Agenda: main results of operation amid the coronavirus infections and immediate priorities
The meeting was held via videoconference.
Excerpts from the transcript:
Today we will discuss the spread of the coronavirus infection. The situation is objectively improving; we are past the peak of the coronavirus outbreak. In particular, the increase in the number of new coronavirus cases recorded yesterday is the lowest so far, no more than 1 percent. This means that we can hold fewer meetings on the epidemiological situation. Before, the Coordination Council met almost every day. Now one meeting per week will be enough to deal with the current issues.
But this does not mean we can relax. We must continue to monitor developments, identify new patients and promptly provide medical assistance to them.
This includes assistance to the regions. Many of them are lifting the temporary lockdown. People can visit public places or go on vacations. But we must not forget about the safety measures.
We will continue to send teams of medical specialists to the regions that cannot fight the epidemic on their own, as in the case of Dagestan.
We will continue the practice of high volume public testing. Moreover, we will extend the term for granting free test systems to government and municipal medical institutions until May 1, 2021. The relevant Government resolution has been signed.
Such diagnostics must be accessible everywhere and to everyone. There must be an opportunity to take a virus and anti-body test at any time and in case of the slightest doubt. If the disease is detected, the treatment must be started as soon as possible. And, early diagnosis is important for all other diseases.
The Government resolution on resuming the health survey has been signed. As you know, it was suspended due to the complicated epidemiological situation in the country. Decisions on starting it will be made by the heads of the regions depending on the situation on their territory.
Colleagues, I would like to hear your reports and discuss the decisions that you are making within your competence for countering the infection.
Ms Golikova, please tell us about the spread of the coronavirus in this country.
Tatyana Golikova: Esteemed Mr Mishustin, colleagues, good afternoon. I would like to start by saying that on 31 January 2020 you, Mr Mishustin, approved the national plan for preventing the import and spread of the new coronavirus infection in the Russian Federation. Of the 22 items in the plan, all have been fulfilled but one. We managed to organise this effort so as to avoid introducing a quarantine under a state of emergency. This is probably a rare case when a failure to implement an item in the plan turned out to be positive
This was made possible by the implementation of the scientifically substantiated forestalling strategy based on the continuous assessment of the global spread of the new coronavirus infection, analysis of the trends of the epidemiological process, modelling of epidemic scenarios, and the preventive measures.
The strengthening of sanitary protection at the border with China from the start of the epidemic there allowed us to prevent exponential growth in the number of infected people. If this had not been done at the very beginning, we would have faced a fairly serious spread of the disease in late January in the Russian Federation.
We have repeatedly talked about this, but I would like to repeat it because these are the main results of our work: the absence of the spread of the new coronavirus infection in Russia during two and a half months gave us time to re-profile beds for the treatment of coronavirus patients. The beds were provided with oxygen sources and other necessary equipment. The regions reported that they had 52,000 beds, of which only 25,000 were ready to receive coronavirus patients by the start of the epidemic. When it reached its peak, the number of beds exceeded 184,000. Almost 15,000 beds in 72 federal and private medical facilities were adapted to treating coronavirus patients.
Over 76 billion roubles were transferred from the federal budget alone for re-profiling and equipping beds at the federal and regional levels. The Defence Ministry and the regions built and opened hospitals in record time. In May, 17 new hospitals were opened in 16 regions. Now the Defence Ministry is finishing the construction of another two hospitals – for the Voronezh Region and the Republic of Daghestan. A hospital is under construction in the Pskov Region. The building of one more hospital is planned in the Republic of Tyva following the President’s instruction.
Large infectious disease hospitals are being established in the regions. Importantly, the quick deployment of field hospitals by the Defence Ministry in different regions made it possible to prevent the spread of the infection in their territory. The Emergencies Ministry deployed airmobile and temporary field hospitals as well as temporary accommodation centres in Daghestan, and the Orenburg and Samara regions.
The training of medical personnel was organised very quickly. Over 1.4 million medical workers were trained to treat coronavirus patients. In early April, medical aid for such patients was rendered by over 40,000 doctors, 142,000 paramedics and 25,000 medical attendants. Today’s figures are completely different: 131,000 doctors, 272,000 mid-level medical staff and almost 63,000 junior staff.
Diagnosis is another important issue that you mentioned in your opening remarks. Russia was among the first countries to develop, in the shortest possible time, the diagnosis tests for the coronavirus infection with high analytical sensitivity and diagnostic specificity. This helped control the spread of the coronavirus in our country. Today, Russian research results in this area are used in over 30 countries around the world, in Asia, Africa and Latin America.
Thus far 114 test systems for diagnosing COVID-19 have been registered in Russia, with 794 laboratories that carry out such diagnoses operating across the country. So far, 23.8 million tests have been carried out, and the country now ranks second in the world in test coverage. As we have repeatedly noted, testing coverage made it possible to identify the most complex forms of the disease, including asymptomatic and low-symptom forms, which significantly limited the spread of the infection across Russia and prevented an avalanche-like increase in mortality rates.
The work on vaccines began in the earliest days of the novel coronavirus epidemic. Today, in accordance with the plan approved by the Government, 26 vaccines are being developed. The vaccine developed by the Gamaleya National Research Centre for Epidemiology and Microbiology is undergoing clinical trials. Another vaccine developed by the State Scientific Centre “Vector” is being examined by experts to obtain permission for clinical trials, and we hope that approval will be granted in the next few days.
The pre-clinic and clinic research results make us confident that several effective vaccines will become available in Russia in the near future, and they will enjoy demand internationally.
We are the only country in the world that has provided free testing and medical help to patients affected by COVID-19. Considering that treating these patients is costly, the regions were instructed to amend their respective territorial state guarantee programmes for free medical help and the corresponding cost agreements, according to which the rates for providing inpatient and outpatient medical help have been changed, including by way of redistributing the mandatory medical insurance funds, which were previously allocated for occupational medical checkups and routine medical examinations. We have set a separate rate for providing medical help to patients affected by the COVID virus. All regions have made these amendments. The highest rates for inpatient treatment were set in Moscow, the Chukotka Autonomous Area, the Yamalo-Nenets Autonomous Area, and the Kamchatka Territory.
According to the Federal Mandatory Medical Insurance Fund, from March to May (this is the actual data based on paid bills), 22.3 billion roubles have been allocated from the state guarantee programme for treating patients affected by the novel coronavirus infection. According to preliminary data for June, the funds allocated for these purposes over the entire period will total about 40 billion roubles.
The timely implementation of the stay-at-home order, especially for people over 65, preserved the health of older people and prevented the rapid spread of the virus among this group.
In Russia, people over 65 make up 15%-16% of the patients affected by the coronavirus infection.
Thanks to the timely measures, we managed to prevent the healthcare system from collapsing on an avalanche of hospitalisations. We managed to space out the mass hospitalisation of patients in time. It worked in almost all regions of the country. That is why there are so many saved lives in Russia. The mortality rate from the novel coronavirus infection (so far, we have Rosstat data through May) was 2.3 percent, which is significantly lower than in other countries. I want to note the mortality rate during the first five months of 2020. It’s the same as in the first five months of 2019. This means that, despite an increase in mortality in April and May, Russia had room for reducing the mortality rate, which we accumulated and used to prevent a dramatic increase in these numbers.
Resuming the regular provision of medical help and routine medical checkups (you signed an order to resume this), as well as vaccination, will allow us to return to our routine detection of chronic diseases, provide medical help and, of course, reduce mortality.
Despite the fact that the borders were closed and international air travel was suspended, Russian citizens abroad were not left stranded. As many as 266,000 of our fellow citizens came home on inbound flights. I must commend our colleagues from the Ministry of Communications and Mass Media, the Federal Air Transport Agency, the Ministry of Transport and the Foreign Ministry for doing a great job.
Over the last two months, the number of new cases has been decreasing, which made it possible to begin gradually relaxing the restrictions. We are also working to resume international flights with countries that comply with our criteria, mutually. We expect that soon the aviation authorities will provide the corresponding information.
Over the entire period of observation, 523,249 people recovered in Russia.
Of course, these are just the results I believe are worth noting. I think my colleagues will elaborate on other aspects of this effort. But I would like to say that we have to move forward considering the experience we have acquired to be always ready to respond. In this sense, there are several proposals on how to organise this work in the future.
First, in order to prepare for the autumn and winter epidemiological season and in case new threats arise in the future, we have to preserve a reserve of beds; we have been instructed accordingly. The beds must also have the necessary medical equipment. As of yesterday, there were 169,000 designated beds in the Russian regions. We understand that some of them will probably be returned to regular use. Nevertheless, as we discussed yesterday at the meeting of the State Council Working Group, a ceratin reserve must be maintained.
Second, a purchase order for domestically produced life-saving equipment must be issued to the Russian medical industry. This equipment is not just important for the pandemic, but also for routine healthcare. The availability of personal protective equipment was a problem we faced, especially at the beginning. We took immediate measures to address this issue, including simplifying the registration procedure for imported items. We need to analyse this situation further including medical item import access to the Russian market and perhaps simplify it while not allowing low-quality medical products in.
Third, it is necessary to revise the system of qualification upgrade and in some cases change it. Universities must be involved. We have to create a human resource reserve in case a similar situation arises in the future.
Fourth, we have to closely analyse the current state of infectious disease care and upgrade it as part of the national action plan to restore the economy, which is under development now. We have to revise and update the procedure for providing medical aid during infectious disease epidemics as well as corresponding clinical recommendations, and upgrade the laboratory base and repair hospitals if necessary.
Fifth, the world is facing a new disease affecting various body systems, which has not been studied completely yet. We don’t know yet what the long term consequences will be for people who recovered from the novel coronavirus infection, especially in its most severe form. This is why I believe it is necessary to ensure long term in-patient observation of these people as well as the frequency and volume of medical examinations depending on age, the severity of the disease and other factors, as well as to establish a corresponding rehabilitation system.
Sixth, scientific research is another important issue. Russia has taken an active part in studying the coronavirus. When people first fell ill in Russia, Russian scientists isolated strains of the coronavirus; we now have more than 100 of them. Russian samples have become a significant contribution to global monitoring of the virus’s variability. However, we should not be limited to the study of the virus and the search for vaccines. It is necessary to study, as I said, the long-term effect of the coronavirus on various organs and systems of the body and to set a task for scientific institutions to conduct additional research.
During the pandemic, the Russian Education Academy and Russian Psychological Society specialists together with other interested agencies, with support from the Ministry of Education and Science, carried out several studies commissioned by the Health Ministry and the Federal Biological and Medical Agency to monitor the psychological state of the population. In addition to studying psychological conditions, specialists held free consultations for various sections of the population and developed several methods to diagnose and correct the emotional state. We believe these studies should be continued, because the psychological state of people is as important as physiological.
In conclusion, I would like to say that a lot of work has been done to counter the novel coronavirus infection and a high level of cooperation was reached between the federal and regional authorities, which made it possible to address such important and complicated tasks. Today, this is a well-developed mechanism for smooth professional work. In this sense, I would like to thank my colleagues from the federal executive agencies and the Russian regions, as well as you, Mr Mishustin, for organising this great amount of work that we have carried out. This is not over; we still have a lot to do, but I believe we have already passed an important stage.
Mikhail Mishustin: Thank you, Ms Golikova, for the detailed report.
Clearly, our healthcare system can handle the load. It is largely thanks to our doctors and medical workers who are genuine professionals and work with total commitment. We are deeply thankful for that.
However, we should remember that our medicine also has vulnerable spots that were revealed in this urgent situation. These problems require solutions. Of course, we avoid them in the future and this is what we talked about just now in detail.
Infectious disease care needs an upgrade to protect our citizens and provide for stable scheduled medical assistance in normal life or in case of new threats. The main thing is to ensure improvement of the specific infrastructure and staffing. I would like to ask Denis Manturov, the Minister of Industry and Trade, to take the floor. In this difficult time we were closely engaged in the relevant production and import of personal protective equipment.
Mr Manturov, tell us please, about the current situation.
Denis Manturov: Mr Mishustin, colleagues. Thanks to the timely decisions adopted by the Government we quickly built up our manufacturing capacity for COVID-related products and have completely discontinued purchases abroad.
The regions have accumulated sufficient PPE reserves by now; judging by Health Ministry standards, we have enough to last medical institutions one to four months. We are also completing a number of investment projects that will let us increase the output of medical gloves, respirators and protective glasses. We are emphasising the launch of production for new items, especially so-called rapid tests and recently registered medicines against severe pneumonia: Laevilimabum, Olokizumabum and the anti-COVID drugs Favipiravir. And of course, we are preparing to produce the vaccines under the Health Ministry's approval as soon as clinical testing is finished.
We are also completing the execution of government contracts on medical equipment, specifically lung ventilators and infrared scanners.
Aware that we will saturate the domestic market quickly, we had prepared in advance a decision that lifted the EAEU restrictions, and we started to export the most in-demand antivirus products.
We have involved our trade missions in this work, identified target markets, established an online platform for exporters and are micromanaging the process of international certification. Austria and Egypt have already bought pilot consignments of our test systems. As for Bulgaria, Serbia, Pakistan and the United Arab Emirates, this is in progress. We have begun to supply our protective coveralls to Turkmenistan and are preparing for bids in Brazil. The Persian Gulf countries are buying antiseptics and disinfectants. We have started to export lung ventilators again.
At the same time, we are providing humanitarian aid. Under your instructions, we sent yet another plane with individual protection gear and medications to Kazakhstan on July 9. We are preparing consignments to help the Central African Republic, the Republic of Zimbabwe and the Republic of the Congo.
Naturally we are offering these items to our foreign partners without infringing on our domestic supply. Considering our production capacity, we are starting to create, at your decision Mr Mishustin, a state reserve of COVID items. The list and volume of items for backup inventory have been agreed upon. We are submitting our regulatory acts to the Government. As the experience of the last few months has shown, this will be a major component of biosafety in this country.
Mikhail Mishustin: Thank you, Mr Manturov. I would like to give the floor to Health Minister Murashko.
Mikhail Murashko: Esteemed Mr Mishustin, esteemed colleagues.
As Ms Golikova has already mentioned, clinical testing of the vaccine is being conducted today. The first phase is over, and we are now in the second phase. We hope to complete the testing of one vaccine candidate very soon – in two weeks. We have received the documentation for another vaccine candidate. They were submitted for authorising clinical tests. Now our experts are evaluating it, after the evaluation is completed, the second vaccine will be authorised for testing, and upon passing it, it will also be used by medics.
As of today, we have designated 169,000 beds. At the peak this number reached 184,000. Some of these beds are in reserve because there are about 112,000 patients in medical facilities now. Intensive care is fully available. There are 25,000 intensive care beds in the country. Lung ventilators are being used for 3,120 hospital patients. While medical treatment was being rendered to COVID-19 patients, we also established profile hospitals for treating patients with acute cerebrovascular disorders, acute coronary syndrome, injuries, oncological and endocrinal diseases. A separate unit has been established at the Shumakov Federal Centre of Transplantology. This is an infectious disease unit for post-transplant patients.
The federal centre for oncological patients with the coronavirus infection continues operating. Federal facilities like the Bakulev Centre of Cardiology and Cardio-Vascular Surgery have already resumed regular operations and are receiving scheduled patients. Resumption of planned activities is very important while observing counter-epidemiological measures that, in part, prevent the admission of coronavirus patients to hospitals that treat other kinds of health issues.
We continue upgrading our approaches to treatment. We have issued seven iterations of medical recommendations for treating COVID-19 patients. Now medical experts are working on the eighth version of medical recommendations, which includes the best experience of foreign specialists and of our own. The Government has issued a resolution on organising medical aid during the spread of dangerous diseases. In line with this resolution we have already drafted and are preparing for review medical recommendations on treating patients that were sick with the new coronavirus infection.
Today, over 460,000 medical workers are rendering treatment to patients. The introduction of a new organisational instrument – remote intensive care consultation centres – has played a major role in preserving the life and health of people. Specialists from any region can receive consultations at these centres for almost every category of patient. Foreign experts have also consulted these centres. They have helped adults, cardio-vascular and cancer patients, and, importantly, pregnant women.
Today, we have an information resource that allows us to promptly monitor the situation in every region and every medical facility. We plan to download a new block on vaccination into this resource. It will allow us to have a precise data base on patients and their diseases.
The ambulance service has improved a lot thanks to the funds allocated by the Government. Almost 3,000 Class B and Class C vehicles have been made available to the regions, which increased the effectiveness of the ambulance service. Sure enough, it worked under an increased workload during that period.
Concurrently through organisational and methodological activities, Roszdravnadzor is conducting inspections to check on the effectiveness of medical treatment.
With regard to scheduled activities, it is critically important to resume preventive checkups and routine medical examinations based on previous restrictions. We know that diagnosing diseases, including cancer, in the early stages can improve prognoses. The documents on additional payments to medical workers for detecting a malignant neoplasm in the amount of 1,000 roubles have been signed. Temporary guidelines for preventive checkups and routine medical examination have been approved. Recommendations for transferring and reserving free beds for patients with the coronavirus infection - in case the numbers increase - have been sent to the regions.
Preparations for the fall and winter season are underway. According to the experts, it is important to expand flu vaccination coverage. The state order has been placed, and everything is going as planned. But we know that flu prevention needs special attention.
International activities have become important as well. We are doing more than providing consultations to our international colleagues. Our teams of specialists have been sent to a number of countries and are working there. The greatest number of specialists is working in Kazakhstan. Our colleagues were faced with large numbers of patients. In order to share their experience and help Kazakhstan’s healthcare system, almost 100 Russian specialists are now working there.
An adequate supply of medications is a critically important element if we want to ensure the smooth operation of medical institutions. Due to a Government resolution on special arrangements for supplying medications to the market, we were able to avoid dependence and stress for medical organisations. The domestic manufacturers responded to the increased need for medications and, as Mr Manturov mentioned, medications - both antiviral and those for treating serious complications, pneumonia - became fully available to specialists in Russia and are now being exported.
The remote purchase of medications was first introduced in May, which was necessary during the lockdown. Also, with the Government resolution of 30 June 2020, the continuity of drug therapy for outpatient and inpatient treatment has been fully implemented.
With regard to key areas for increasing accessibility, the stable functioning of medical organisations is a key element here, including the response system for challenges in the healthcare system. The mandatory health insurance system’s financial stability is an important element for overall stability. So, 100 percent of the average monthly amount of funds is being used during this period. We use it to pay for medical help and salaries. An advance payment system has been introduced, which made the uninterrupted organisation of medical activities possible. Also, revenue shortfalls at medical organisations have been identified, and work is underway to reimburse these funds.
Primary care modernisation continued as usual during this period, as did the work on draft documents. Algorithms have been worked out and passports created. Now that the financial standards have been approved, we will proceed to the final approval of the upgrade programmes starting 1 January 2021. We believe this area is critical for increasing accessibility and the level of satisfaction of the people in our country.
Upgrading infectious disease treatment and emergency response systems are key to improving accessibility.
So, as part of upgrading infectious disease service, we plan, in addition to medical institutions and the lab complex, to improve the vertically integrated infectious disease service as part of information interaction and treatment standards. New routing models are being developed as well. All of this is used in the procedure for providing treatment to patients with infectious diseases, which is a licensing requirement for all medical organisations.
We also see the need to improve approaches to lab diagnostics, including research and practical guidance in this area. Updates to education programmes and approaches to continuing professional training is a challenge facing the entire healthcare system, since during this short period we were able to provide, using distance training courses, advanced training to 1.4 million specialists in the country. Also, we provided the access rights to these courses to our Russian-speaking colleagues abroad.
In closing, I would like to thank you, Mr Mishustin, for your focus on the healthcare system. Also, words of thanks go to all our colleagues who worked as a team for the timely and excellent organisation of medical help. That includes the Ministry of Industry and Trade, the FMBA of Russia, Rospotrebnadzor, the Emergencies Ministry, the Defence Ministry and many others. I believe that this consolidated approach to providing medical care must be saved for the future.
Mikhail Mishustin: Thank you, Mr Murashko. Ms. Popova, please go ahead.
At the beginning of the year Russia found itself among three centres of infection: China, Iran and Europe. After over six months of sustained effort we can say that today's results were achieved partly by considering the experience in other countries. First, we introduced restrictive measures at the beginning of the virus outbreak and not at the peak of incidence of the disease; we didn’t wait for a spike. As a result, we did not allow exponential growth. The peak of the epidemic was kept down in the Russian Federation and the mortality rate per 100,000 people at that point was actually one of the lowest in the world among countries that were affected (and still remain affected) by the new coronavirus. Thanks to following the restrictions, we managed to generally prevent a high mortality rate among people over 65, and here Russia also has one of the lowest rates in the world.
The incidence of severe cases is also low. In April it was 5.6 percent, which is also one of the lowest rates in the world, and today it is actually about 3 percent.
We managed to minimise the time between seeking medical assistance and admission to a hospital. Over 70 percent of all diagnosed patients receive medical assistance in the first two days after diagnosis. Prompt responses to the emergence of hotbeds and a low concentration among organised teams were also important. I would say that 60 percent of all cases in the teams were symptom-free and were promptly identified. This is extremely important. Those people received medical assistance in a timely manner, which held down the severity of the disease progression.
The volume and coverage of testing, which you mentioned, Mr Mishustin, is also important. Ms Golikova said that we are the leading country in the world according to rates per 100,000 people.
The distinctive feature of the Russian Federation and our strategy is that we are not reducing our coverage. Approximately 300,000 medically examined people a day is a very high and significant rate. This is what allows us to prevent severe cases of the disease from progressing and to control the situation in all regions of the country. It is important that our initiatives have been supported and the timeframe for providing all Russian regions with free test kits, paid for out of the federal budget, has been extended both for the regional offices and departments of the Federal Service for the Oversight of Consumer Protection and Welfare and the public health services of the Russian regions. I would like to say thank you for this and we certainly mean to continue doing this.
I also want to report that, given the time since the maximum daily figures we recorded, the Federal Service for the Oversight of Consumer Protection and Welfare has been conducting large-scale serologic testing since late June. The tests have been and are being conducted in 23 Russian regions on over 61,000 volunteers, who were randomly selected out of 650,000 applicants in conformity with the standards of international science and the World Health Organisation.
So far we have summed up the results in six Russian regions that finished the testing, in 19 regions we have completed practical examinations, and we have added more regions. Currently we are seeing that existing immunity and the level of herd immunity in the country is at about 26 percent. It is evident that we have the highest figures in major cities and lower figures in the rural areas. This is attributable to the specifics of the epidemic’s process. And I want to point out that 42 percent of the examined children up to age 6, and up to 38 percent of children between 7 and 13 demonstrate maximum levels of group immunity, given that the number of patients and the relevant disease rate in this age bracket are the lowest. It gives certain optimism, but there are still many stages that we need to go through to keep the situation under control.
I also want to note that this epidemiological situation forced us to develop a new legal framework very quickly. The virus is new: we don’t know anything about it, we don’t know how it spreads and we don’t know its epidemiology. And along with our colleagues from various agencies, whom we thank, we have developed a legal and methodologic framework consisting of over 400 documents as of now, related to the novel coronavirus.
Today, we have talked about the importance of testing if we want to have a clear understanding of the epidemiological situation. On behalf of the Government, Russian-made test systems were sent to 32 countries at absolutely not cost. We sent out sets of our test systems and diagnosis reagents for conducting nearly a million tests. The CIS countries are widely using our test systems in these difficult circumstances. At your request, Mr Mishustin, we are sending out more sets there in order to organise testing.
I would like to say that our approach to the epidemiological space as a common space for the CIS countries, and many years of hard work has allowed us to properly coordinate our efforts today. This is bearing fruit amid the pandemic. Today, we see increasingly often the post-Soviet countries using our test systems, our methodology and our entire regulatory and methodological base. Each of these countries has come to realise that the erstwhile sanitary-epidemiological surveillance system that was destroyed during a certain period and under the influence of certain forces, must be restored. We are receiving proposals to organise this system. Our colleagues are working in Kazakhstan and Kyrgyzstan, and recently returned from Moldova.
This period has demonstrated the unity of the sanitary surveillance system in the country not only as a vertically integrated structure, but also as a structure that interacts with the departmental sanitary surveillance services. I would like to thank my colleagues from the Defence Ministry, the Federal Security Service, the Federal Guard Service, the Administrative Directorate, the Interior Ministry, the Penitentiary Service and the Russian Guard, which have state departmental sanitary services, for their good work. Working together, we managed to avoid the complications of the epidemic situation in these federal executive bodies and their subordinate departments with large staffs and high densities of workers. This is another sign that integration and unification are yielding great results.
Today, we are already able to sum things up and, most importantly, extract lessons and not to forget them. We see that there’s a service in the country that has proved its strength.
However, there is also a need for certain changes. I would like to highlight four areas which we should focus on in order to ensure sanitary-epidemiological and biological safety in the country.
First, we need to upgrade the sanitary-epidemiological service’s infrastructure. Of course, the labs, too, because what we saw, the needs that arise during an emergency period, are critically important components for providing prompt responses. Of course, we must ensure the digital conversion of the sanitary and epidemiological service’s processes and services and to develop modern information and analytical capabilities for operational monitoring. We must improve the legal basis for the unified public centralised sanitary and epidemiological service. Of course, this is important – we must develop domestic science which made a major contribution to eliminating the threats of epidemics and reducing the risks. It requires support and the coordination of interagency efforts in order to achieve important and effective results in a short time.
Recent times have been very challenging and stressful in all respects, including professionally, psychologically and socially. It showed that consolidation and unity are important. I want to thank you very much for the very high level of coordination of activities between all federal executive bodies and entities at the government level. This is also an invaluable experience which, of course, needs to be used, preserved and built on. We, for our part, are ready to do our best.
Mikhail Mishustin: Thank you, Ms Popova.
Colleagues, I would like to thank everyone who took part ̶ and that includes everyone attending this meeting ̶ in fighting the coronavirus infection. We can see that the situation has become less acute. But we must continue to keep it under control. Once again, please do your best to get us there.