For the past five years, nurse Svetlana Shchedrina has been stowing away protective masks and latex gloves. Right now she has two large boxes of each.
Shchedrina, 37, told The Moscow Times she was forced to start stockpiling after the tuberculosis hospital in the Urals city of Kurgan where she works stopped providing its staff with more than two or three sets of masks and gloves to use over a 24-hour period.
“We wash our masks, dry them, wipe them down with towels and then use them again,” Shchedrina said by phone Wednesday.
Now, as Russia braces for the coronavirus pandemic which has already swept across a host of other countries, Shchedrina is taking stock of what she has in preparation for receiving coronavirus patients, should Kurgan be hit. At the moment, the city has not reported any cases.
But as The Moscow Times reported Wednesday, medical experts are raising questions over the efficacy of Russia’s testing procedures, which may have resulted in much lower official infection numbers than the reality. As preparations step up, attention is turning to how the country’s struggling healthcare system would cope with a surge in patients.
On paper, Russia looks well prepared to deal with a widespread coronavirus outbreak. Only five countries in the world have more hospital beds per person, according to World Health Organization (WHO) data, and Russia has a higher proportion of doctors than most richer countries.
But Judy Twigg, a professor at Virginia Commonwealth University who has been studying Russia’s health system since the 1990s, said the theory belies reality.
“If you dig beneath that surface just a little bit and start to ask questions about what those hospitals actually look like, how well those personnel are trained, what the logistical setups are and overall quality control, then we have some serious doubts about the robustness of the system,” she said.
Twigg and others also questioned the reliability and relevance of the top-line statistics on Russia’s health system, as information and data can be closely guarded. In a shocking report published just weeks ago, a state watchdog found that a third of medical facilities in Russia had no running water and 40% lacked central heating.
Experts also pointed to weaknesses in the set up of individual facilities which could be exposed as infections grow.
“We don’t have enough beds in intensive care units (ICUs),” Vasily Shtabnitsky, a Moscow-based pulmonologist told The Moscow Times.
“In general, 10% of all hospital beds should be in ICUs,” he said. “But in Russia, it’s only around 5%. What that means is that hospitals are not ready for a large increase in seriously ill patients.”
Shtabnitsky explained that Russian hospitals typically only have wards for either basic or intensive care. That means patients with moderate conditions often end up in ICUs, potentially taking up beds, ventilators and caregiving. Moreover, those wards are already largely “occupied,” Shtabnitsky says, with little spare capacity.
Heightened risk
In the context of a pandemic, Russia’s weaker record on infection controls within hospitals could also put vulnerable patients at heightened risk, Twigg said.
“A lot of these people, for whom there isn’t space in high-level ICUs, are going to be put on wards with other patients,” she said. “And you worry that people who might just be sick with influenza might have patients next to them with the coronavirus.”
A curiously-timed spike in pneumonia cases is already exerting extra pressure on ICUs in Russia, Shtabnitsky added. Last week, the RBC business daily reported that Moscow saw a 37% increase in pneumonia cases, a phenomenon doctors are noting around the country. Even Russian lawmakers have begun raising fears that misdiagnosis could already be rife.
Like in many countries, Russia’s authorities have already started scrambling to address some of the potential pressure points. Construction started this week on a new coronavirus treatment facility outside Moscow that the city wants to have completed within weeks, and there are reports of local authorities starting to order more respiratory ventilators. Russian medical website Medvestnik reported that Moscow has launched a tender for more than 150 new ventilators, while several other regions have also issued public procurement notices in recent days.
This quick response is one area those with experience of Russia’s health bureaucracy say it is strong in.
“Historically, the health system of the U.S.S.R. and Russia was built on the basis of mobilization — it is militaristic, even — because governments were preparing for an emergency,” said Yury Krestinsky, who previously worked in Russia’s Health Ministry and now leads Sberbank’s healthcare business.
Krestinsky hopes this feature of the system could allay concerns about a lack of capacity in ICUs. For instance, he said that of Russia’s 800,000 regular hospital beds, 15% could be quickly transformed into intensive facilities, meaning 120,000 patients with more serious conditions could be treated at one time.
“Of course we don’t have enough money for everything in our medical care system, but if we talk about emergency mobilization, this still works and it works well,” he added.
This capacity to marshal extra resources is already being called upon in Russia’s response to the coronavirus, with Russian prisoners, students and military personnel being asked to produce medical masks and other equipment to avoid a shortfall.
But Russia’s wider defensive policies have also undermined its health system, experts, professionals and NGOs say. Moscow has stepped up its import substitution drive in the medical sphere in recent years, tightening the screws on what equipment and medicines hospitals and pharmacies can buy from abroad as recently as summer 2019.
“There’s a real question mark about the Russian production of the kind of antivirals that we hope will turn out to be effective against the coronavirus,” said Twigg.
She added that if advances are made on treatment or vaccinations, in the current set up, “it’s not clear that kind of avenue is going to be available to Russian patients.”
Doctors’ concerns about the quality of Russian-produced equipment being used in hospitals have also grown in recent years, Shtabnitsky said. Last summer a dozen Russian healthcare NGOs wrote to President Vladimir Putin calling for the government to rethink a proposed ban on importing some kinds of ventilators from abroad. The letter went unanswered, one of the signatories told The Moscow Times, and the ban came into force.
Commentators also point to sharp regional disparities in the quality of healthcare in Russia.
“There is a big difference between Moscow and the regions,” said Ivan Konovalov of the Doctors’ Alliance, an independent trade union linked to Kremlin critic Alexei Navalny. “In Moscow, there is more money, there is equipment and there are doctors. Lots of doctors are forced to move to Moscow because of low salaries in the regions. Moscow is not so bad, but still quite bad.”
“But in the regions it’s catastrophic,” Konovalov added. “They don’t have enough doctors, hospitals are in a really bad condition and they don’t have sufficient, modern equipment.”
“The medical system in Russia is not at all ready for the coronavirus — or any other pandemic.”
While some governments have taken drastic steps to address shortfalls in equipment — British Prime Minister Boris Johnson publicly called on the country’s manufacturers to switch their assembly lines to start churning out more medical ventilators — Putin has insisted Russia has the situation “under control,” saying it effectively contained the virus by sealing off Russia to travelers from China in the early days of the outbreak.
While not everybody buys that argument, and as Russians digest stories of a health system at breaking point in northern Italy, few want to find out just how well Russia’s system would hold up if tested to the extreme.
“Let’s hope that we manage this situation with little bloodshed,” Shtabnitsky concluded.
