3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
The Coordination Council (see Section 5) determined the number of beds necessary in each region to cope with the COVID-19 outbreak. Clear requirements for buildings and hospitals were defined (including number of ventilators, reanimation beds, oxygen supply, etc), as well as general requirements for available personnel and equipment.
Specific hospitals and departments are being deployed or repurposed to deal exclusively with COVID-19 patients (see Section 2.1). Cancelling planned medical procedures and non-emergency surgery has been recommended to free up beds and human resources. Primary healthcare services providing home care are required to reorganize to prioritize patients with fever and respiratory issues as well as patients aged over 60 years. Mobile teams of specialists have also been set up to fly across the country to support hospitals and health workers in the regions as required. On 15 June, 11 regions had benefitted from 16 such support missions (http://government.ru/news/39873/),and in addition, the Tuva region at the end of June.
Several Federal remote reference centres were set up for COVID-19 / pneumonia patients, which are able to conduct consultations and give advice using telemedicine. Decree 171 recommends regional authorities replicate these remote reference centres and their functions at regional level.
Ways of accelerating the implementation of the telemedicine objectives of the ongoing National Health Project are being investigated, in particular to allow initial diagnostic consultations and the prescription of medicines.
A list of medicines needed for COVID-19 patients has been developed and shared with manufacturers (most of them Russian). Law amendments passed on 31 March established that public procurement can be carried out without competition in order to fight drug speculation during emergencies, while the retail and wholesale of medicines and medical devices can be restricted for 90 days and a specific procedure can be set up for the registration and circulation of drugs and medical devices. Another law passed on 1 April authorized online sale of prescribed medicines during emergencies. From 3 June until the end of the year, for better access and coordination purposes, the State will control the distribution of COVID-19 medicines: every week, manufacturers have to share their distribution plan and the application requests from regional authorities with the Ministry of Health and the Ministry of Industry and Trade, which can adjust them if necessary (http://static.government.ru/media/files/C5ygPhGx22PCYiyz0wZsofUnnID8Ro2c.pdf). In the beginning of June, the Moscow Government created a reserve of 10 million packs of 53 drugs to treat patients with COVID-19. (https://mosgorzdrav.ru/ru-RU/news/default/card/4112.html). From 30 June, to improve continuity of treatment for COVID-19 patients, a circular reviewed the procedure to include brand-name medicines in the list of drugs that can be purchased by health facilities and allows patients returning home or being treated in another medical facility to continue treatment with the same brand-name medication that they received in hospital. (http://government.ru/news/39960/).
In order to increase production volumes, a set of rules have been issued to authorize and regulate the use of confiscated alcohol for the production of sanitizers (http://government.ru/news/39955/).
In view of the autumn-winter epidemic season, another COVID-19 wave or future new epidemic threats, the Government is planning next steps and setting priorities. Deputy Prime Minister Golikova and Minister of Health Murashko have discussed expanding the coverage of the influenza vaccine, preserving the reserve of beds created in the past months (see Section 2.1), creating a reserve of trained specialists, and modernizing the infectious diseases delivery services (http://government.ru/news/40023/). Influenza vaccination campaign will start in September and aims at covering 60% of the population, by 10% more than in previous years, and 75% of those in high risk groups. By the end of September, Rospotrebnadzor will conduct a screening survey of the population searching for 17 respiratory viruses, including influenza A, B and COVID-19 viruses (http://kremlin.ru/events/president/news/63764).
The President of the Russian Federation signed Decree No.12 on 4 January 2021 about the response procedure for the authorities in case of outbreaks of hazardous infectious diseases (http://publication.pravo.gov.ru/Document/View/0001202101040020?index=0&rangeSize=1). The Government is expected to develop and approve the operating procedure for inter-agency and cross-regional response within three months.
The action plan for the development and strengthening of the system of federal sanitary and epidemiological surveillance during 2021-2028 was approved by Government Resolution No. 3680-р of 30 December 2020 (http://static.government.ru/media/files/9eEceLE3zKFgn1AZNQobbtvLvklprtuj.pdf ).
Three vaccines for COVID-19 have been developed and registered in the Russian Federation. The combined vector vaccine "Gam-COVID-Vac" (developed at the Gamaleya National Research Centre) was registered on 11 August 2020 (https://minzdrav.gov.ru/news/2020/08/11/14657-minzdrav-rossii-zaregistriroval-pervuyu-v-mire-vaktsinu-ot-covid-19). A peptide antigens vaccine – "EpiVacCorona" developed by the “Vector” Institute of Virology – was registered on 13 October 2020 (https://www.rospotrebnadzor.ru/about/info/news/news_details.php?ELEMENT_ID=15660). On 20 February 2021, the Ministry of Health registered an inactivated virus containing “CoviVac” vaccine developed by the Federal M.P. Chumakov Center for Research and Development of Immunobiological Preparations (https://minzdrav.gov.ru/news/2021/02/20/16138-minzdrav-rossii-zaregistriroval-tretyu-rossiyskuyu-vaktsinu-ot-covid-19 ).
Coronavirus vaccination has been included in the immunization calendar according to epidemic indications, and population groups have been identified and prioritized for vaccination by Order of the Ministry of Health No. 1307н of 09.12.20 (http://publication.pravo.gov.ru/Document/View/0001202012160048?index=0&rangeSize=1 ).
The Ministry of Health developed and on 19 January 2021 disseminated Standard Operating Procedure in the regions to manage the workflow for healthcare organizations and healthcare workers involved into COVID-19 vaccination in adults (https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/053/957/original/1-%D0%B8-1-155.pdf?1611062698).
A special form for making appointments for COVID-19 vaccination has been available on the public services portal since 31 January 2021 (https://www.gosuslugi.ru/landing/vaccination).
On 20 February 2021, Deputy Prime Minister T. Golikova reported that 4129 vaccination posts have been organized, over 11.1 million vaccine dose sets have been produced, and another 59 million dose sets will be produced in the first half of 2021 (http://government.ru/news/41588/). The Ministry of Health prepared a plan for the distribution of vaccines across the country in the next three months. In this plan, regions will receive 480,000 doses in December. A vaccine supply schedule was developed as well. Logistic passports describing preparedness for vaccination in all Russian regions were presented to the Government. Each week, vaccine producers will update the Ministry of Health on the current stock of vaccines. The Ministry of Health, within two days, is required to distribute the available stock according to the needs of particular regions (http://government.ru/news/41125/).
According to a RBC report of 20 February 2021, at least 3.23 million Russian citizens have received the first dose of COVID-19 vaccine based on the data of regional ministries of health (https://www.rbc.ru/society/20/02/2021/602fb2019a7947f5acf0a70a).
100 vaccination posts have been set up at Moscow city polyclinics, 62 posts have been set up in private healthcare organizations, and some mobile posts have been set up in shopping-malls. As of 17 February 2021, over 555,000 individuals have been vaccinated in Moscow (https://mosgorzdrav.ru/ru-RU/news/default/card/5357.html).