The first COVID-19 patient in Ukraine’s western region of Ternopil was registered on March 20. On April 3, the number of infected patients in the region had reached 114 people. 83 of them live in the Monastyryska district. Coronavirus victims in the district include a high amount of medical personnel – 10 doctors and 22 nurses have fallen ill, including 5 children, 4 government officials, 3 police officers, 1 priest, and one kindergarten teacher.
The first medical practitioner to fall ill with coronavirus in the region was a nurse from the admitting department. The head of the local doctor’s union, Doctor Vitaliy Tryshchuk from the Monastyryska Regional Hospital, spoke to hromadske about why all medical employees of the hospital weren’t isolated after the nurse’s confirmed diagnosis, and how Ternopil’s medical staff continue to work.
Why have so many medical personnel fallen ill and what do we know about ‘patient zero’?
The first medical practitioner who’d fallen sick was a nurse from our admitting department. I don’t know how she got sick, but she went to the ER, and she was in a sorry state. She needed to be artificially ventilated.
She was lying in the hospital for a few days with an influenza A diagnosis. According to our algorithms and protocols, we should have first excluded influenza A and B. The lab confirmed her influenza A. Then consultants and infectious disease specialists arrived, and she was investigated for coronavirus.
Then we have the first seriously sick patient in the Ternopil region. We investigated her for coronavirus, and she had a confirmed coronavirus infection. That’s one factor. The second is that we practically have no PPE (personal protective equipment – ed.) We didn’t have overalls, we didn’t have protective screens, respirators, we didn’t have masks – the only masks we had were from old stockpiles, or masks that someone had sewn for us or that we’d received from volunteers. We already had a pandemic for a week, but there weren’t even any masks in the pharmacies.
“We have a lot of contacted people, over 1,000. That’s why we would like more test-systems, because there’s a problem with the quantity of people we’ve checked.”
What was the order of events?
If we isolated all of our medical staff, then no one would be left to provide help. We didn’t think about how to isolate people, we thought about how to save people, and how to help them.
Of course, we started to investigate everyone that came into contact with the patient, that came into probable contact with the patient. We started a massive investigation into coronavirus, and we started to find this infection. Additionally, we also had the following situation: a priest from the town of Zalishchyky was at a funeral, and half the village came into contact with him. This is also a source of infection.
First of all, we started to investigate all the medical personnel. Practically speaking, our medical staff were the first contact vectors, and I think, some of our medical staff was indeed infected in that period of time. The other half of medics that fell ill were in contact with patients from the villages of Shveikiv and Kovalivka. They were also infected because those people had a lot of people who needed to be investigated and assisted.
When you talk about a mass investigation of medical staff, do you mean express-tests? Or did you use PCR tests? (PCR is short for polymerase chain reaction, a type of test that is labour-intensive but accurate and relatively quick – ed.)
No, we only investigated medical staff with PCR tests. It seems to me that we tested nearly all of our medical staff.
Who remains in isolation?
The only people isolated are those with confirmed diagnosis and those who had direct contact with the patient. But our hospital has been re-profiled as an infectious disease hospital. This means that it's a closed campus. Doctors and other medical personnel are in the hospital nearly around-the-clock. They have limited contact with other people, including hospital employees.
Right now, when we already have so many patients, we’ve gotten some PPE. Seeing as our hospital has been under quarantine, all of our planned events have been canceled – operations, births, and so on. Only “clean” institutions can handle those. We’re only working with coronavirus-infected patients.
“[She] didn’t have a confirmed diagnosis of a coronavirus infection – she had a confirmed diagnosis of influenza A. And only after a few days was the coronavirus infection diagnosis applied.”
We have a regional hospital, not an infectious disease one. We have an intensive therapy ward, a surgical ward, a maternal ward, and so on. The infectious disease ward was closed back in 2016. That's why we weren’t prepared with a full anti-infectious stockpile at that time. All of the regional infectious disease wards, I think, are completely supplied, and probably, they have prepared isolation beds.
What’s the mood like amongst the medical personnel, and are they working overtime? How are you talking to management, and have their salaries been doubled as was promised for everyone working with coronavirus patients?
Regarding whether workers are quitting, then personally I haven’t seen any requests. You know, that one – I think maybe an orderly or maybe a nurse – wrote such a request today. But I don’t know if that request was signed.
I haven’t even heard thoughts like these among doctors, that someone wants to write a resignation request. On the contrary, I know that doctors have gone to work with their heads raised, even without PPE. For example, one infectious disease specialist worked this way, and some of the press had written about it. You understand that Monastyryska is a small town, and everyone knows each other here. It’s obvious that it would be shameful for doctors to write a resignation request because of a disease we’re duty-bound to fight.
Yes, doctors and medical staff are working overtime, and some of them have fallen right off their feet. You know that 32 of our medical staff have gone off-duty, including senior and junior medical personnel, meaning those nurses and orderlies that we already don’t have enough of. We also don’t have enough doctors. For example, there are sick among the doctors who have been directly involved in treatment. We may really run out of medical personnel if there is in reality going to be mass infections. And as far as I know, there have been requests to other medical institutions for them to help our doctors if necessary – especially to anesthesiologists and infectious disease specialists.
I’ve also recently heard that some of our nurses who had previously worked for us have agreed to once again work in the admitting department. We recently had a situation where people who don’t have a coronavirus infection but, instead, for example, have appendicitis or those who need to give birth, ran into the situation where other medical institutions didn’t want to admit them. Other hospitals know that Monastyryska is an infected region, and that’s why our people aren’t always getting the help they need.
This question has yet to be solved and it’s not entirely understood which medical institutions are obligated to admit our urgent patients. It’s written that those [hospitals] that haven’t been re-profiled [need to take them] but we only have the right to provide treatment for confirmed COVID-19 cases.
That’s why we currently have this collapse in our treatment system.
Have volunteers – ordinary residents from the town – started to somehow help?
Yes, the populace has rallied. These are volunteers, activists, teachers, businessmen. Actually, they’ve been helping us with PPE: single-use overalls, masks, goggles, caps, gloves, disinfectants.
You know that right now we have a deficit of these things, especially masks. We also don’t have respirators of the right level of protection. Thanks to these good samaritans, we’re now practically more or less supplied, and right now we can work safely for a few days.
The Minister [of Health] said that you should have already received protocols for treating people sick with COVID-19. Can you tell us whether this is really the case? What are these protocols and how will treatment be handled?
I can’t say anything about these protocols, as that’s being handled by therapists and anesthesiologists. As far as I know, there were Italian and Chinese protocols, but some of the medicines cannot practically be found in Ukraine for these protocols. For example, these are antimalarial medicines like chloroquine.
How do people react to doctors now? How have their opinions of doctors changed?
Of course, people are scared. They look at us as their last hope, especially in situations where we aren’t needed by anyone in a different region, and are needed only in our own.
People have united, people are expressing their gratitude on Facebook, they trust us and look at us with hope in their eyes. People look at doctors with admiration – their anger is reserved mostly for the authorities and the government, because they didn’t supply and protect us. And if the government doesn’t protect us, then there will be no one left to help people.
Is there some way to help doctors at the moment? To contribute to supplying respirators or protective robes, or to support doctors’ morale?
I’m not just the head of the laboratory department, but also the head of the regional medical union. I’ve already told some of the media that our colleagues are worried that they’d be made into scapegoats, because they presumably didn’t adhere to safety standards or maybe they allowed some sort of malfeasance to occur.
I have to say that our medical staff, despite our lack of PPE, have saved people’s lives. They went to battle without the necessary amount of gloves and masks. We didn’t even talk about respirators, you understand?
We spoke about having enough masks every day and protective single-use overalls. Right now respirators are very difficult to find. Through some miracle, activists and volunteers are sourcing them. But we still don’t have them in the necessary quantities. Now we’ve started collecting funding for the hospital to buy two artificial ventilators.
Our teachers are really helping out, our activists. And the diaspora has also started collecting money for us.
I do have some reservations regarding our medical staff, particularly: will they be paid compensation for falling sick at work while fulfilling their professional duties? Will there be the promised 300% bonuses?
Maybe it will be like it was under the previous minister of health, [Ulana] Suprun, where there was free diagnostics, but then it turned out that the money wasn’t there. This is what we’re thinking about. And I’ve been asked, as the head of the union, to voice these concerns. This relates to overtime work as well, and I can say that my laboratory assistants worked all through Saturday and Sunday until the evening. People are working night and day.
/ Interview by Stanislav Kondratyev, translated by Romeo Kokriatski
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