A huge tent stands in the courtyard of St. Petersburg Hospital No. 2 — an extra emergency ward if the hospital receiving ward can’t cope with a surge of coronavirus cases. The hospital, one of the city’s largest, has 1,200 beds. At the end of March, the director was told to get ready to receive Covid-19 patients, train its staff and stock up inventories.
St. Petersburg’s Covid-19 statistics are less dire than Moscow’s. The number of confirmed cases has been fluctuating between 35 and 120 per day over the past week, in contrast with Moscow’s number rising to over 3,000 new cases a day. On April 14, 799 cases had been confirmed in St. Petersburg.
So far, the tent has not been used. But the hospital’s staff say they are in the “calm before the storm.”
What they don’t know is how devastating the Covid-19 tsunami will be when it hits.
A day in the new life
“We are torn between hope and uncertainty, and the uncertainty is really the hardest part right now,” Pyotr Puzdryak told The Moscow Times. Puzdryak is a vascular surgeon who was retrained to deal with infectious diseases.
“We are sailing through troubled waters. There is so much we don’t know for a fact, from the true numbers of people infected and recovered — a lot of people must have already had Covid-19 without even noticing — to how many people had it and died before testing began. With both the Chinese and the Italian scenarios in front of us, we are doing the best we can with what we have to avoid a disaster.”
Up to 270 ambulance vehicles arrive at the hospital per day, most with patients showing symptoms of Covid-19, pneumonia or acute respiratory syndrome, he said.
Puzdryak and his colleagues are on 24-hour shifts. The protocol is 20 minutes per patient in the emergency ward, where he is assigned. All the routines have been changed to deal with the Covid-19 emergency. Everyone on staff gets their temperature checked every day and takes a coronavirus test once a week.
“The training helped a lot, thanks to our chief doctor Vladimir Volchkov, who had first-hand experience creating infection wards in past flu epidemics,” Puzdryak said. “But there is a lot to learn and get used to, like how to work in gear that is like a spacesuit for many hours without food, water and bathroom runs. Or how to how to use a phonendoscope — a stethoscope that amplifies sound — without touching your face, and how to find veins when you’re wearing thick goggles that fog over when you breathe.”
Ready or not
When the hospital was ordered to start operating as an infectious diseases center in the end of March, there was a serious shortage of just about all protective gear, from airtight respirator masks to surgical gowns and eye gear, Puzdryak said. “Given the dire shortages of basic personal protection equipment, I thought a lot of my colleagues were just going to resign,” he said. “But no one quit. There is a strong sense of camaraderie and mutual support. The attitude ‘if not us, who?’ was stronger than everyone’s fears.”
According to the St. Petersburg Health Committee, the city’s hospitals currently have 1,784 ventilators, and the local government has announced tenders to buy more. Earlier this month St. Petersburg governor Alexander Beglov said the city would need a further 1,600 ventilators in a bad-case scenario.
“At the moment, we are fully stocked with equipment, including ventilators and personal protective gear, which is, I must admit, a huge relief. We know that this is not the case in all Russian clinics.”
To keep spirits high, the hospital staff send each other corona memes. One of them shows Death spraying disinfectant over her scythe, cursing the panic.
But Puzdryak doesn’t see much panic. “I don’t see it much among the patients who come in, although the situation must be terrifying: doctors and nurses dressed like cosmonauts, and everyone knows there is no easy cure,” he said. “But people are upset to be separated from their families. No visits are allowed, and people know they will have to get through this on their own.”
If the virus doesn’t get you, starvation will
What does upset the staff is how hard it has been to motivate the Russian people to stay home. “Thousands of people fear losing income much more than they fear catching the virus,” Puzdryak said. “I read in the news that many people are already facing unemployment, unpaid leave, crippling debts and instant poverty — and they see that prospect as another form of death.”
Businesses, which have been most affected by restrictions introduced by the government in an effort to handle the pandemic, have so far only been given the option of putting off some of the payments they are required to make. The measure has been called a “suspended sentence” by some entrepreneurs, who already have mounting debts.
A lot of Russians remember the economic reforms of 1990s, when Russia's population shrank and the annual death rate exceeded the birth rate. The country was hit by a wave of unemployment, poverty and crime.
“The truth is that in Russia, the topics of the coronavirus and poverty go hand in hand. Just look some of the most popular jokes about Covid-19,” Puzdryak said.
A popular one making the rounds in St. Petersburg is: The Russian Pension Fund cares for you. They give you small pensions so you can’t waste money on gambling or traveling to dangerous places, like China and Italy.
In one illustrative recent incident, St. Petersburg entrepreneur Alexander Zatulivetrov, the owner of several restaurants, announced on April 9, that he would open his eateries, come what may, on April 15, under the slogan “I am as safe as a bank or the metro.”
“We don’t have a strong lobby,” he wrote on social media. “But think how many people work for us! These are people who don’t have a single chance of getting a bank loan. The banks have lost their consciences. If you care as much as I do, please join me.”
Under pressure, he had to cancel his plans.
The more the virus spreads, the greater the risk that Puzdryak and his colleague will have to do what they dread: make morally wrenching choices to allocate shrinking resources among growing numbers of patients with equal needs.
In the meantime, the doctors’ own call for support is being heard by the media, the public and private donors. After the doctors at St. Petersburg’s Pokrovskaya Hospital posted a video on YouTube on April 3 showing their catastrophic lack of individual protective gear, the reaction was powerful and immediate, from media campaigns to direct donations of masks from Leningrad rock band frontman Sergei Shnurov, the Yabloko party and private donors.
Grassroots campaigns under the slogans like “Support Doctors!” and “We’re together!” have sprung up all over the city. Private companies are providing gear, food and water which volunteers deliver to the hospitals daily. “I talk to doctors at St. George Hospital a lot, and they say volunteers bring them hot meals,” Puzdryak said. “We’ve never heard so many warm words of encouragement before. I can’t even say how much it means to us.”