A journalist who recovered after covid interviewed the Chief Infectious Disease Officer of the Ministry of Health

All this Novye Izvestia journalist Irina Mishina discussed with the chief specialist in infectious diseases of the Ministry of Health of Russia, Professor Vladimir Chulanov.

- Vladimir Petrovich, many experts predict a third wave of coronavirus infection in Russia. Is it worth it in this regard to prepare for a new surge in morbidity?

- So far, we are seeing a decrease in the incidence. But the development of the epidemiological situation depends on many factors. One of them is related to how much we will try to observe precautionary measures, and this is, first of all, wearing masks and maintaining social distance in crowded places, for example, in transport. In some European countries, after the decrease in the increase in the incidence, people forgot about precautions, as a result, a new surge in the incidence.

Another condition for reducing the incidence is the restrictive measures that the authorities are taking in the regions, for example, for visiting theaters and cinemas. And, of course, an important condition is the presence of immunity against coronavirus infection. For this, vaccination is carried out free of charge in our country. We already have 3 vaccines in Russia, this is a unique situation. They are developed by different institutions using different technologies.

- There are different versions about the origin of the coronavirus. Among others, there is a version about its laboratory origin. Covid is also called a type of bacteriological weapon. What do you think about that?

- Today there is no data in the world that the coronavirus is of artificial origin. In order to answer this question, special international commissions, including through the WHO, conducted investigations. As a result, they came to a negative conclusion.

- Are there enough doctors in Russia to treat coronavirus and viral pneumonia? It's no secret that they work with huge loads, among them there is a high mortality rate, many complain about professional burnout. In Kommunarka, where I was treated for coronavirus, there are a lot of doctors from the regions. They say that covid is now being treated by retrained dentists, surgeons, gynecologists... Is that really so?

- There are many patients, so many hospitals have been redesigned entirely for patients with COVID-19. Of course, infectious disease specialists alone could not cope with such a flow, therefore they attracted doctors of other specialties. There is a thoughtful training program that they must complete before working with coronavirus patients. For all doctors there are special recommendations developed by the Ministry of Health. This document is constantly being updated, for today its 10th version has already been released. By the way, the first version was released on January 29, 2020, when there was not a single registered case of COVID-19 in Russia. In addition, now there are many training courses, webinars that are available to all doctors. There have been many important scientific papers that help to learn new things about coronavirus infection.

- Now there are new methods of treatment, and there are reports of how doctors help people even with total, 100% lung damage. Such cases were in Moscow - a patient was cured with 100% lung damage at the N.V. Sklifosovsky. Patient Elena O. was recently discharged from the hospital at VDNKh after 100% lung damage. And from Tver they reported a completely unique case - there they rescued a woman in labor, Ekaterina S., with 100% lung damage. She underwent a cesarean section and then transferred to artificial lung ventilation. The treatment was protracted, but the woman recovered, her child is healthy! How do doctors now cope with severe viral pneumonia?

- For the treatment of patients with severe viral pneumonia, resuscitators have developed a special step-by-step approach of the so-called respiratory support. In case of especially severe lung damage, the ECMO method can be used - extracorporeal membrane oxygenation, which replaces lung function. In addition, hormonal drugs such as dexamethasone and special biological drugs are used to stop severe inflammation. Among these biological drugs, there are two Russian ones: levilimab and olokizumab.

- Recently there was a message about the results of a study, according to which Western experts declared the ineffectiveness of existing drugs for the treatment of coronavirus. Are there really problems with medications? What are the treatment protocols for coronavirus in Russia? Are they different from foreign ones?

- I think you mean the results of a large international study "Solidarity". It involved hospitalized patients. That is, those who are seriously ill. The conclusions of experts were not that drugs against coronavirus are ineffective, but that they should be started as early as possible. When a person with COVID-19 is admitted to the hospital, most often it means that the disease has already gone far, and the time for effective antiviral drugs is missed. These patients are treated with dexamethasone and biologics. They stop active inflammation caused by the virus. If treatment with antiviral drugs is started as early as possible, then they will be most effective and help to avoid a severe course of the disease. In addition, Russian treatment protocols use drugs that prevent blood clots from forming. They are called anticoagulants. These drugs are mandatory, since blood clots are often formed during coronavirus infection. They can be the cause of death.

- Yekaterina S., a woman in labor from Tver, with 100% lung damage, said that the thoughts that her just-born child needed her helped helped her to survive...

- A person must want to recover and become healthy, this is a very important condition. But recovery is most often the result of common work. Yes, I would call it work, common work - both for the patient himself and for the doctors.

- In the CT center, where the ambulance for coronavirus took me, I saw how patients with minor lung damage were given a whole set of drugs for home treatment free of charge. Also, to my family members after my hospitalization with coronavirus, the doctor gave out an antiviral drug for free as a preventive measure. And after I was discharged, they gave me a free drug against blood clots. Are we lucky, or are free medicines given out to everyone during an epidemic?

- This is a special program. Health Minister Mikhail Murashko proposed to provide free medicines to patients with COVID-19 at the outpatient stage of treatment, this was supported by the Russian Government. For this, for targeted use, first 5 billion rubles were allocated from the budget, then another 2.7 billion. In addition, additional funds were allocated for treatment with anticoagulants after discharge from the hospital. These are drugs that reduce the risk of blood clots. They must be taken for a long time, as blood clots can form after recovery from COVID-19.

- Recently, there has been a lot of talk about the treatment of coronavirus with plasma. However, the publication in the authoritative medical journal JAMA is alarming: the result of 10 clinical studies, which combined 11 782 patients, showed that treatment with anticancer plasma compared with placebo or standard treatment does not affect the risk of death from COVID-19. This is true?

- Plasma treatment of people who have been ill is a well-known method of treating various infections, not only coronavirus. It is based on the fact that there is a ready-made immune response in the blood of a person who has been ill, which is called antibodies. They are capable of destroying the virus of a sick person who is injected with such plasma. This is an antiviral method, which means that it must be applied at an early stage, by analogy with antiviral drugs. I repeat: antiviral treatment is really effective in the early stages of the disease.

- Doctors often say: "Covid is not as bad as its complications are". Indeed, many die from complications in the kidneys, heart, and lungs. Chronic diseases are exacerbated in people. How can all this be treated, or at least diagnosed, if the person was discharged from the hospital, and the doctors in the district clinic have no idea about the treatment regimens for coronavirus? For example, after being discharged from the hospital, they began to treat me with sage. Primary care not prepared to follow up those who have had viral pneumonia?

- Doctors of polyclinics, as well as doctors of hospitals, are trained in the treatment of patients with COVID-19. In addition, the patient is discharged from the hospital with recommendations. The extract indicates with what drugs, in what doses and for how long a person should continue to be treated.

- What about breathing exercises to restore lung function after viral pneumonia? Can you only undergo rehabilitation in commercial centers?

- Today, rehabilitation can be done within the framework of compulsory health insurance programs. Many medical institutions have already joined in this work.

- Vladimir Petrovich, now there is a widespread reduction of beds for the treatment of coronavirus. This is explained by a decrease in the statistics of diseases. But in February, personally, after the detection of coronavirus and viral pneumonia, I faced difficulties in hospitalization. Is it early to close down beds and departments for the treatment of covid and viral pneumonia?

- During the period of compaction, problems always arise, then everything gets better. The number of beds depends primarily on the current morbidity situation. Now we are seeing its decline, so the number of beds is decreasing. Keeping empty unclaimed beds is irrational. But during the pandemic, we learned how to flexibly manage the bed fund. And if we need to quickly deploy an additional bed fund, we can do it as soon as possible. Today we must be prepared for any infection, life has taught us this.