The War Zone: Inside Moscow’s Covid-19 Hospital

13 May 2020 17:57

An elderly woman sits hunched over on a bench of the changing room at Moscow City Clinical Hospital 52. Her shift is over but she is too exhausted to move. Around her, a bustle of doctors and nurses are just getting ready to start their shift.

They follow a strict dress code. A soft gray t-shirt, white cotton trousers, and a hazmat suit. Gloves are pulled over the top and sleeves are tucked in, shoes covered and protective goggles fitted snugly over the cheeks, forehead, and nose - followed by a mask respirator and a hood. Their lives might depend on the personal protective equipment being worn properly.

This locker room is the gateway to the ‘war zone’ of one of Moscow’s busiest COVID-19 hospitals. On February 29, it became one of the first hospitals in Russia to start admitting patients with the novel coronavirus. Now, it treats hundreds of them. Award-winning reporter Elena Kostyuchenko and photographer Yuri Kozyrev, from our partner outlet Novaya Gazeta, spent more than 24 hours documenting the work of doctors and nurses in this COVID-19 hospital as Russia emerges one of the world’s epicenters in the pandemic.

BACKSTORY

With more than 240,000 cases, Russia now has the third—largest COVID—19 outbreak in the world. Nearly 60% of them are in Moscow. There’s a growing consensus that the actual number of cases is much higher than the government reports. Moscow Mayor Sergei Sobyanin said screening results suggested that 2% of the city’s 12,5 million residents could be infected, meaning that the Russian capital alone could account for some 240,000 cases. To slow down the spread of the virus, Sobyanin has extended the lockdown in the capital until May 31.

Cases are growing by more than 11,500 daily — nearly doubling the official figure of just two weeks ago, when Russia’s health care system was already struggling. This is now the fastest dynamic in the world after the US. Beds, personal protective equipment, and medical staff are all in short supply. Outbreaks have occurred in numerous hospitals, two dozen of which have been placed under quarantine.

More than 1500 doctors, nurses, and orderlies work at Moscow City Clinical Hospital 52. Some have come to help from the regions. Almost all have had to retrain.

Ambulance Queues

The people rushing through reception look like ghosts in their white suits. Gurneys rumble along the corridor as new patients are unloaded from the line of ambulances outside. More than 100 patients are admitted daily. This late April morning, there are three ambulances outside. But as soon as one drives off, another one pulls up.

Reception Department. Photo: Yuri Kozyrev / Novaya Gazeta

“I’ve forbidden for more than one ambulance to be allowed in reception,” says Marina Cheremukhina, head of the department. “Otherwise, a crowd forms and everyone has COVID-19.”

For every patient that’s admitted, there is a standard procedure. Medics take their blood pressure, pulse, temperature, CT scan, ECG, urinalysis, and medical history.

Last Hope for Survival

Mikhail Ketskalo is a former military doctor. He went through the second Chechen war, then served at the Vishnevsky Central Military Clinical Hospital and left with the rank of lieutenant colonel. Today, he heads the ECMO Centre at the hospital.

The head of the ECMO Center, Mikhail Ketskalo. Photo: Yuri Kozyrev / Novaya Gazeta

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, provides patients with cardiac and respiratory support when their heart and lungs are failing. It used to be only used in transplantology, but today it is used for acute respiratory failure. It’s a very complex and expensive method, but it allows doctors to save around 50% of those who can’t even breathe on a ventilator. For many, it’s their last hope for survival.

“The conditions are extreme here but quite comfortable, unlike other institutions. We are not dealing with a particularly dangerous infection. This is not the plague, this is not West Nile fever. Still, it is dangerous,” he says.

“We have a lot of patients under the age of 50, and some patients under the age of 40. But again, this is because we are a specialized department. Unfortunately, ECMO is unavailable for the elderly.”

The hospital was down to its last two ECMO machines at the time of reporting.

A patient connected to a ventilator. Photo: Yuri Kozyrev / Novaya Gazeta

Nurse Turned Patient

The most critical patients - not only in the hospital but in all of Moscow - are admitted to the hospital’s ICU #7. There 13 folks in here — eleven are on ventilators, five on dialysis. All but one have tested positive for COVID-19.

They lie on their beds naked, covered only with sheets. Their bodies are stained with purple antiseptic, drying wounds and bedsores, their chests lifted mechanically by ventilators. Among them are a woman with convulsions and a large man from Georgia, who the doctors nicknamed ‘Kid’. His lungs are filled with pus and he is in a state of toxic shock. He is also on a mechanical ventilator and connected to an ECMO machine. People in yellow hazmat suits bring another device to carry out a plasma exchange to treat the cytokine storm syndrome, which occurs when the immune system goes into overdrive in COVID-19 patients.

In another room, Lena Petrova sits on the bed. Just a few weeks earlier, she was in a serious condition herself. Petrova is an ICU nurse. But for the past month, the 44-year-old has been a patient in her own unit. Today, she is finally preparing to go home.

Nurse Lena Petrova is discharged after 31 days in the hospital. Photo: Yuri Kozyrev / Novaya Gazeta

There are no official figures but it’s estimated that hundreds of medics across Russia have already become infected with COVID-19. At Moscow City Clinical Hospital 52, so far 24 workers in total have fallen ill. Last month, Russian health care workers created their own online list of local medics who died during the COVID-19 pandemic. There are currently more than 170 names on the list.

Petrova was one of eight medics to have contracted COVID-19 in her unit but her road to recovery has been the hardest. She has a bruise on the corner of her mouth from where the oxygen tube was placed and an incision from the tracheostomy hidden under a patch on her neck. Doctors were considering whether she would need an ECMO machine, but the illness didn’t progress to that point.

“I was afraid to open my eyes. To wake up and see that I have a tube in my hip, an ECMO [device],” she says, wiping away tears.

Can’t Cure Everybody

In the evening, resuscitator Denis Pavlov treats a female patient who earlier had convulsions but is now staring at the ceiling, unresponsive to her name being called.

Resuscitator Denis Pavlov and nurses prepare to transfer a patient to another intensive care unit. Photo: Yuri Kozyrev / Novaya Gazeta

“After 5-6 days on a ventilator, a superinfection, which survives the hellish conditions of our bacterial therapy, enters the lungs. COVID-19 opens the way for it. 2‒3‒4 bacteria live in colonies, antibiotics don’t always have time to work. Such is life,” Pavlov says. “We love our patients very much. But we can’t cure them in some cases.”

At night, the doctors fill out the patient’s monitoring diaries. Some discuss ‘Kid’s’ condition.

“He will die either way,” says one medic.

“He might live,” Pavlov insists. “At Botkin hospital (St. Petersburg's Botkin Infectious Disease Hospital, one of the largest in the country - ed.) we’ve pulled people out after long toxic shocks.”

An hour later, Pavlov is standing above the man himself - his heart rate is elevated at 140 beats per minute and his chest is trembling.

“He is in the severe stage of septic shock,” Pavlov explains. “The day before yesterday - even yesterday at lunch- we were treating [his condition] as promising. Then an infection set in. We tried all types of therapy. There are no more brilliant ideas.”

At two in the morning, Sveta Luchkova sits down to sign empty blood containers. She checks endless lists for any signs of change in the patients. Alena, a fifth-year medical student, walks behind her. Two weeks ago she was called up by the Ministry of Health. With staff shortages plaguing Russia’s healthcare system, Moscow has been calling on medical students to step up and help out the doctors and nurses on the frontline of the pandemic.

“It's scary,” Alena admits. “But I thought it would be worse.”

At 8 a.m., the next shift starts. The doctors and nurses swap notes on their patients, updating those coming on shift of the progress and setbacks of the night.

“How did you sleep?” one doctor quips.

“Very funny,” another responds sarcastically.

In the afternoon, Petrova is preparing to check out of the hospital. The medics help her to a wheelchair and place her belongings on her knees. Staff line the corridors and clap, calling out well wishes as she is wheeled out of the building and placed into a taxi. Not all patients are as fortunate as Petrova though. ‘Kid’ dies in hospital the following day. Doctors spend an entire day trying to save him, but they don’t succeed.

/Translated and abridged by Natalie Vikhrov, with materials from Novaya Gazeta correspondent Elena Kostyuchenko and photographer Yuri Kozyrev. Courtesy of the Russian Language News Exchange.