2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
From 3 June, hospitals will be allowed to resume planned medical procedures (see section 3.3). Hospitals reprofiled for COVID-19 activities can gradually return to their normal work in regions where the epidemiological situation allows (http://static.government.ru/media/files/QAZ79dd9JhXTImvJbm4d8C6sjtHEBJMs.pdf). In Moscow, on 29 July, 37 of the 48 CT centres were back to their regular activities (https://www.mos.ru/news/item/77476073/) and on 27 July, 21 hospitals had returned to normal operations (https://www.mos.ru/news/item/77544073/). On 11 July, the Mayor of Moscow said that 8600 beds can still receive COVID-19 patients in Moscow, of which about 5000 are currently unoccupied.
According to Minister of Health M. Murashko, over a third of all dedicated beds are unoccupied and available for coronavirus patients as of 2 February 2021 outside Moscow (https://www.rbc.ru/rbcfreenews/601942d99a794723419ac95c).
Due to the improving epidemiological situation in Moscow, the number of beds for COVID-19 patients in hospitals and back-up hospitals has been reduced by 4700. The current number of beds is almost 9000 (https://mosgorzdrav.ru/ru-RU/news/default/card/5333.html).
The first rehabilitation centre for patients with COVID-19 opened in the Ulyanovsk region, focusing on the respiratory system, physiotherapy exercises, and oxygen therapy (https://ria.ru/20200718/1574504920.html).
Deputy Prime Minister Tatiana Golikova indicated that 52,000 beds were available at the beginning of the epidemic, of which only 25,000 were ready to provide assistance to patients with COVID-19, while at the peak of the epidemic the number of COVID-19 beds available rose to 184,000 (http://government.ru/news/40023/). On 13 July, the President said that more than 170,000 beds are dedicated to COVID-19 patients across the whole territory, of which 66% are occupied (http://kremlin.ru/events/president/news/63635). The beds equipped with mechanical ventilation devices have an 8% occupancy rate and those with oxygen 34% (http://kremlin.ru/events/president/news/63382). On 2 April, the Federal Government published a list of public and private hospitals repurposed to provide assistance to COVID-19 patients, which has been updated twice (latest update: http://static.government.ru/media/files/miJSZHQ7rBd8xsADXWt09bLTRFEmEhMI.pdf) . As of 15 July, the Ministry of Defence had built 17 infectious disease centres in 16 regions, while two others are being completed in the Voronezh region and Dagestan Republic. In addition, a hospital is being constructed in Pskov and another one is planned in the Republic of Tuva (http://government.ru/news/40023/). Some of these hospitals responded to specific and acute outbreaks such as in Dagestan, where three multifunctional medical centres were built by the Ministry of Defence (https://tass.ru/obschestvo/8663595) with equipment, PPE and medicines supply, and were open at the beginning of July.
As of 28 October 2020, 223,100 beds nation-wide have been assigned to treating patients with COVID-19, of which 123,000 have an oxygen supply and 28,400 beds are equipped with ventilators. On average, about 19.1% of bed capacity remains free, but bed occupancy is over 95% in five regions (http://kremlin.ru/events/president/news/64293#sel=14:11:TlU,14:25:Ucl). In total, as of 19 January 2021, over 270,000 COVID beds have been mobilized, including 31,000 ICU beds and over 1200 CTs (https://rg.ru/2021/01/19/minzdrav-bolee-600-tysiach-medikov-privlecheny-k-lecheniiu-bolnyh-s-covid.html).
In Moscow, 44 federal, city and private hospitals can receive COVID-19 patients, with a total of 40,000 beds (http://government.ru/news/39846/). This includes the new “Komunarka” hospital, which was built as a state of the art clinical centre and repurposed immediately in February as the central hospital dedicated to patients with confirmed or suspected COVID-19, as well as the new infectious disease hospital that opened on 20 April and additional temporary facilities constructed in nine hospitals In addition, 48 primary care institutions with CT scanners have been repurposed for early diagnostic and outpatient care for patients with COVID-19. According to the Mayor of Moscow, as of 30 April, COVID-19 bed occupancy was about 50%, and around 25% on 10 June (http://government.ru/news/39846/).
Five back-up hospitals in Moscow were equipped and fully prepared in April 2020 and made operational in October to provide secondary care. They can accommodate over 7,000 people for treatment at once, including approximately 500 patients in ICUs and 208 – in resuscitation. Over 33,000 patients were treated in fever clinics from the beginning of October to mid-January to avoid the need for reorientating Moscow clinics for coronavirus treatment and to maintain the delivery of routine care in the city (https://mosgorzdrav.ru/ru-RU/news/default/card/5257.html).
As of 14 May in St Pertersburg, COVID-19 patients can be received in more than 6,000 beds in 19 hospitals plus, for mild cases, in three additional infectious departments in other health facilities or in the temporary hospital built on the exhibition center “Lenexpo”.
All medical institutions have been provided with two-weeks reserves of medicines and stocks of personal protective equipment with continuous updating of stocks. On 4 May, the temporary ban on the export of PPE and other medical equipment was removed as Industry Trade Minister Denis Manturov said there is no shortage of masks or other sanitary products in Russian pharmacies. On 29 July, First Deputy Minister of Industry Sergey Tsyb said that every day, the Russian Federation could produce 14.5 million masks, 200 thousand protective suits, 115 thousand pairs of gloves, 50 thousand goggles, and 380 thousand litres of antiseptic agents, and that enterprises currently work at 70-80 percent of their maximum capacity. Other medical equipment (8,500 ventilators, 2,000 thermal imagers and 17,500 air disinfecters) will be delivered to the regions in August / September (http://kremlin.ru/events/president/news/63764). On 15 July, Minister Manturov mentioned the ongoing export of Russian-made equipment in terms of tests, PPE, and ventilators (http://government.ru/news/40023/). On 6 April, a Government decree established that only pharmaceutical companies will be able to sell a set of medical devices including masks, respirators and gloves, and that their price should not increase by more than 10%. On 29 July, First Deputy Minister of Industry Sergey Tsyb said that Russian production capacity of antivirals now significantly exceeds the needs of the domestic market. A reserve of PPE and medicines is thus being created, as requested by the President (http://kremlin.ru/events/president/news/63764)