“The University Hospital is not an ordinary hospital; in addition to medical work, it performs other important tasks - it conducts research and teaches students, residents and graduates. In fact, all over the world, university clinics are a landmark, a beacon that allows health care to move in the right direction even in a storm”, - said Simon Matskeplishvili, deputy director for research at the Moscow State University Medical Research and Education Center, in an interview with Scientific Russia. ...He admits that if the number of patients were higher, then the mortality rate could also be different.
At the same time, Matskeplishvili shared several secrets of the clinic's success. In particular, throughout the entire work, only one patient with a coronavirus was in one ward. At the same time, all staff were maximally involved in working with patients. Employees, students, residents, graduate students of the Faculty of Fundamental Medicine of Moscow State University also helped to nurture them. That is, each patient received a lot of attention from doctors. In addition, consultations of the center's leading specialists were held daily at the covid hospital. They made individual decisions for each patient.
At the same time, the head of each of the four linear clinical departments of the center, while working with patients with coronavirus, actually became the director of his separate division, having received all the necessary powers, and ensured the continuity of treatment when changing duty.
Another important success factor is that the clinic from the very beginning critically revised almost all recommendations for treating patients with coronavirus and developed its own protocol, which was repeatedly modernized in the process - until it became ideal.
Matskeplishvili noted that the mistake of many was the emphasis on fighting the virus, while there was no antiviral therapy for SARS-CoV-2. This led to the false impression that "since we cannot eradicate the virus, then we cannot cure the patient." At the same time, various covid hospitals have tried almost all antiviral drugs that did not have the desired effect, and sometimes had side effects.
At the same time, the university medical center almost immediately abandoned such drugs. “If we recall other viral infections, much more serious and dangerous than coronavirus: measles, viral encephalitis, poliomyelitis, then we do not treat them with antiviral drugs. We treat the disease itself... This thesis is hundreds of years old, and Avicenna, Hippocrates, and the famous graduate of the Moscow University of Mudrov formulated it, and it sounds like this: “It is necessary to treat not a disease, but a patient”, - says Matskeplishvili.
In addition, the Moscow State University clinic quickly concluded that coronavirus is not a disease of the respiratory system, it is a systemic disease. Therefore, it was important to focus in particular on the cardiovascular system and the blood coagulation system. “Based on all this, we realized that we must treat acute systemic inflammatory disease, accompanied by damage to the blood vessels and vasculitis. And vasculitis is always thrombosis and organ perfusion disorders. This means that we need anti-inflammatory and anticoagulant therapy, ”said the deputy director for research at the Moscow State University Medical Research and Education Center.
In particular, the clinic used the drug colchicine - "for stable patients with COVID-19, so that they do not become unstable".
Unlike the protocol of the Ministry of Health on the treatment of patients with coronavirus, the protocol of the Moscow State University clinic takes only two pages. A specific algorithm is described there, from which it is clear how to treat a particular patient. Indeed, often the doctor does not have time to study large documents, Matskeplishvili complains.
“Many doctors have used and are using this protocol [developed by the Moscow State University clinic], and not only in our country, because it works. In it, you can find principles for the treatment of patients about which little is said in the official recommendations, primarily outpatients and, most importantly, those discharged after treatment. In the hospital, they receive high doses of anticoagulants, and at some point this therapy is stopped and they are allowed to go home. They may have serious problems with the blood coagulation system. We accompanied all our patients with rather long-term anticoagulant therapy”, - Matskeplishvili said.
The radiological service also provided great assistance in the treatment of patients, which provided doctors with full information about the condition of patients around the clock. The clinical laboratory also helped, which gave the results of a blood test for interleukin-6 in an hour, and a genetic test for hereditary thrombophilia - within a day. By the way, it sometimes took “days and weeks” for Matskeplishvili's American colleagues.
Also, the clinic, according to him, managed to perform "a real miracle". The mortality rate of patients on mechanical ventilation was less than 15% (in other covid hospitals - over 80%). Matskeplishvili noted that the MSU Medical Center avoided several fundamental mistakes made around the world in the treatment of COVID-19. “One of them was the emphasis on mechanical ventilation and powerful anti-cytokine drugs. The preparedness of clinics for the treatment of patients was assessed by the number of available ventilators, while almost no patients were treated in a more or less stable condition in order to prevent the degree of respiratory failure when they need artificial ventilation”, - he explained.
The Moscow State University clinic took a different path - it actively treated patients in linear departments in order to prevent the development of severe respiratory failure. If artificial ventilation of the lungs was nevertheless necessary for the patient, then the specialists of the clinic tried to delay as much as possible the intubation of the trachea and transfer of the patient to invasive mechanical ventilation, which is often associated with high mortality rates.
“Artificial ventilation of the lungs is a very complex, high-tech procedure that requires, in addition to a ventilator, a specialist who operates this device. It is very important to change the regimens on time, constantly adapting them to the clinical situation. It seems to me that in this respect we were able to achieve the necessary balance”, - Matskeplishvili said.
He believes that the main lesson to be learned from the pandemic is not to go crazy. As one of the founders of modern medicine, Sir William Osler, said: "The best disinfectants are water, soap and common sense". According to Matskeplishvili, panic sometimes aggravated the course of the disease, because "fear does not stop death, fear stops life".
The doctor also recalled that science is a real engine of progress, and it will save humanity. “Science is an opportunity to find the right answers to the right questions. Let's remember what questions have been asked and asked during the current pandemic. Is the virus artificial? Do I need to wear masks? Will there be a vaccine? Can I get infected again? But the main question was rarely asked: how to treat sick people? But this is one of the main questions. This is what we ourselves asked. And we found the answer”, - Matskeplishvili said.
“It turned out that the virus is not insidious, not secret, not terrible. You just need to understand how it works and, accordingly, prevent it”, - he added.