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/).
IIn 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/). An influenza vaccination campaign will start in September and aims to cover 60% of the population -10% more than previous years – and 75% of those at risk. 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 Ministry of Health of the Russian Federation has issued a registration certification for a vaccine to prevent COVID-19. The vaccine was developed by the Gamaleya National Research Centre for Epidemiology and Microbiology and. is a vector two-component vaccine based on the human adenovirus. The vaccine passed national safety and efficacy trials on several species of animals (rodents and primates), and later the vaccine was tested on two groups of volunteers (38 people in each group).According to the MOH announcement the vaccine does not contain the components of the COVID-19 virus; and a two-fold injection scheme should allow long-term immunity up to 2 years (https://minzdrav.gov.ru/news/2020/08/11/14657-minzdrav-rossii-zaregistriroval-pervuyu-v-mire-vaktsinu-ot-covid-19).
The President’s Office announced a list of instructions on measures aiming to increase healthcare system preparedness for the autumn-winter epidemic season, including, but not limited to:
- maintenance of the COVID-19 specialized beds reserve, with the possibility of deploying additional beds, including beds for complicated cases of influenza and other acute respiratory infections treatment, as well as patients flows isolation in the facilities.
- expansion of teleheath services (for remote consultations between a doctor and a patient), to prevent the spread of respiratory infections and other infectious diseases.
- building reserves of medicines, disinfectants and antiseptics, medical devices, equipment and PPE, necessary for prevention and treatment of acute respiratory infections (including COVID-19), in pharmacies and medical facilities