Mikhail Mishustin: “There has been a significant increase in the infection rate and the burden faced by medical institutions is growing. It is essential that we do our outmost to make sure that the situation does not reach a critical point, and stop the infection from spreading further. We are talking about the health of our people here.”
Mikhail Mishustin’s opening remarks
Mikhail Murashko’s report on hospital beds’ availability and vaccination
Anna Popova’ report on the epidemiological situation in the regions and measures to prevent the incidence rate from growing
Tatyana Golikova’s report on a package of measures to alleviate the epidemiological situation
Excerpts from the transcript:
Mikhail Mishustin: Good afternoon, colleagues.
Today, we will discuss specific measures that we will take to step up our efforts to fight the coronavirus. There has been a significant increase in the infection rate and the burden faced by medical institutions is growing. It is essential that we do our outmost to make sure that the situation does not reach a critical point and stop the infection from spreading further.
These are hard times for medical workers. For more than eighteen months now, they have been caring for COVID patients.
In keeping with the Presidential instructions, the Government continues to support medical workers. We will transfer another 69 billion roubles to the regions for paying out special social benefits. This will cover funding needs until the end of the year. I have already signed a directive to this effect. I am asking the Ministry of Healthcare to make sure that each region receives these funds on time and in full.
The situation with the coronavirus is deteriorating. In this context, we all need to strictly abide by sanitary and epidemiological requirements. Getting a coronavirus vaccine is essential. By getting a jab you not only show that you care about yourself and your close ones, but also help doctors, nursing staff and other medical workers, and ambulance drivers who are working under tremendous stress with little sleep or rest.
As more people started to get sick, a number of regions had to once again repurpose their medical facilities as COVID hospitals.
Mr Murashko, could you please report on the situation with the availability of hospital beds in the Russian regions? Are there enough beds and equipment? Could you also share a vaccination update?
Mikhail Murashko: Mr Mishustin, colleagues,
I would like to express profound gratitude for the support of medical personnel whose current working conditions closely resemble a combat environment. We have been working in pandemic conditions for over a year now, and we can already see specific trends and compare various periods.
I would like to recall that we simultaneously cared for 1.3 million patients during last year’s peak. This year’s statistics are approaching those of last autumn, with 1.2 million patients now under the care of medical personnel.
A rapid increase in the number of patients is the main distinguishing feature of the current period. We are exceeding the 2020 period in terms of this increase. First of all, of course, this problem is linked with the number of vaccinated patients because people who did not get the jab on time now account for the lion’s share of all patients.
The healthcare system is being reconfigured, and converted hospital beds account for over 30 percent of all hospital beds in many regions of the Russian Federation. Since early October, the number of active cases has increased by almost 23 percent, and it has increased by 12 percent in the past week.
Measures implemented by a number of governors this week and late last week made it possible to slow down the spread of the infection process somewhat, and we believe that it is precisely non-pharmacological and non-medical measures that are highly essential today.
In response to the rapid increase in the number of patients, we have already deployed 274,000 hospital beds. I would like to note that general hospitals have contributed 232,000 beds. In all, 255,000 patients are now being treated in hospitals.
The number of serious cases of unvaccinated patients has soared in absolute terms. Every intensive care specialist hears patients say that they regret not getting the jab, but these people are already in intensive care, and it is very hard to rectify this situation.
The number of patients in need of ventilators is also on the rise and now totals 6,700 people.
Local medical centres have enough intensive care beds, but the number of serious cases and the need to transfer them to third-level institutions treating cardiovascular and other health disorders is causing the greatest strain today. The same can be said of the need to transfer patients in a timely fashion for rehabilitation in order to vacate hospital beds.
I would like to note that the regions are showing an asymmetrical epidemiological process. I would like to note the following six regions where we see a challenging situation. They include the Udmurt Republic, the Perm Territory, the Orenburg Region, Bashkortostan, the Ivanovo Region, the Tyumen Region and the Republic of Tatarstan. The situation is calling for a differentiated approach, including restrictive measures, and we have therefore sent additional medical teams to a number of regions, and they are working there today.
In addition, we have noted a fast disease progression rate where the patients’ condition deteriorates within two or three days following the onset and the patient needs to be taken to hospital. To reiterate, these are, of course, unvaccinated individuals, including (a hallmark of this season) young people. They have also become part of the contagion process and tend to fall seriously ill.
The cases among children under 18 have increased significantly as compared to previous year. About half of the cases show strong clinical manifestations, meaning that the pediatric service has also found itself under an increased burden.
We have more pregnant female patients today than previously. ICU counselling centres have been created for all types of patients, including children, pregnant women and adult patients, which take care of severe cases.
We had a meeting today where, among other things, we discussed care for expectant mothers. The number of severe cases that require intensive care has doubled since last year, meaning that vaccination of pregnant women is our number one priority if we want to prevent mothers and children from getting sick and undermining their health.
Notably, we are changing clinical approaches to therapeutics depending on strain mutation and the course of the disease. The 13th version of the guidelines has been released. A pocket version of the guidelines is now available, offering a clear algorithm of decision-making at the outpatient and inpatient stages of treatment depending on severity of the case.
The unprecedented workload calls for clear-cut treatment algorithms. The funds allocated by the Government for the outpatient phase have been made available to the regions, and the regions have purchased the medications. Roszdravnadzor monitors the availability of medicines. They have been issued clear instructions to monitor the situation in every constituent entity.
Mr Mishustin, there are over 15,000 vaccination sites in operation today. There are enough vaccines in every region. Notably, vaccination has picked up pace and we have seen the number of vaccinations growing over the past week with 55 regions showing a good pace and an increase in the number of vaccinated people. I would like to mention the Republic of Tatarstan, the Chuvash Republic, Sevastopol, the Bryansk Region, the Lipetsk Region, the Yamalo-Nenets Autonomous Area, the Voronezh Region, the Udmurt Republic, the Ryazan Region, and Bashkortostan.
Of course, it is not too late even today to get a jab.
I would like to note another recent trend where the number of patients with a booster jab has increased. According to our recommendation, vaccinated people need to come back for a booster jab six months after taking the first two vaccine doses. The number of the patients who have taken good care of their health and have taken a booster jab is up and now over 2.5 million patients.
There’s one more particularly important matter. In conjunction with Roszdravnadzor, the Interior Ministry is working on ways to counter the issuance of fake certificates. Over 1,000 fake certificates have been identified in the Moscow Region. We are grateful to our colleagues for this work. These perpetrators are creating an illusion of false vaccinations which can cause damage to people's health. The situation with fake certificates has stabilised. Our colleagues have done their part in the regions with tangible effect.
Another issue that I would like to touch on concerns the aftereffects of the coronavirus infection. The highest risks include cardiovascular diseases, fibrotic changes in the lungs, neurological disorders, and autoimmune conditions. Notably, the Government has allocated additional funds to this end, and in-depth medical examination for post-COVID patients is now available in 79 regions. We are holding this process back in other regions, because of the high number of cases there. However, the number of patients who have taken an in-depth medical examination has increased to over 75,000 as of last week.
So I would like to take this opportunity to tell people that it is an accessible and simple procedure which will help you avoid multiple major health complications.
Mikhail Mishustin: Thank you, Mr Murashko.
Right now, it is critically important to step up vaccination rates in order to contain the further spread of infection.
Ms Popova (addressing Anna Popova), please describe the epidemiological situation in the regions. What measures are being taken by the heads of regional administrations and chief sanitary physicians to prevent increased incidence of the disease and how effective these measures are?
Anna Popova: Mr Mishustin, colleagues,
We are at that phase in the epidemic process and in the situation where morbidity grows practically simultaneously in all constituent entities of the Russian Federation. In fact, this is the first real season for COVID-19. We are facing an autumn surge, with the epidemic process engulfing practically all the constituent entities at once, without a consecutive involvement that we witnessed during the previous surges.
Last week, 222, 241 cases were recorded, which is 15.5% higher than during the 40th week. Over the last five weeks, we note a trend for growth against the background of seasonal incidence of ARVI plus flu.
Likewise over the last five weeks, there is a growing proportion of cases that are recorded in the capital cities, mostly in Moscow – from 8% at the 35th week to 19% last week – given that the proportion of cases recorded in the Moscow Region and St. Petersburg amounts to 7% and 8.6%, respectively.
Last week, the share of the regions declined from 82% to 65% , and this is also a characteristic feature of the current epidemic process.
Today, we see a clear growth of morbidity in 72 constituent entities – from 2.5% in the Komi Republic to 45.9% in the Smolensk Region. In six constituent entities, the situation is stable, without significant dynamic.
The growing incidence of disease is observed in all age groups. The absolute comparison of figures is probably the most real indicator, because we don’t see the true dynamic, if we speak in terms of proportions. At the end of last week, the highest incidence growth was observed among school-age children and citizens aged over 60 years. The maximum morbidity figures per 100,000 of the population of definite age are also recorded in the 65+ age group.
The greater incidence of cases encompasses all clinical forms, primarily due to an increase in acute respiratory viral infections of the COVID-19 etiology. At the same time, I would like to note that the specific share of pneumonia in the COVID-19 pattern has decreased somewhat, as compared to the 2020 upsurge. This highlights the contribution made by vaccination, and this already shows that vaccination is effective. The share of pneumonia in the pattern of COVID-19 diseases dwindles in those areas where a large number of people have been vaccinated.
We continue to work inside pockets of infection, and we are currently supervising 2,090,638 people who have been in contact with the virus. We will continue this work.
I would like to recall that there are two options for stopping the epidemiological process. It would be more appropriate to talk about two aspects of one direction. This implies restrictive measures, aimed at enforcing rules and sanitary requirements, so that every person acts to protect his or her own health. There are also restrictive measures to reduce ways of transmitting the virus. And the second aspect is achieving collective immunity and stipulates immunisation, so that every person is protected, acquires immunity and will not contract a serious disease when coming in contact with the virus.
We can see a clear trend when the epidemiological situation is becoming aggravated in regions which are not applying restrictive measures to the greatest possible extent. Unfortunately, restrictive measures are not always introduced in those areas where more and more people over 65 years old are being infected.
Today, more and more regions are introducing oversight measures in the form of a QR code in exchange for services. In all, 28 regions have introduced this rule for cultural and entertainment events, 25 regions stipulate this measure for public catering outlets, and 28 regions use this rule for holding sport events. Nineteen regions use it at hotels, and seven others stipulate this rule for shopping centres.
But I would like to note that such measures are sometimes introduced in a highly incorrect manner. For example, people wishing to visit a shopping centre are required to present their QR codes to cashiers. In effect, people can enter a shopping centre, talk to others and stay there completely unhindered. At the same time, regional authorities are reporting that they have made such a decision.
I would like to warn regional leaders against such decisions. They are not very effective: Although the relevant decision has apparently been made, the situation will continue to unfold.
I would like to draw your attention to the long interval between proposals from chief state sanitary doctors and actual decision-making. Regardless of the infection, the epidemiological situation does not allow decision-makers to get off to a slow start and weigh pros and cons for a long time when it comes to a measure from a tried-and-tested arsenal. When this process takes 10 days or even two weeks, the epidemiological situation is, of course, getting worse.
I would also like to say that to increase the vaccination rate, the authorities in 63 regions have made vaccination against COVID-19 compulsory for high-risk categories of people. This situation is developing and the number of regions that have made this decision is growing. As of today, three more regions have made this decision in addition to the 63 regions mentioned. This summer we saw the high efficiency of this decision.
I would like to add that seasonal respiratory infections are a very heavy load on the healthcare system. I will mention again the risks of flu in this epidemiological season. Following week 41, we recorded that the epidemiological threshold was exceeded in 62 regions. The adult population was the hardest hit.
Under the circumstances, it is very important to conduct differential diagnostic procedures for diseases with respiratory symptoms. I will quote some WHO statistics. The European countries studied the biomaterial of patients that were not diagnosed with Covid. A seasonal flu virus was revealed in a quarter of such cases. So, the epidemiological situation is developing in Europe and certainly in Russia. Anti-flu immunisation leaves much to be desired: a mere 20.3 percent of the total population has received anti-flu jabs. Last week, this figure was increased by only 2.7 percent.
In the past four weeks, the number of people that underwent tests did not go below 300 of every 100,000 with the exception of two regions I have to mention. These figures are important for understanding what is going on. These regions are the Republic of Kalmykia and the Sakhalin Region where no more than 200 people underwent tests last week.
On your instruction, a resolution by the Chief Sanitary Doctor was adopted (it entered into force on Saturday, 16 October). It reduced the time for obtaining laboratory test results to 24 hours. Now this is a mandatory requirement. I would like to ask all those who are involved in this: 24 hours rather than 48 hours.
I would like to say that the measures that are being taken now (unfortunately, only 28 regions require QR codes) are insufficient. The developing epidemiological situation calls for a much quicker response and the adoption of measures on a much larger scale.
At a meeting of the emergency response centre we discussed in detail what measures can and must be taken today. I believe we need additional regulations at this point to make the adoption of such measures as quick as possible.
Mikhail Mishustin: Thank you, Ms Popova.
Indeed, with the situation at hand, the coronavirus sanitary precautions need to be extended. It is very important to promptly curb the spread of infection. All the necessary instructions will be issued.
Ms Golikova (addressing Tatyana Golikova), I know you have repeatedly discussed additional response measures to the difficult coronavirus developments at the Emergency Response Centre meetings and at a meeting with the regions. Please report on the proposals you have come up with.
Tatyana Golikova: Mr Mishustin, colleagues.
As has already been mentioned, the situation with the spread of the novel coronavirus infection continues to deteriorate. As we can see every day, this trend is reflected in the mortality rate.
I would like to remind you that President Vladimir Putin gave instructions to achieve collective immunity by autumn 2021 in his Address to the Federal Assembly. Your instruction was to achieve a level of collective immunity of the adult population of at least 80 percent, including those who have had the infection. Unfortunately, it is just over 45 percent at this stage. This level does not help significantly improve mortality rates. As before, the vast majority of patients in a grave condition, in particular those in intensive care, are unvaccinated, including those older than 60 and patients with chronic diseases and registered with the relevant observation clinics.
Last week and yesterday, we discussed this with our colleagues from federal executive bodies, heads of regions and members of the Emergency Response Centre. We considered a set of additional measures to reduce the epidemiological tension not only around Russia, but also in specific regions.
As for our proposals, the first is to ask the President to announce nationwide non-working days from 30 October to 7 November 2021.
Those regions where the situation is especially difficult could introduce non-working days even starting this Saturday, 23 October 2021.
Simultaneously with the non-working period, only citizens who have been vaccinated or have had the coronavirus disease should be allowed to visit public places and will need to present their QR code to enter.
To implement this approach, regional governments will need to adopt relevant decisions concerning the non-working days as well as the requirements for admission to public events and specific places included on the list that should be compiled and approved, that is, presentation of a QR code confirming prior vaccination or coronavirus disease, or a negative PCR test result for those who have exemption from vaccination.
Furthermore, it is necessary to ensure control over the observance of all restrictive measures, not only the current precautions, but also the new restrictions to be introduced in the coming days. We also strongly recommend that the Russian regions immediately adopt decisions concerning unemployed and unvaccinated pensioners requiring them to self-isolate at home and only go outside when absolutely necessary.
This is because these people are at the greatest risk of contracting the virus as well as of severe or fatal illness, especially if they have not been vaccinated.
We also suggest that employers immediately transfer working unvaccinated and not previously exposed to COVID-19 employees over 60 to remote work for a period of at least four weeks, so they get vaccinated, provided they don’t have medical contraindications.
Also, we propose asking the employers - we already asked them this last summer, and we believe we should do it again - to give their workers two days off so they can get a jab.
I would also like to draw your attention to additional financial support measures for the healthcare system that will be taken, based on your instructions, in the coming days.
First, with regard to additional support for the mandatory health insurance system, when we were making this decision upon your instructions recently, it was in force until October 1. To date, the Health Ministry, in conjunction with the Finance Ministry, has agreed on the amount of additional financial support in the amount of 56 billion rubles to support the mandatory health insurance system.
In addition, under your instructions, we propose considering, for the first time, in addition to the funding under mandatory medical insurance, to provide for the possibility of centralised procurement of certain expensive medicines for administering at hospitals, because we see that a number of regions are not buying expensive medicines, thus saving on corresponding therapy and, unfortunately, not providing timely medical help to patients.
Finally, it’s about providing additional support for outpatient clinics and the final approval of the parameters of this support by December 31, 2021.
In addition, after expiration of the period through November 7 and while closely monitoring the epidemiological situation and the situation in the healthcare system, we suggest that the regions start carefully opening industries and sites that will be closed during the days off. When I say “carefully” I mean introducing QR codes when visiting these places so as to prevent the spread of the coronavirus infection.
As I mentioned earlier, we are talking about QR codes for vaccinated people and patients who have recovered from COVID-19, as well as the possibility of receiving PCR and using PCR for citizens who have contraindications for getting a jab.
I would like to bring up yet another issue. You are aware that we use sick leave certificates for people who are in contact with the sick or who are in quarantine. We are aware of the fact that a fairly large number of people are in quarantine. Rospotrebnadzor is monitoring this situation. But we see a different picture if we look at the sick leave certificates. We see a significantly smaller number of people in quarantine who obtain corresponding sick leave certificates, meaning that these people are not self-isolating and are fully active, going to work and visiting other public places, which they absolutely should not be doing in these circumstances. We are asking the regions to look carefully into this situation and we are also asking the public to remain in self-isolation if they are in contact with infected people, especially family members. This must be done absolutely in order to avoid spreading the disease.
Mr Mishustin, the solutions that we are proposing are very complex. Perhaps, not everyone will think they are necessary. But based on the epidemiological situation and the pace at which the disease is spreading across Russia, as well as the situation in other countries (many of which are also at risk of COVID-19 spreading and cases rising), we want you to support these proposals and contact the President accordingly.
Mikhail Mishustin: Thank you, Ms Golikova.
Indeed, these solutions are complicated. I would also say, we are compelled to make them, and they are necessary. New cases are on the rise, and we must contain the spread of this dangerous infection.
The previous restrictions have confirmed the effectiveness of these measures. Over the entire period of our fight against the coronavirus, we have gained considerable expertise and knowledge. The necessary equipment has been purchased. Production of the necessary medical products and preparations has been established. But the burden on the healthcare system continues to increase. In a situation like this we must be proactive. Our people’s health is at stake.
Ms Golikova, based on today's discussion, I want you to summarise the proposals that we heard today and report them tomorrow during the President’s meeting with the Government.
I also want my First Deputy Andrei Belousov and Minister of Economic Development Maxim Reshetnikov to act swiftly and draft proposals on measures to support businesses. We need to help businesses continue to operate without interruption.