We are accustomed to the fact that an examination in a polyclinic is a long queue, walking around offices and floors. Everything was different here. An SMS message informed me that, as a person who had had coronavirus pneumonia, I was being invited for medical examination at the Healthy Moscow pavilion in one of the parks in Moscow. It was unusual to wait for your turn to the doctor, walking in the park and eating ice cream. By the way, it took about an hour to wait: there was a decent queue of those who had been ill, there were unexpectedly many young people in it. It is said that covid mainly affects the elderly, but this is apparently not entirely true.
Clinical examination takes place in two stages. But first, you need to go through a long text test and answer a lot of questions about your condition after the coronavirus. Then - examination of the first stage: measurement of height, weight, body mass index, blood pressure and intraocular pressure; ECG.
They also took an express blood test for sugar and cholesterol. They measured it twice: cholesterol turned out to be lower than it usually happens at my age, and sugar was increased: ice cream failed...
But the main thing is spirometry and measurement of saturation, lung volume. Then, with these data, I was referred to a general practitioner, who commented on all the indicators and gave a referral for additional examinations - ultrasound of the heart and x-rays of the lungs.
To top it off, they took three blood tests - clinical, biochemistry and D-dimer - it is done for those who have had a severe coronavirus. The analysis helps to identify signs of blood clots.
The entire examination took about an hour, and it was organized in such a way that there was not a minute to wait for their turn: the nurses coordinated the flow of people in several rooms.
The new rules for clinical examination are related to the fact that in 2020 a record number of people died from diseases of the circulatory system in Russia: 97,300 more than in 2019. Diseases of the circulatory system are one of the complications of coronavirus infection. About one in five patients develop blood clots, and about 23% of patients with COVID-19 and thrombosis die. It is important to identify possible complications at an early stage.
A natural question arises: the medical examination has passed, the examinations have been carried out. What's next?
And then, in theory, there should be treatment of the identified complications, deviations and rehabilitation. And this means he will return to the district clinic with long queues. Coronary angiography, which shows the state of the coronary vessels and arteries, is not easy to get: queues. Rehabilitation today is something from the category of unattainable desires. For example, having received a referral to the Rehabilitation Center in Yudino near Moscow, I learned that the queue would be there only in 3 months. The cost of post-covid rehabilitation in the Rus sanatorium exceeded 90 thousand rubles, but all places were booked several months in advance. The Moscow rehabilitation center on Novy Arbat has just begun to carry out post-covid rehabilitation programs, and getting there is also not so easy.
“The Ministry of Health is now developing rehabilitation programs. This is relevant: post-covid complications in 80% of those who have been ill, in some, the complications extend for a period of up to 6 months. In the regions, the issue of rehabilitation is also being resolved, partly it will be carried out in outpatient clinics for compulsory medical insurance", - told to Novye Izvestia infectious disease doctor Yevgeny Timakov.
The rector of the Higher School of Health Organization and Management, Doctor of Medical Sciences Guzel Ulumbekova looks at the problem more pessimistically. “In my opinion, such a medical examination is the right decision. But identifying the consequences of covid is only part of the problem, after this complication must be treated. And this requires additional capacities and volumes of free medical care. The facilities are provided by doctors, the presence of inpatient and day beds, and special equipment. The main question is: where to get doctors? Now there is a 1.5-fold shortage of doctors in the primary care, there are not enough rehabilitation specialists, geriatricians. At the same time, it is necessary to create modern rehabilitation centers. And all this requires additional government funding. It is also necessary because the number of patients increased due to the pandemic. In a hospital, treatment of one patient with covid costs an average of 135 thousand rubles. But after discharge, she still needs rehabilitation, which also requires funds.
According to the most conservative estimates, state funding for medicine should increase by one and a half times over the next three years. It's just to survive and not lose the population”, - Guzel Ulembekova said.
The first step in helping covid survivors has been taken. Will there be enough resources to ensure that a full-fledged treatment follows after the diagnosis? So far, it is known that Vladimir Putin called on the government to launch a special program for the development of the medical rehabilitation system in 2021 and allocate at least 100 billion rubles for it. 60 billion rubles, that is, the main amount of funds, "must be provided for the period until 2026".
I would like to hope that after the elections this will not be forgotten.