As Coronavirus Overruns Russia, Doctors Are Dying on the Front Lines
Facing dire shortages of protective gear and amid fears that the worst is yet to come, more than 180 medical workers are reported to have fallen victim so far and thousands have been infected.
Credit...Sergey Ponomarev for The New York Times
By May 14, 2020
MOSCOW — Dr. Rimma Kamalova says her hospital’s leadership ignored her
warnings about an unexplained pneumonia outbreak back in March. She kept
working.
The hospital admitted more than 50 people for planned procedures the day
that the staff learned a deceased patient had tested positive for the
coronavirus, records show. She kept working.
The hospital was ordered quarantined, with Dr. Kamalova and more than
1,200 other staff members and patients trapped inside. Days later, she
grew feverish, but she kept working, relying on her own intravenous line
for relief.
“Give yourself a drip, get up, treat, lie down, give yourself another
drip, get up, treat,” Dr. Kamalova, head of the rheumatology department
at Kuvatova Republican Clinical Hospital in the south-central Russian
city of Ufa, said in a telephone interview. “You had no choice.”
Russia is hailing its medical workers as heroes, their photographs
plastered on billboards and their stories glamorized on state TV. But as
the country develops into one of the global epicenters of the disease,
those workers are suffering astonishing levels of infection and death in
their ranks.
And as the number of reported coronavirus cases in Russia grows, many fear the worst is yet to come.
At one top Moscow hospital, a department head said that 75 percent of
the department’s staff was sick. In St. Petersburg, 1,465 health care
workers have caught the virus, the governor said on Wednesday,
accounting for more than one in six of the city’s total cases.
Russia’s health minister, Mikhail Murashko, said on Wednesday that 400
Russian hospitals had suffered outbreaks of the coronavirus.
Credit...Anton Vaganov/Reuters
Like their colleagues in much of the rest of the world, many of those
doctors and nurses are suffering from a shortage of protective gear and
equipment. But Russian health workers are also at the mercy of a
convoluted, depersonalized and unforgiving bureaucracy that increasingly
appears outmatched by the pandemic.
An internal federal government document obtained by The New York Times
illuminated Russia’s lack of preparedness. In late March, regional
Russian officials were sounding alarm bells about a drastic undersupply
of protective equipment and pervasive confusion about how they were
supposed to tackle the virus.
Those problems still have not been fully resolved. Now, six weeks later,
even doctors at Moscow’s top hospitals are reporting nearly
overwhelming levels of infection among their colleagues.
“I think that, as of today, I know a handful of people who have not been
sick,” Dr. Evgeny Zeltyn, a cardiologist at a Moscow hospital, said.
Dr. Zeltyn said he had been lucky: He was at work when he collapsed with
a fever of 102 degrees. He received treatment right away, spent the
night in his hospital as a patient and was back at work within five
days.
“People are fighting,” he said. “People are incredibly tired.”
Doctors say they are hampered not just by a lack of equipment and
protective gear but also by a rigid, top-down governing system that
discourages initiative and independent thinking. Medical workers who
have spoken out have faced pressure from the authorities; three doctors
who tangled with their superiors over working conditions fell from windows in recent weeks, though even the Alliance of Doctors, a medical-worker activist group highly critical of the government response, has described those as possible stress-related suicides, not homicides.
“People in administrative positions generally don’t know how to make
decisions — they know how to carry out orders,” said the doctor who said
that 75 percent of their department was sick, who would speak only
anonymously for fear of retribution. “And they keep getting
contradictory orders.”
The contradictions in Russia’s coronavirus response start in the
Kremlin. A nationwide lockdown came to an end on Tuesday on orders of
President Vladimir V. Putin, even as Russia was reporting about 10,000
new cases daily. Its total of 252,245 confirmed infections exceeds that of any other country except the United States.
Russia has reported 2,305 coronavirus deaths, almost certainly an undercount, given widespread reports of faulty testing and other causes of death being recorded for patients who died of Covid-19, the disease caused by the virus.
Russian officials, however, insist the country is now well prepared,
with a large reserve of hospital beds and ventilators, and widespread
testing that is identifying many asymptomatic carriers of the virus.
They have criticized the Western news media, including The Times, for casting Russia’s pandemic response in an excessively negative light.
The pandemic has also hit doctors and nurses in Western countries, but
the number of medical workers’ lives lost in Russia appears
disproportionately high as a share of the overall national death toll.
In Britain, at least 275 health and social care workers have died, out of a total of more than 30,000 coronavirus-related deaths in the country.
Underlining the risks of Russia’s often chaotic scramble to fight the
virus, an intensive care unit caught fire at a St. Petersburg hospital
on Tuesday, killing five Covid-19 patients, and a similar blaze at a
Moscow hospital on Saturday killed one. The preliminary cause of both
fires: an overloaded ventilator.
For much of this year, Russia seemed to be in an enviable position as
the pandemic raged through Western Europe. The government appeared to
recognize the dangers of the virus early on, closing much of Russia’s 2,600-mile land border with China in January. Two months later, Russia was still recording fewer than 100 new cases a day, and Mr. Putin said the virus was “contained” and the situation “under control.”
But behind the scenes, Russian regional officials were making it clear
to the Kremlin that the situation was not under control — and that the
medical system was ill equipped to cope with the pandemic, despite
having had two months to prepare. By late March, at least 28 of Russia’s
85 regions were reporting severe shortages of protective equipment,
ventilators and testing materials, according to a region-by-region list
of challenges compiled by the federal Emergency Situations Ministry and
dated March 29.
The 24-page document, described earlier by Russia’s Kommersant newspaper,
was provided to The Times by the Alliance of Doctors, and confirmed as
authentic by the ministry’s press office. The document was prepared as
an overview of the regional obstacles in the pandemic response, the
ministry said in a statement.
In addition to supply shortages, the document reveals confusion among
regional officials over what they were allowed and expected to do to try
to limit the spread of the virus. Federal directives carried “diverging
interpretations, with diverging indicator criteria and implementation
deadlines,” officials in the Tomsk region in Siberia said.
Regions described delays in receiving coronavirus test results and
information about travelers from abroad, and confusion about their
authority to shut down businesses, limit train travel and punish
quarantine violators. Several said they did not know where they would
get the money to finance the additional medical expenses.
“Specifics are lacking as to how medical workers working in the hotbed
of the epidemic will be paid,” officials from the Vladimir region in
central Russia wrote.
A Tomsk government spokeswoman had no immediate comment; Vladimir region
did not respond to a request for comment. Two other regions, Mari El
and Oryol, said they were now better prepared in terms of protective
equipment and hospital beds.
Some doctors have said that financial considerations, coupled with
limited protective equipment and leadership failures, helped cause one
of Russia’s worst coronavirus outbreaks, the one that trapped Dr.
Kamalova and 1,200 others in the hospital in Ufa, in the region of
Bashkortostan.
Dr. Kamalova and another department head at the hospital said the signs
of an outbreak, such as a spate of pneumonia cases, were apparent well
before the quarantine was imposed on April 6. But the hospital continued
to admit patients for planned procedures up until April 6, according to
records a doctor provided to The Times.
Critics ascribed the decision to admit patients — which ended up
exposing more people to the outbreak inside the hospital — to the
leadership’s effort to maintain the hospital’s revenues.
“The administration is hostage to the numbers,” the second department
head said, speaking on condition of anonymity for fear of retribution.
“This was a failure of the system.”
The health ministry of Bashkortostan is investigating reports of earlier
cases of pneumonia at the hospital, a spokeswoman for the regional
government said. Nine Covid-19 patients have died at the hospital, she
said, none of them health workers. She said the government could not
comment on any financial motives in the hospital leadership’s actions
and noted that the planned patients admitted on April 6 had arrived
before the quarantine was put in place.
“Medical workers continued to work in near-wartime conditions,” the
spokeswoman said, describing the state of the hospital during
quarantine. “The mood has now gotten better and the doctors are prepared
to keep working.”
Within days of the lockdown, doctors and nurses started falling ill,
according to interviews with five people who were inside the hospital
during the quarantine. Wards on the second floor were set aside for sick
medical workers, but it was not enough. In one case, patients staged a
protest when doctors and nurses were hospitalized in an adjoining room.
Reinforcements arrived from other clinics in the region, and the sick
medical workers gave the new arrivals a crash course in treating the
coronavirus. Some nurses-turned-patients set intravenous lines on each
other rather than entrusting their colleagues from outside clinics to do
the job.
“You didn’t realize how this transpires, how bad this can get,” one
medical worker said, describing the experience of catching the
coronavirus on the job, “when they don’t know what to do about it.”
Sophia Kishkovsky and Oleg Matsnev contributed reporting.
