A provincial physician confession: “Going to the hospital today is double dangerous!”

Maxim Osipov, a well-known writer, a cardiologist at the regional Tarusa hospital in the Kaluga region, published the recommendations of his hospital colleague Artemy Okhotin, preceded by the following words:

“In Russia the situation with the epidemic is complexified because of two reasons:

1) The absence of the political leader - the one who could take responsibility for the development of the situation, and -

2) the absence of a scientific leader - many of us have watched the Chernobyl TV series, so you probably remember the figure of the academician Legasov — thus by now we have Chernobyl without Legasov, the hierarchy is destroyed.

In this position, you have to give the ad hoc advice, such that in a "peaceful" time the doctor would not give. I highly recommend you read the recommendations of Artemy Okhotin, a general practitioner and cardiologist from the Tarusa Central District Hospital, whom I consider to be one of the smartest and most talented doctors I have met. I made some efforts to ensure that Dr. Okhotin wrote this text, and I am glad that he agreed: doctors do not like to exceed their powers, act in conditions of uncertainty, but the current situation really leaves no choice.

M. A. Osipov, cardiologist of the Tarusa Central District Hospital

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COVID-19 - what to do?

Increasingly, people are personally or publicly asking what to do if they become ill.

Coughing, fever, aching all over the body, and sore throat are common “flu-like” symptoms. Today is almost certainly COVID. It is impossible to give one piece of advice for all occasions; each situation is individual. In ordinary life, I try not to give general advice and parting words at all, especially on the Internet. But today the situation is special, people do a lot of excess and often harm themselves. Therefore, I decided to write more likely everyday than medical, thoughts about what is happening.

1. DON'T BE EAGER TO TAKE ANALYSIS ON CORONAVIRUS - this will not affect your chance to recover, but it can greatly complicate the situation. For example, you may become infected while you are taking the test. A negative analysis will create a false sense of calm, while COVID tests are often mistakenly negative. A positive analysis will make you the object of attention of the state, for which your personal well-being is not the main thing. A confirmed diagnosis of Covid in itself will not affect what needs to be done.
2. DO NOT SEEK FOR THE OPPORTUNITY TO MAKE CT. Firstly, as with the analysis, the detection of signs of COVID, even bilateral pneumonia, in itself will not affect what needs to be done next. With KOVID, even in the lightest patients on CT, bilateral pneumonia is often detected, which passes by itself. But, as with the analysis, if you have bilateral pneumonia on a CT scan, the chances are good that you will be in the hospital only because of the CT results, and there will be no benefit from this. Secondly, tomographs often do not properly disinfect, and even if you do not have COVID, you can get infected in the tomograph, in the waiting area or when communicating with staff.
3. You should bear in mind that there is NO SPECIAL TREATMENT OF COVID, all available methods, including antiviral drugs and immunomodulators, are more experimental in nature and their effectiveness has not been proven. The most promising of them (Remdesivir and plasma of recovered people) are not yet available for mass use even in the USA.
4. Hospitals are in a very difficult situation, which is largely due to the arrival of a very large number of mild patients. Doctors are not enough, they are trying to save those who are in serious condition. GOING TO A HOSPITAL IF THERE IS NOT A LIFE THREAT IS DANGEROUS, AND TODAY IT IS DOUBLE DANGEROUS. Therefore, if there is no threat to life - do not risk it.
5. HOW TO UNDERSTAND THAT THERE A LIFE THREAT? This is the hardest part. As long as there is no shortness of breath (lack of air), while only high fever and excruciating cough are disturbing, most likely there is no threat, and you just have to endure it. This is non-medical advice, in “peacetime” and in conditions of developed medicine, I would probably advise otherwise, but today the risk caused by getting into the health care system may be higher than the risk of the disease itself.
6. Many doctors (especially those who make official statements) will tell you that you need to call a doctor, an ambulance, and go to the hospital. I do not agree with this. Unfortunately, the majority of doctors examining sick patients will not be able to distinguish a serious situation from the one that is not, and their tactics will often depend on the instructions of the authorities and non-medical considerations.
7. CAN I TREAT myself? The effectiveness of most drugs used in COVID is doubtful, and many of them have side effects. Cases of death from self-medication of COVID, for example, from taking hydroxychloroquine, are described. Therefore, you can only accept what is safe enough. This drink (in moderation), paracetamol (up to 2-3 g per day), analgin (there is evidence that it can cause blood pathology, but this risk is very small, 1-2 cases per million). If cough and fever persist, you can start taking an antibiotic - Azithromycin, 500 mg on the first day, then 250 mg once a day. It is believed that it is effective precisely in Covid, but it is little confirmed. Azithromycin, however, may help if you have common bacterial pneumonia. For coughing, you can take drugs with codeine, but they have recently been available only with a prescription. Dextromethorphan (Tussin-plus) drugs were banned several years ago, but Butamirat, which is part of the Sinecode syrup, remains - it is not so effective, but it can be bought without a prescription.
8. And what If I get worse because of these tips? How can I give advice without seeing the patient? In ordinary life, such advice should not really be given. But these are not medical advice; they are not a substitute for medical advice. These are purely personal considerations, due to the difficult moment in which you and I are. You still have to make the decision yourself.

Take care of yourself! We will overcome it!

Artemy Okhotin, Doctor, Tarusa Hospital”