won’t bring us new ones. This is unsettling.
In general, a kind of paranoia has developed — every 10–15 minutes you’re washing your hands, wiping something. But in general it seems to me that I have already been ill in a mild form. About a month ago my wife had a type of cough. Perhaps we were ill, but we certainly won’t find out unless there will be mass testing for antibodies. So I continued to work. As a conscious citizen, I turned in swab samples twice, but they didn't send me the results. As far as I know, because of the workload for the laboratories now, the results only come back if it's positive. Of course, you could stay put and sit at home for two weeks without getting paid. But back then we had a lot of people walking around sniffling — it’s that kind of weather, and the time of year.
In this case, giving the swab sample was at my own initiative. In general, the doctors who are working with these patients should be tested weekly, but it’s not happening here.
I work in intensive care in one of Moscow’s hospitals. It has not been repurposed and has not been closed for quarantine, although patients with coronavirus began to appear more than a month ago. Practically every day suspected coronavirus patients are brought to us, we are all in contact with them, but we don’t have protective equipment. They bought the minimum — maybe 20–30 suits. This is a typical situation: a patient is brought in with a temperature, he lays here for a few days, everyone comes in contact with him and then the [coronavirus] test comes back positive. After that everyone puts on [protective] suits and waits for the team that takes patients to Kommunarka. It’s a damned circus.
Due to this complete [lack of precautions], about fifteen doctors here have already fallen ill. The majority of them tested positive and are sitting in self-isolation at home. Many continued to work with a fever: if all the employees with symptoms went into quarantine, there'd be no one left on the job.
In theory we should be closed for quarantine, but in practice they aren’t taking any protective measures. There’s no protective equipment, at most they wipe down [surfaces] with a wet cloth. They made us sign papers saying that we are working with protection, but [when] Rospotrebnadzor comes to verify this they greet the management and [then] leave.
Meanwhile, the hospital is continuing to schedule appointments. Many departments are carrying out planned operations: either they change the statements — claiming it’s an urgent operation — or they simply do it for a fee. The entire country is closed, but an individual [can] still come here, walk around the hospital, come in contact with all of the doctors, have their operation and [then] leave.
We, the employees, do not understand why this situation has developed. There’s no dialogue with the administration. We thought that the head doctor here would soon be dismissed, but, on the contrary, the other day he was promoted. And even if the doctors understand all the risks of the situation and try to diminish contact [with patients], the nurses and nurse’s aides have no choice. For them, that salary of 40,000 rubles [$535] is a lot of money. They can’t lose [that].
I work in the intensive care unit of the Botkin Infectious Diseases Hospital. We have only confirmed coronavirus patients. In our intensive care unit specifically, there are usually six to eight people in twelve beds. 50–60 percent are gravely [ill]. The rest do not require mechanical ventilation. But this situation is constantly changing, the data quickly becomes irrelevant.
According to stories from colleagues working in other hospitals, I’ve come to the conclusion that the work in our department is being done exactly as it should be during this kind of epidemic situation. All of the employees are well protected, there’s zoning rooms and protective equipment. In the “contaminated zone” [you] strictly work for four hours at a time. Then sanitizing, shower, clean hospital pajamas, and rest.
I know that in many hospitals they are working for more than four hours at a time. But this is not right. Our patients are seriously [ill], they require careful work. It’s physically difficult to go for more than four hours in tight fitting masks, glasses, suits, and so on.
Because of the way things are organized here we have no patients among the hospital staff, they all give swab samples daily. There are people who are on sick leave but none of them are confirmed coronavirus [patients]. Either [they have] a cold or another disease unrelated to the coronavirus.
We have more work, including paperwork. We are sending reports on the status of patients more often. Plus a mandatory daily video call with some Moscow colleagues about pregnant women who are currently in the department. There is little real [input] from them, because the people there understand that the doctors on the ground have a more complete picture, and they generally agree with our chosen tactics.
To the conspiracy theorists, I would say that there are probably more patients who have gone through a mild form [of the coronavirus] than in the official data. There will not be an exact number until there is mass testing. But we are certainly treating all of the serious [cases].
While we are dealing with everything, there are no critical moments. There’s a fighting spirit. Swine flu and SARS knocked us around, but we handled it. We'll handle this, too. You and I know it.
Translation by Eilish Hart