A much more important role is played by the circumstances in which the patient finds himself.
"Express treatment" according to express test
My story began in mid-January. I was admitted to one of the Moscow hospitals for an operation. The day before, the doctor Alexander Myasnikov warned me: “If you can, postpone the operation. A hospital covid is not a covid that is on the street, in a vehicle, or in a store. In the hospital people are infected with a severe form".
Doctor Myasnikov looked into the water. After 4 hours in the admission department of a Moscow hospital (where most of the time I was just waiting for some doctor, and patients were streaming past me), I began to cough, I began to show signs of suffocation. The hospital in which I was staying received patients with coronavirus in the spring. Either it is not the correct routing of patients, or poor disinfection is to blame, but it is after hospitalization in this hospital that many become infected with the coronavirus. The ambulance doctors will tell you about this later.
My operation was postponed, and after a week the cough began to torment day and night. Then the cough suddenly disappeared, but the taste and smell disappeared. The temperature rose after 7 days, and immediately 39.2. Thus, my incubation period was exactly 14 days.
I heard that coronavirus is treated with the antibiotic Azithromycin and started taking it. But the temperature did not subside. I couldn't even sit - my whole body ached. Then came a cough, the attacks of which brought him almost to fainting. Familiar doctors advised me to drink the antibiotic Klacid, which helps with pulmonary diseases. But it didn't get better. Now I understand that I have lost precious time. Immediately after the taste and smell disappeared, it was necessary to take PCR, blood for antibodies and do a CT scan of the lungs. If I did not self-medicate, I would not have subsequently 60% of lung damage, suffocation and 10 days between life and death. But besides this, there was another factor that disorientated me, like many other patients with coronavirus. These are express tests for covid, which, like mushrooms after a rain, appear on the free market even in Auchan and can be easily ordered with home delivery. These very rapid tests have unanimously shown that I have no coronavirus. Alas, they were all wrong.
The first conclusion: the coronavirus is difficult to recognize, the disease develops gradually, often over several weeks. A combination of symptoms: loss of taste, smell, cough, temperature - a reason to immediately consult a doctor and do a computed tomography, which will show whether the lungs are affected by viral pneumonia.
Hospitalization: the price is 200 thousand?
I called an ambulance only 5 days after the temperature rose. The doctor also took an express test from me, which turned out to be negative. But I came across a meticulous team. After listening to the lungs, the doctor said, “This is pneumonia. We need to do CT".
There was a long queue at the CT center at the city polyclinic # 209, where the ambulance brought me. Those who had lung damage up to 25%, or CT-1, were given a set of medicines for coronavirus, which had to be treated at home. Those who had more lung damage were immediately, without any clothes, offered to the hospital. I had at least 50% lung lesion on CT. Hospitalization was inevitable. And here comes the most important moment. Your life depends on where you go and how focused the clinic is on the treatment of coronavirus.
I heard from medical friends that the optimal treatment regimens for severe covid are at the 52nd Moscow City Clinical Hospital. But I was offered hospitalization in a temporary hospital in Krylatskoye, explaining that the number of hospitals accepting patients with coronavirus decreased due to the "improvement in the epidemiological situation." In Moscow and the region, infectious beds for patients with COVID-19 are being massively rolled up. As it turned out, the following were recently excluded from the list of receiving patients with coronavirus in Moscow: Morozovskaya Hospital, GKB No. 17, Loginov Scientific and Practical Center, GKB im. Mukhina, the Scientific and Practical Center for Tuberculosis Control, two buildings of the Sechenov University, the Central Clinical Hospital "Russian Railways-Medicine", the Medical-Sanitary Unit of the Ministry of Internal Affairs, the hospital of the Russian Academy of Sciences, the Scientific and Clinical Center of the FMBA. Currently, the list of hosting hospitals is limited. In Moscow, 3,200 beds will be returned to planned work. Earlier it was also reported that five more metropolitan hospitals with 2.2 thousand beds will return to normal work - these are hospitals named after Inozemtsev, named after Yudin, no. S.I. Spasokukotsky and Scientific and Practical Center of Addiction. At the same time, reserve hospitals continue to operate at the Krylatskoye Ice Palace, the Sokolniki Exhibition Center, the Moscow Automobile Trade Center and at VDNKh. At the same time, the Ministry of Health of the Moscow Region announced the re-profiling of infectious facilities. How relevant is it now?
The ambulance doctors and I started looking for options. At the Research Institute named after Sklifosovsky was no place. Regarding GKB 52, they answered me somehow evasively: they say, they are now treating coronavirus mainly from medical workers. Then I decided to risk hospitalizing myself through a paid ambulance. They replied that hospitalization in the 52nd City Clinical Hospital would cost me 200 thousand rubles - the chief doctor allegedly "demanded" this amount from this ambulance. And paid treatment will cost 400 thousand rubles. Subsequently, the Moscow health department will inform Novye Izvestia that this is not true. Also, a representative of the Moscow Department of Health spoke about the claims to private "ambulances", which often do not even take their patients to the emergency department. There were cases when patients were planted without taking them to the admission department of the N.V. Sklifosovsky. To top it off, the paid ambulance offered me hospitalization at the Central Clinical Hospital of the Russian Railways. However, on googling, I discovered that this hospital no longer accepts coronavirus patients. After that, I lost my trust in the paid ambulance once and for all.
Information about hospitalization in the 52nd City Clinical Hospital, where severe covid is treated (this was my case), I nevertheless decided to clarify at the reference hospital. They replied that the hospital is still involved in the treatment of covid, but hospitalization is subject to availability. “In principle, patients are admitted even by gravity, if there are places, but if there are none, there is only a paid option - 400 thousand rubles for two weeks. A day spent in a double box - 15 thousand rubles, in intensive care - 20 thousand rubles a day. At discharge, the amount may increase due to additional procedures, such as blood transfusion and treatment of complications, as well as the use of additional medications, "- explained in the information desk of the 52nd Moscow City Hospital. On the website of the medical institution it was listed: calling the ambulance for hospitalization - 25 thousand rubles, placement in the ambulance in the 52nd hospital - 280 thousand rubles. Frankly speaking, the treatment of severe coronavirus on a paid basis is not cheap these days ...
But still I was lucky. In the end, the Moscow ambulance sent me to City Clinical Hospital # 40, better known as the medical center in Kommunarka. Now I can say with confidence: this has become one of the main successes in my life.
Conclusion two: when hospitalized by a paid ambulance, check the information with the website of the medical institution or the referral service of the hospital where you are sent. When hospitalized by an ambulance under compulsory medical insurance, try to insist in any way on hospitalization in hospitals of the Moscow Department of Health with the practice of treating covid - they use proven treatment regimens for coronavirus plus specialists with experience in treating Covid-19.
To be honest, what I saw at the medical center in Kommunarka became one of the strongest, but pleasant shocks for me in recent years. I knew that this center was recently built. But, getting used to the typical buildings of Moscow city hospitals, most of which were built in the 70s of the last century, I mentally prepared for the pandemonium in the admission department and a long wait in a long, narrow, dirty corridor. But I saw something that is incompatible in my understanding with the hospital.
It was the very "hospital of the future". Instead of a reception area, there are boxes, each of which has a separate entrance from the street. These boxes were spacious rooms with a separate large bathroom. Each had a device to breathe oxygen through a mask. The nurses came to this box to take tests - PCR, blood. Then the doctor came in and shook her head sadly, taking the oxygen saturation and listening to her lungs.
The results of computed tomography of the lungs were in a common database available to medical institutions of the Moscow Department of Health. Kommunarka doctors reviewed them and found the percentage of defeat over 50%. It was a bilateral viral pneumonia with a specific "glass" lesion in the lungs. And although PCRs were not yet ready, it was obvious that this was a coronavirus, and a severe one.
In the admission department, they immediately put in droppers with paracetamol and saline solution to bring down the temperature, and gave me an oxygen mask. There were many doctors and nurses, and everyone acted very quickly. It is noticeable that the treatment is subject to a well-established protocol.
After about half an hour I was put on a gurney and taken to the department. The first thing that I saw on the floor was a large rack with things packed in black plastic bags. When I asked what it is, the nurse replied that these are the things of those who were sent to intensive care. There were a lot of such packages, several dozen. “Yes, we now have a lot of patients with a severe course, we send a lot to intensive care”, - the nurse confirmed.
For some reason, the wards for patients with coronavirus seemed to me to be a large densely populated space with conditional partitions separating patients from each other. What a surprise it was when I found myself in one of two spacious single boxes with an area of at least 20 meters with a bed connected to a nurse's console and oxygen supply. The bathroom in my room was at least 10 square meters. I was especially impressed by the shower, which could be taken while sitting.
After hospitalization, despite the fever and coughing fits, which doubled over and turned inside out, I felt pretty good. At least she could watch TV in the ward and use a laptop. It seemed to me that the main thing was to bring down the exhausting temperature above 39. So I thought until the crisis came...
On the first day of my stay in the hospital, PCR results and a blood test for antibodies to coronavirus came. It turned out that I got to the hospital on time: C-reactive protein, which shows inflammatory processes in the body, exceeded the permissible norm by 5 times, and the platelets were much higher than the norm. Coronavirus, as it turned out, is dangerous not only with lung damage, but also with thickening of the blood, which leads to thrombus formation. Its consequence can be a stroke, heart attack... Therefore, one of the first medications that are prescribed to patients with covid is blood thinners.
Love of life is not according to Jack London
Treatment in Kommunarka begins at 6 am. It is at this time that a nurse comes to you, who measures oxygen saturation (the volume of oxygen in the lungs), pulse and temperature. Pills are delivered early in the morning. The first two days with coronavirus infection, you need to drink 8 tablets of coronavir, and also a blood-thinning drug, something for the microflora of the stomach and an expectorant mucolytic, in my case - bromhexine. In addition, the treatment regimen provides for several droppers of Dexamethasone and saline solution per day. At a temperature - intravenous paracetamol. In addition, twice a day, injections in the abdomen with a blood thinner.
The first day in the hospital seemed like an adventure to me. A variety of specialists constantly came to the ward - from a cardiologist to an oncologist and a surgeon, examined, made appointments. In between, I watched TV. The temperature seemed to have stabilized, and I began to think that in a few days I would be at home. But the course of coronavirus infection is very different from the usual bacterial pneumonia.
I felt suffocated in the middle of the second day at the hospital. This was approximately the 20th day after infection and the 10th day after the onset of the disease itself. The cough and fever are gone, but I can't breathe. This is a terrible feeling. During such an attack, you feel how life is leaving. I have never experienced such a state. Saturation dropped to 84 units (critical level - 89). The doctors got their bearings instantly. Head department ordered to carry out his commands. It was necessary to lie only on the stomach - so the lungs were straightened and filled with oxygen, it was necessary to breathe through an oxygen mask. The agonizing days of the struggle began.
Doctors and nurses measured oxygen saturation every hour, day and night. I stopped distinguishing the time of day, I was afraid to sleep - I thought that in my sleep I would stop breathing. Moreover, sleeping with an oxygen mask was not comfortable. The nurses showed up constantly. In general, I have a feeling that the department is largely based on nurses, doctors are the management of the process and an individual treatment regimen. And the sisters and nurses are always there: injections, IVs, just talk when it's hard. A very young nurse with a difficult name helped me a lot, who kept telling me how the most difficult patients recover, even after mechanical ventilation. It seems to me that the medical staff was on duty for 24 hours - in spacesuits, glasses, masks, without sleep. By the way, many employees in Kommunarka, according to them, have had coronavirus. After that, it seems to me, a person becomes more sensitive to someone else's misfortune. Personal experience of dealing with the disease also appears.
...After a few days, the saturation slowly began to rise from the 85 level. But as soon as you change your position and lie on your back, asphyxiation covered again. When the oxygen saturation stabilized, they began to teach me to breathe on my own. It was hard and scary to breathe on my own, without an oxygen mask.
And then it turned out that after a week of fighting for my life, I had lost so much strength that I almost could not walk. I had to learn this again. But then a new misfortune appeared - either from drugs, or as a complication, a frantic arrhythmia began, which disappeared only after the pills; the pressure jumped. But it all seemed like nonsense compared to the fact that I began to breathe! I never thought it was such happiness - just to breathe...
The third conclusion: the worst thing in coronavirus pneumonia is suffocation and lack of air. This can only be experienced in a hospital with experienced doctors. I doubt that in an ordinary, non-profile GKB I would have been pulled out the way the doctors at the medical center in Kommunarka did. But the best doctors are powerless if the patient does not fight for his life, does not follow the difficult and sometimes unpleasant prescriptions of doctors.
After two weeks of our fight against coronavirus with the doctors, the head of the department said: “The crisis is over, you are on the mend. We have three negative PCRs. We have done everything we could, the worst is behind us".
... Patients in Kommunarka are transported home in ambulance cars. They took me to the entrance. They didn't recognize me at home - so much changed. And I myself still did not feel confident: I could hardly speak - there was not enough air, an exhausting cough began. I also had to learn to walk again. Legs and arms did not obey for more than a week. And my heart was pounding. But the main thing is that I breathed and my brain worked clearly and clearly. This was a major victory, because many people after the coronavirus begin to have mental problems. These are not only panic attacks.
Unfortunately, coronavirus often leads to memory loss, inability to absorb information, and strange behavior. “I have become some kind of wonderful. I have forgotten many simple things, I can’t remember my home address, ”admitted my friend, who had recently had a coronavirus. The following response about the consequences of the coronavirus on Facebook is also indicative:
“5 weeks of communication with the covid just ended. I remembered several horror films, science fiction films, when an alien populates a person and begins to command them. At first, this alien tried to take part of my brain back from me. I tried so well, but I resisted. Then he began to drain energy from me and send it somewhere. He did it. Even my voice became weak. But I learned to resist and resist. He is about to get tired of fighting me".
Clinical medicine, at least in Moscow, is capable of helping even the most severe patient with coronavirus. There was a case when in the Research Institute of Emergency Aid. Sklifossovsky, Moscow doctors saved a woman with 100% lung damage with covid. But how the fate of the patient after the illness will turn out is in most cases the matter of the person who has been ill. But complications after coronavirus pneumonia, alas, happen to almost everyone. They differ only in severity. And deaths from complications occur almost more often than with the coronavirus itself. Two of my classmates - Vladimir Molchanov and Andrei Borodin - died from the consequences of covid and complications quite recently.
After I was discharged, they called me from Telemedicine and asked how I felt. Honestly admitted: "Bad." The voice on the phone replied indifferently: "In this case, you need to call a doctor." Yes, but why are you then? Once a doctor from the district clinic came and left the medicine. We took PCR. That's probably all. I am now struggling with complications myself, based on the appointments made in Kommunarka.
One could put an end here, but questions remain. First of all, to the statistics of coronavirus diseases. How exactly the epidemiological situation improved, to be honest, it was not very clear to me from the hospital walls: long queues at the CT center in the district polyclinic, overcrowded intensive care unit, a three-hour waiting time for a CT scan in the hospital upon discharge, sweaty from exertion and constant running from one severe patient to another doctor... All this suggests that the incidence of coronavirus remains high.
I asked the doctors of the ambulance and at the hospital whether there were fewer patients. The answer was the same everywhere: “Perhaps a little. But there is no need to talk about a recession”.
Is it worth it to close the hospital beds so massively against this background and expose both patients and doctors to extreme? After all, we are talking about the lives of thousands of people who may find themselves without qualified medical care. Recall that the lockdown continues to operate in Germany, the Netherlands, Great Britain, Austria ... A new measure is being discussed in the Czech Republic - double masks to avoid infection. In Russia, the official statistics assure that the epidemic has passed its peak and is moving towards reducing infections. The number of beds for coronavirus patients is shrinking. This means that someone's chances of survival are also reduced.
Instead of output. Clinical medicine today gives a greater chance of defeating the coronavirus. All that is later is Russian roulette.