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'All The Hospitals Are Full': Russia's Health-Care System Scrambles As COVID-19 Cases Rise

Ambulance workers transport an elderly woman -- with suspected coronavirus symptoms -- from a bus stop to a hospital in central Moscow on April 17.

MOSCOW – On April 13, ambulance driver Dmitry Belyakov rushed to Zheleznodorozhny, a city just outside Moscow, to pick up a woman in her early 40s with a suspected coronavirus infection.

A central hotline directed him to a hospital in Voskresensk, a suburb 90 kilometers away, that specializes in COVID-19 cases. But when he got there, he was told six other ambulances had arrived in the meantime and there were now no free beds.

“We waited there for over an hour, making calls and trying to find a hospital that would take us,” Belyakov said in a phone interview. “In the end, they told me: ‘Figure it out yourself.’”

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His direct supervisor eventually called to say the Zheleznodorozhny inpatient clinic would make space for the patient. Belyakov set off on his way back to the city he had left hours earlier. He was home by midnight.

Belyakov, an 18-year veteran of Moscow’s ambulance service, considers himself lucky. Some colleagues have made longer journeys to find places for patients, he said, trying hospitals in three towns; one reported traveling 190 kilometers to find a medical facility that was not full to capacity.

Russia seemed like an outlier for weeks as the coronavirus spread across Europe, the United States, and elsewhere. But since early April, the illness has taken a firm hold in the world’s largest country, with the official number of confirmed cases rising each day – even as suspicions persist that those official figures may not reflect the real scale of the epidemic within its borders.

Now, with confirmed cases exceeding 42,000 and the official death toll from the virus at 361, medical workers across the country are scrambling to keep pace. In Moscow, where over half of the cases have been registered, the health-care system is already being stretched to the limit.

A month ago, President Vladimir Putin insisted his government had “managed to prevent the mass penetration and spread of the illness in Russia.” But on the same day that Belyakov struggled to place his patient, Putin reversed his tone, painting a much bleaker picture of Russia’s battle with the virus.

“We have many problems and nothing to brag about here. And there’s no point in relaxing,” Putin said in a video call with regional governors from his official residence outside Moscow. “We have not passed the peak of this epidemic.”

Moscow’s Health Department says at least two dozen hospitals in the city were being transformed into dedicated coronavirus treatment centers.
Moscow’s Health Department says at least two dozen hospitals in the city were being transformed into dedicated coronavirus treatment centers.

Putin spoke the same day Russia recorded what was then its highest single-day spike in cases, with 2,558 new patients. By April 17, a new record – more than 4,000 new cases -- had been set.

“All of Moscow’s inpatient and intensive and emergency units are working to extra capacity,” an official at the city’s coronavirus crisis center was cited as saying by the newspaper RBC on April 11. “All patients delivered by ambulance will be placed under care and will receive the necessary medical assistance.”

Moscow’s Health Department said on April 14 that at least two dozen hospitals in the city were being transformed into dedicated coronavirus treatment centers. The city could run out of hospital beds within two or three weeks, it warned.

At Hospital No. 15 in western Moscow, doctor Irina Sheikina says beds have already run out. The hospital had 1,492 patients as of April 17 and only 1,300 beds. Wards were being expanded to accommodate the influx, almost all of which is due to COVID-19, she said.

“We currently have 501 patients with lab-confirmed COVID-19 infections,” Sheikina told RFE/RL. “And pretty much all of them have COVID symptoms and CT scans [typical of COVID patients].”

Fortunately, she said, there is no shortage in her hospital of personal protective equipment (PPE), and medical students and volunteers are helping staff bear the burden. Sheikina herself is a pediatrician by training who transferred from another center to help at Hospital No. 15.

Although the hospital has too few nurses and orderlies, she said spirits are high.

“We are focused on the job, and while we’re tired morally and physically, we’re not wilting,” she said.

A doctor observes through a glass window the condition of a patient in a ward at the Moscow Sklifosovsky emergency hospital treating COVID-19 patients in Moscow.
A doctor observes through a glass window the condition of a patient in a ward at the Moscow Sklifosovsky emergency hospital treating COVID-19 patients in Moscow.

On April 14, Moscow Mayor Sergei Sobyanin suggested that the worst was still to come, estimating that so far Russia’s capital was only in the “foothills” of the contagion’s peak.

But Moscow is Russia’s richest city by far. Elsewhere across the country, experts say the outlook is dire, with under-equipped medical staff steeling for an influx of patients. Controversial reforms to the health-care system in recent years have cut back the number of hospitals in the country.

According to a 2017 analysis of government figures by the Center for Economic and Political Reforms, a Moscow think tank, the number of hospitals in Russia halved between 2000, Putin’s first year as president, and 2015.

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The official justification for many of the closures is a so-called “optimization” of health care into a smaller network of high-tech institutions -- but for Russia’s provinces, where many live in poverty, the disappearance of clinics can spell the end to affordable, accessible care, and a serious liability when epidemics like this one hit.

At one hospital in Ufa, in the Bashkortostan region, doctors faced with a sudden influx of patients with severe pneumonia have complained of inadequate PPE supplies and indifference from hospital management.

“We’ve been reporting to our management at every stage, but it took no measures,” Rimma Kamalova, a rheumatologist at the Kuvatov Clinical Hospital, told RFE/RL’s Tatar-Bashkir Service. “They told us we’re working badly.”

But it is Moscow that has so far been hit hardest by the coronavirus, and where the attention of the medical community is focused.

Over the past week, as COVID-19 cases spiked in the city, social-media users have been fed jarring images showing a concerning pattern: rows of ambulances standing in long lines outside hospitals full with patients.

Ambulance Traffic Jams At Moscow Hospitals As COVID-19 Cases Surge
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In one widely shared video, an ambulance driver leaves a hospital outside Moscow after a nine-hour wait to deliver a patient, and the camera pans round to show a huge line of other ambulances waiting to enter.

Belyakov said the lines were a temporary bottleneck resulting from the opening of two hospitals north of Moscow that are dedicated to treating COVID-19.

“All the drivers from Moscow and the region flocked there,” he said, adding that the situation has since improved.

He has now been assigned to a special ambulance brigade handling patients with suspected COVID-19. But he’s still faced with the same problems, he says: “All the hospitals are full.”

Plans are in place to turn a maternity clinic in Zheleznodorozhny into a COVID-19 hospital, which Belyakov says is his “only hope.”

Until that happens, he’s been taking to the road in hopes that the hospital he’s directed to will still have a free bed when he, and his patient, arrive.

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    Matthew Luxmoore

    Matthew Luxmoore is a Moscow-based journalist covering Russia and the former Soviet Union. He has reported for The New York Times in Moscow and has written for The Guardian, Politico, The New Republic, and Foreign Policy. He’s a graduate of Harvard’s Davis Center and a recipient of New York University's Reporting Award and the Fulbright Alistair Cooke Journalism Award.