Fatal situations in the Murmansk "dirty zone"
By Tatiana Britskaya
Valeria takes out a thick letter from the Investigative Committee. There are many words on the sheaf of papers but the meaning fits into one sentence:
“The Committee is refusing to initiate a criminal case.”
It also says that the facts of the case are that her mother contracted covid while lying in the cardiology department of a Murmansk hospital and that this was the reason for her death. The investigator did not check why or how this was possible or who might have been responsible. They only point out that “medical assistance was provided in full.”
The inspection materials also have a list of the facts. “Patient S. was given a Covid-19 smear on 06/13/2020 and the result of the smear was negative. Patient S. came into contact with another patient in the same ward who tested positive for covid-19. The infected patient was scheduled to be transferred to the regional hospital on their recommendation. On 26.06.2020, smears were taken from all the infected lady’s ward neighbors, including patient S. The results of nasopharyngeal smear No. 63 turned out to be positive.”
The Murmansk Regional Clinical Multidisciplinary Center (MRCMC), where Valeria’s mother was treated after a heart attack, is called “City Hospital”. This is an old fashioned way of saying this but for many years the clinic worked as an emergency hospital serving the regional center. A year ago, its status changed, but urgent care, ambulance and emergency services remained. But because the MRCMC had not officially been recognized as a “covid hospital”, when the summer began, the patients began to get infected, got sick and died from the coronavirus. And yet this news did nothing to cause alarm.
When an emergency patient is brought by ambulance, there is no time to wait for smear results. The person needs to be saved.
Normally epidemiologists have special long standing protocols in place for such cases. When an epidemic is declared in the region, any patient admitted to any hospital without testing negative for infection is considered conditionally positive. Observational triage boxes are created where such patients are treated and generally, they do not come into contact with other patients.
However, by June 13, when Valeria’s mother entered the Moscow Regional Children’s Clinical Center, there were obviously no conditions for isolation there. The employees of the institution told Novaya Gazeta about this and the materials of the pre-investigation check do not refute this either.
The covid situation in the Murmansk region shows colossal mistakes made by the medical care policy makers in the region. During the epidemic, it became clear that the reason for these mistakes was not so much a lack of funding or staff shortage, the mistake was in their grossly misunderstanding the principles of effective medical procedures.
Simply put, poor planning and mismanagement of the situation by hospital management is to blame.
Due to its remoteness, any epidemic comes to the Kola Peninsula a month or two later than the population centers. And local epidemiologists know this very well. This happened with the coronavirus but what made a mistake possible was the failure to take into account the mistakes and successes of our neighbors. What the regional health ministry should have done was to adopt the same simple decisions that experts have been repeating since the beginning of the pandemic and put them into their protocols. Namely, they should have allocated one of the large general hospitals for covid patients. People who had tested positive could have been treated there for heart attacks, injuries or surgery. In each medical institution that provides emergency assistance, they needed to specify which observation beds would be used by patients admitted without a negative test. These rooms are known as “dirty zones”. Any personnel entering such an area should only do so wearing protective equipment and the only exit should be through a sanitary inspection area.
Such “dirty zones” should be kept isolated until the people there get a negative COVID test. This protocol physically separates the flow of patients without a test from those who have tested “positive” or “negative”. They also should have introduced mandatory coronavirus testing for all patients admitted to hospitals from the first days of the pandemic.
Whatever the justifications of the Ministry of Health, none of these decisions were made in time on a national level. The cost of this irresponsibility was hundreds of patient and medical worker deaths.
In the summer, the employees of the MRCMC turned to the regional duma.
“Patients with COVID-19 started coming to the city hospital in April. And every day their number has increased threefold. Now the situation is dire. There are too many patients coming through the resuscitation ward, X-ray and the emergency rooms. There is only one cubicle there which is used as triage for both clean and dirty patients. Usually there are 6 or 7 people left in contact with each other and this includes both infected and non-infected people. The therapy center is so clogged that infected people have to sit on chairs in the department and wait for free space. The situation is the same in intensive care. “
At a briefing and in answer to such questions, the acting head of the regional health ministry, Inga Aniskova, said, “We must have strict triage rules to protect other patients.”
Nevertheless, Valeria had to write a complaint to the regulatory commision trying to understand why her mother ended up in a cemetery instead of being discharged two weeks after being admitted to the cardiology ward at city hospital. Why was she placed in a ward with a person whose coronavirus had remained undetected?
Above are some possible solutions that would have saved the situation. And none of these ideas are amature fantasies. These are the opinions of experts. And it was these decisions that kept the situation in the Komi Republic stable and prevented covid from blazing through the region. But the Murmansk regional authorities decided to look for their own path and instead, created “covid” beds in most of the hospitals in the region, including the regional “city” hospital, which just happened to be the only one licensed for a number of high-tech medical interventions such as for cardiac surgery. And of course last week when the second wave in the region became difficult to ignore, covid-positive patients were again identified in cardiac surgery among postoperative patients.
Another systematic error that led to the spread of the infection turned out to be when rotational workers from a construction site in the village of Belokamenka, which has become the largest hotbed of infection in Russia, were taken for observation to different cities of the region, including Murmansk.
The problems of adhering to the protocol for transferring patients who have been identified as having covid from ordinary hospitals to an infectious disease hospital still have not been worked out. There are no specialized clinics for them. And the results are hot spots in almost all hospitals.
Planned medical care has been stopped and now the region is in third place in terms of mortality in the country.
As of October 25, there were 36.6 cases per 100 thousand of the population. Only St. Petersburg and Moscow had more and it really seems as if the leadership of the region and the regional Ministry of Health have their own way of working things out.
At the last briefing, Governor Andrei Chibis made a small discovery in the field of medical statistics. This was his statement:
“The mortality rate is connected to those people who were diagnosed with coronavirus and who died in the hospital. If we did fewer tests, then as a formality, there would be many less deaths from covid per capita,”
His position on the math is actually hard to make sense of. If a patient had never been tested for covid, no one would ever know that they had died from covid. This is the first flaw. The second is that they do not want to statistically calculate the mortality from the number of people tested. It is a smaller number per 100,000 people. This is a better way for them to see the scale.
But it is more profitable for the regional Ministry of Health to calculate the percentage from the number of “cases”. Even if Chibis had this in mind, by the end of things, this also makes no sense. The more “asymptomatic” carriers are identified, the lower the percentage of deaths from covid and not the other way around. This is something from a school mathematics course.
But if we really do the math, this is not the answer. At the same briefing, the acting head of the regional health ministry Inga Aniskova, one of the speakers, said that 70% of those who died from covid had cardiovascular pathologies, 30 had endocrine pathologies and another 10 had oncology. Excuse me, but they only count these types of percentages during election years. And even then, these are only in separate regions, among which Murmansk has never been invited.
Andrey Chibis by the way has spoken publicly about the openness of the coronavirus numbers:
“We must have a clear diagnosis; the more objective the picture, the more balanced our decisions will be. “
It is difficult to argue with this. But why then weren’t the death statistics of the security forces published in the statistics from headquarters? They make up a big part of the population of the security in the region. And why didn’t they name the inhabitants of as many as five cities and towns? Polyarnye Zori, Polyarny, Snezhnogorsk, Gadzhievo, Ostrovnoy, Zaozersk are not served by the Ministry of Health of the region but by the Federal Medical and Biological Agency of Russia (FMBA). Why isn’t there any data from these settlements in a regional summary that was repeatedly recognized by officials? At the same time, the FMBA does not hide the numbers. On the morning of October 26, there were 786 new cases in addition to the official “regional” sick count of 18,691 patients.
On the 25th, the region officially showed a record daily increase. There were 189 positive tests. How many need to be added to this number to get an objective picture? And this would even be taking into account the fleet, military and other “security personnel”.
And here are some more secrets. It is difficult to see the math in the story of the “pre-fabricated hospital”. Why did The Tent, which had been delivered to its home near Murmansk for a billion budget rubles remain empty for several months? Why they didn’t just use it remains beyond understanding. Now the structure is being dismantled and the equipment has been removed. What was that?
At an operational meeting, the head of the regional health ministry, Dima Panychev, said that they were planning on designating one of the MRCMC buildings as a covid hospital. This would apparently be a second building since the head of the first continues to work in the regional hospital. Cardiology, where Valeria’s mother had been, as well as other departments are being transferred to this other building. The decision was made against the background of the increase in morbidity.
They never talk about the lack of beds. On the contrary, they deny the facts. But just a couple of weeks ago, patients from Murmansk were offered an exciting trip to Olenegorsk or Monchegorsk for treatment. These are hospitals 120 km away.
Perhaps we can understand that there was a real reason that the firefighters declared the “miracle tent” unsafe. Officials had proudly presented the flammable vinyl panels and unsafe aluminum framework as the “covid” hospital. It literally had the lowest fire resistance, the highest fire hazard, it was completely inadmissible as a permanent care facility. Novaya Gazeta told us there were documents telling us all about this strange and very expensive structure. But nevertheless, the head of the region was quoted at a regular press conference as saying:
“The concerns outlined in the mentioned documents were taken into account in the design. Today, the regulatory documentation is allowing this hospital to be opened. “
So why didn’t they open it then? And where is the billion?
The vice-governor of Vadislav Sandursky gave this in answer to a request from the prosecutor:
“This was our first time building this type of hospital in the Russian Federation. It was a unique structure and we had nothing to use as a guide. In the regulatory legal acts of the Russian Federation, there are no technical fire safety requirements for such a structure.”
Which really means something like: unless a tent for 700 beds is in the capital, it turns out the authors have nothing to show us.
As of the moment and at the height of the second wave, the billion ruble tent is being dismantled while people are again complaining about the lack of assistance. On October 18, Governor Chibis said on the air of the Russia 24 channel:
“We have no queues for CT scans and unfulfilled requests for emergency medical care.”
Dozens of comments were poured into the message. People published their documents and unfulfilled referrals for hospitalization for covid. And some of these people, judging by these reports, have been waiting for 16 days.
At the end of last week, we learned about the deaths of three patients in a mental institution in the city of Kirovsk in the south of the region. According to Novaya Gazeta’s sources, since the beginning of the pandemic in the region, 13 residents of these institutions have died from covid. This was also not officially reported.
Translated by Adam Goodman
This story was orginally published in Russian by the Novaya Gazeta. It is translated and republished as part of a cross-border media initiative