Mikhail Mishustin: “The new strain of the virus, Omicron, is spreading extremely fast around the world. At the President’s instructions, the Government has developed a plan of additional measures to help prepare our healthcare system for a potential spike in the number of patients.”
Excerpts from the transcript:
Today we are having an extended format meeting as instructed by the President. Ministers and heads of federal agencies as well as all heads of regions are present here. We will discuss the current state of the coronavirus pandemic.
The new strain of the virus, Omicron, is spreading extremely fast around the world. It is known to be highly contagious, as shown by other countries’ experience. Hundreds of thousands of people in Europe are diagnosed with Covid-19 every day. The incidence rate has exceeded one million in the United States.
These numbers cannot but cause concern as Omicron has arrived in Russia as well, not only the capital but other regions too. We can see this from the morbidity statistics.
At the same time, I would like to note that as of today, the increase in the number of cases has not resulted in a spike in hospitalisations. Hospitalisations are what indicates how dangerous the virus is. We are not experiencing the same proportion of severe cases as was the case with the Delta variant. However, there is no clarity as to how fast the new strain is spreading. We must be ready for any developments.
Heads of regions must be present in their regions and, together with local residents, promptly solve any issues that arise on the ground, taking measures to counter the spread of the virus. In view of this fact, the Government has made a decision to postpone the Russian Investment Forum from February to a later date. We will return to this issue when the epidemiological situation improves.
Right now, it is important for heads of regions to intensify efforts, including measures to coordinate healthcare providers, ambulance services and hotlines, engaging students, volunteers and interacting with senior citizens. We must do all we can to protect our people.
The number of Covid cases has been growing over the past ten days. The situation differs from region to region. We are closely watching the developments in Russian regions and see that the problems they face are different.
In some of them, the growth in hospital admissions and the number of patients in a moderate or critical condition causes concern. For instance, in the Tyva Republic, the number of hospital beds occupied has doubled over the past week and the number of patients in a moderately severe condition increased by almost two and a half times.
In the Stavropol Territory, the number of patients with severe illness increased by 23 percent in the past week; the number requiring ventilators grew by 43 percent. Please note the need to detect the illness early and promptly begin treatment.
Unfortunately, not all regions are providing the required level of testing for Covid-19. There were 32 such regions in the past week, among them the Stavropol Territory, the republics of Khakassia and Tyva, the Arkhangelsk Region, and some others. I want to ask the regional heads to provide the necessary testing coverage.
The failure to follow these requirements might lead to insufficient detection of cases and distortion of the real situation. However, the Republic of Khakassia and the Arkhangelsk Region show a higher incidence rate than the country’s average, even given the low level of testing.
St Petersburg and 11 more regions also show a significant surge in Covid cases that exceeds the country’s average.
It is necessary to take additional measures to prevent the spread of the infection and provide an additional supply of medicines both in hospitals and outpatient clinics.
It is also important to work with citizens’ requests and address them promptly. For instance, over a quarter of 1,500 requests regarding vaccination or Covid treatment in St Petersburg have not been addressed on time.
At the instruction of the President, the Government has developed a plan of additional measures designed to prepare our healthcare system for a potential spike in Covid cases.
The action plan consists of several main blocks. I would like to speak about some crucial issues that need to be discussed.
First of all, it is the readiness of the healthcare infrastructure all across Russia. We need to assess the existing capacities, medical personnel, the supply of medicine, oxygen and PPE.
The most crucial thing is to prepare the primary care system. The new Covid variant will put the biggest load on the outpatient clinics.
Therefore, most of these measures concern these facilities and their work amid a surge in new cases. We will allocate an additional 5 billion roubles to the regions to purchase medications. Some of them will be purchased on a centralised basis, for which we will allocate another 15 billion roubles. I would like to ask the Healthcare Ministry and the Finance Ministry to submit draft directives for the upcoming Government meeting.
By repurposing outpatient clinics to accept coronavirus patients, we will be able to allocate funds to cover primary care expenses. However, that is not enough; therefore, we will consider providing additional funding to support the compulsory healthcare insurance system.
Colleagues, please make sure that you oversee this matter personally. Our success in countering the infection at this stage depends on ensuring the uninterrupted operation of the compulsory healthcare insurance system and primary care. This is the responsibility of regional officials.
Covid-19 prevention and diagnostics remain very important. It is necessary to ramp up testing and, due to the worsening situation, increase the production of test kits and thoroughly study the pathogen to clearly understand which strains are most common. We also need to increase the supply of rapid tests to the regions. We will allocate funds from the sequencing reserves to provide enough rapid tests within the first six months of this year.
Meanwhile, we must toughen control over compliance with sanitary restrictions in public places.
As concerns the regional call centres that were launched in 2020, the call centre operators help reduce the workload of outpatient clinic front desks. They can promptly advise members of the public. If a matter cannot be resolved by the 122 hotline, the inquiry is forwarded to a healthcare provider.
We are building up the capacity of these call centres. Virtual automatic telephone stations are already operating in the regions. If you notice a lack of resources (currently, there is no shortage because almost 1,000 telephone numbers are vacant), the federal centre can help with launching extra capacities. We have money for that. Regions received 700 million roubles in subsidies for this purpose.
It is extremely important that call centres have enough staff. This concerns both workers who help relieve clinic front desks, directing patients to the right facility and those who attend to patients receiving treatment at home.
Given the increasing number of calls, it is necessary to involve medical students in this work on a paid basis. We will allocate no less than 300 million roubles per month for this purpose.
I want to remind regional heads that the uninterrupted work of hotlines is your direct responsibility. The federal centre will continue to support you here and will do everything necessary, but you need to constantly monitor this issue. Please personally confirm that it is possible to reach the hotlines and that people will not have to wait. We must be fully ready to meet the Covid peak; it is necessary to ensure the continuous work of all systems. This is what is most important now.
Mr Murashko, please monitor all the medical logistics of the call centres with a focus on additional personnel.
Now I want to address employers. In order to help our doctors and ease the burden on medical facilities, you – where possible – need to move personnel to remote work. This concerns, first of all, elderly people and those with chronic illnesses.
I would also like to ask employers to remember that they must test people who work on site for Covid. You need to create the safest possible environment in the workplace.
The implementation of the plan is a major, demanding task. It is important that all measures are implemented in full and with respect to the current developments. These issues require special attention and constant interaction with the regions. Therefore, we have established a special emergency working group that will be headed by Tatyana Golikova. This group will be in touch with the regions and all interested agencies and organisations round the clock and will make prompt decisions in case of any difficulties.
Ms Golikova, I am asking you to develop draft regulations for the group and to outline the indices and data that will be required, taking into account the given information resources.
As a follow-up on what you have said, I would like to report that the Delta strain represents 60 percent and the Omicron and non-dominant variants account for 40 percent of the sequenced Covid-19 cases in Russia as of 18 January.
The domination of the Omicron strain has been reported in the capital regions, first of all, in Moscow, the Moscow Region and St Petersburg, but the number of new cases was registered in the second week of 2022 in 67 Russian regions.
The regions where the Omicron variant has not yet become dominant, as you have mentioned, must use the time available to them to take the necessary measures to prepare healthcare facilities and infrastructure.
We are closely monitoring the proliferation of the Omicron strain around the world. According to the information available yesterday, the number of confirmed cases has increased by 11.2 times over the past four weeks, which is proof of its high transmissibility, on the one hand, and the countries’ increased testing capacity, on the other hand.
As of this morning, 1,682 Omicron cases have been reported in Russia based on the percentage of sequence identity, but we understand that there are many more of them because not all cases have been sequenced. However, the available sequencing results allow us to forecast the spread of the virus, in particular, the regions that will be affected in the near future.
As of this morning, Omicron cases have been registered in nearly half of the Russian regions, or more precisely, in 42 of them. More than 70 percent of the patients have not travelled abroad during the past six months. This means that Omicron is actively spreading within the country.
The studies of the clinical features of the disease conducted by the institutes of Rospotrebnadzor and the Healthcare Ministry have shown that acute respiratory viral infections represent 54.5 percent of the cases, community-acquired pneumonia 4.1 percent and 41.4 percent of the cases are asymptomatic.
The number of fully vaccinated patients who have undergone genome sequencing is 27.9 percent of the total, 3.2 percent received one doze of the vaccine, 68.9 percent have not been vaccinated, and 4.6 percent have recovered from Covid-19 or have been vaccinated (or simultaneously vaccinated and infected).
The experience of our foreign colleagues shows that revaccination protects against severe disease.
As we exchange information with our foreign colleagues, we believe that the virus will change its development vector to become less virulent and more transmissible. Nevertheless, international data, in particular, the data provided by our American colleagues, show that the number of Omicron cases among children is increasing to 15 percent, primarily very young children aged between 2 and 5 years, and mostly affecting the upper respiratory tract and bronchi.
Yesterday, 495,400 people were under medical supervision nationwide. Within a week, their number grew by 2.9 percent but only 22 percent of them receive treatment in hospitals. The number of hospitalised patients decreased by 4.6 percent in a week.
As of yesterday, we deployed 158,600 Covid beds, out of which 69 percent are occupied.
As of this morning, herd immunity in the Russian Federation amounts to 63.9 percent. As before, there are four regions where the relevant figure is 80 percent: Sevastopol, St Petersburg, the Republic of Karelia and the Chukotka Autonomous Area.
Mr Mishustin, as you noted, proceeding, in part, from reports of our foreign colleagues, the outpatient network would have to bear the brunt during the surge in the disease rate. Therefore, it is necessary to take a number of measures already now: to supply primary care medical workers with personal protective equipment, teach medical personnel sanitary-epidemiological rules for visiting Covid patients, establish separate zones in outpatient clinics for receiving people with confirmed or suspected Covid-19 and, of course, draft schedules for standby doctors and other medical workers.
We must expand the use of telemedical technology in accordance with our plan, and involve, at a region’s decision, non-medical personnel for delivering medications under the control of the Federal Service for Supervision of Healthcare.
Our plan has one more important aspect. Like our foreign colleagues, we are improving our approaches to quarantine and laboratory testing. Thus, we are reducing the quarantine to seven days and making a number of other amendments on which the Chief Sanitary Doctor of Russia will pass resolutions. That said, we will closely monitor the situation and will further adjust the deadlines if necessary.
As I already said, due to Omicron’s high contagiousness, during the surge of the disease rate we will have to return to the practice of transferring nursing homes into the closed regime of work in two-week shifts, as we envisaged in our plan.
With the help of volunteers and crisis centres we are organising hotlines for assistance in the regions, including delivery of food and medications, the work of call centres and aid to primary health care. Therefore, I would like to ask the heads of the regions to provide every support for the We Are Together regional centres and involve our colleagues in this work.
In addition, the plan provides for the use of long-distance technology for processing sick leaves and undeclared extension of the earlier approved support measures during the surge of the disease. You remember that we used all these measures during the first wave and later, and they proved useful.
Mr Mishustin, all federal bodies must submit draft regulations that are required for implementing the plan to the Government as regards the issues on which it must make decisions and to adopt their own directives within the limits of their competence. They must do this as soon as possible to enable us to translate the bigger part of the plan into reality starting next week.
As for financial issues, especially support for the provision of medicines that you mentioned, it would be important and necessary for the Government to discuss this at its next meeting.
Mikhail Mishustin: This is what we will do. Thank you, Ms Golikova. As I said, we plan to intensify the work of call centres. I would like to ask Mr Chernyshenko to tell us in more detail how they operate now and what measures could make them more effective if necessary.
Mr Chernyshenko, go ahead, please.
Let me remind you that Service 122 was established in November 2020 at the President’s instruction. Since then, we have been monitoring the hotline’s operation on a daily basis. As you instructed, last Friday, right before the coronavirus situation deteriorated in Russia, a meeting was held at the Government Coordination Centre that involved all regions. Regional governments were tasked with mobilising this service to handle a possible sharp increase in the number of calls.
The call centres in all regions were stress tested from 15 to 17 January to identify possible problems in their work and, if necessary, to request assistance. More than 15,000 Rostelecom employees simultaneously dialled 122 across the country to simulate a heightened load on the system. They checked if an operator responded to each call within the standard time limit (which is under two minutes) and the correct routing of calls.
What were the findings? We understand that, true, it was a stress test under extreme load, but still, it confirmed the insufficient staffing of medical facility registries and regional call centre operators. The share of unanswered calls with a standard connection waiting time should not exceed 5 percent (a 5 percent loss). Only six regions met this benchmark, which means they are ready for an Omicron wave and potential peak loads – the Tula Region, the Republic of Tyva, the Ulyanovsk Region, the Kurgan Region, the Republic of Mordovia and the Jewish Autonomous Area. In 21 regions, the operators failed to respond to over half of the calls within the standard period of two minutes.
I would like to note that regions that are taking full advantage of artificial intelligence and other technologies, as a rule, achieve better results with taking calls actually using a smaller number of physically present operators in call centres. As of today, 52 regions have implemented this technology and are starting to use it.
Mr Mishustin, as you noted, the regions received subsidies in the amount of 700 million roubles last year to bring Service 122 up to standard technologically. The Ministry of Digital Development has brought to the regions’ attention the technical requirements for spending this subsidy, and circulated a methodology for monitoring the work of regional call centres.
We have asked our colleagues from the Russian Popular Front (ONF) to provide data on the work of the 122 call centres in the regions every week, rather than each month, as was the case before. They agreed, and we will obtain additional information, apart from feedback that we get from citizens nationwide via the integrated government and municipal services website. We have checked, and it turns out that all data acquisition systems continue to function normally.
Each day, the Government’s Coordination Centre collects all topical information about the work of call centres, and this data is analysed accordingly. While doing this, we rely on digital transformation managers in the regions.
Mr Mishustin, I believe that we need specific standards for dealing with the new Omicron variant because it is our opinion that the Delta variant standards are not enough, as stress tests show. I am asking the Ministry of Health and the Ministry of Digital Development to draft new standards as soon as possible, by 19 January, and to submit them to the regions. These standards should specify the number of registry office employees and call centre operators with medical backgrounds, including senior medical students. As you have said, the Government has passed a resolution on issuing sick leave online. We are also studying the possibility of issuing sick leave remotely, so that people would not have to visit outpatient clinics.
I suggest advising the regions to hire medical personnel, involved in the work of the joint service, for contact centres and registry offices in seven days, with the assistance of the Ministry of Health. We have discussed the matter with the Ministry of Health and the Ministry of Finance, and we have adopted a decision to finance the work of medical students for the next two months. As you have said, this is 300 million a month, for a total of 600 million roubles.
I hope that call centres in all regions will receive additional personnel in the next seven days. People will therefore find it easier to get through to the centres and to obtain high-quality medical assistance or consultations.
Mikhail Mishustin: Thank you, Mr Chernyshenko.
I would like to make the following request and give instructions. It is necessary to conduct daily monitoring surveys and to see how long it takes to reach the 122 call centres in all regions. Believe me, the situation will improve immediately if governors and heads of Russian regions personally oversee this matter.
We are dealing with technical infrastructure, and all this will be accomplished. However, the time it takes to call each centre and professional personnel on the receiving end is a very important element.
Mr Chernyshenko, you and the Ministry of Health should find out every day how long it takes to call these centres, and please report to me personally. The national situation is complicated, and, of course, all centres should operate without a hitch. Please supervise this process.
Moscow was the first to respond to the spread of the new Omicron variant. The city started recording additional cases ahead of other regions. I would like Mr Sergei Sobyanin to speak. What is the current situation like in Moscow? What does your experience show? And what should other Russian regions take into account?
Mr Sobyanin, you have the floor.
Mr Mishustin, Ms Golikova, you were correct, Omicron has become the dominant variant in Moscow, the Moscow Region and probably St Petersburg. At least, the available sequencing information shows the dynamic spread of the Omicron strain and an increase in the mathematical progression of its presence among patients who have fallen ill with COVID-19.
The number of cases is growing concurrently with the spread of the Omicron variant. They doubled last week, and will double this week again. Most likely, the dynamic will unfold like that. We will see how many weeks this kind of growth will continue. So far, cases in European cities have been growing like that for at least a month now. This speaks to the complexity of the challenges and problems that we will face and have already faced.
The finding that Omicron causes less severe illness is correct. We see that with the number of cases doubling, the number of hospitalisations has remained almost unchanged over the past week and yesterday which is, of course, good news. Nevertheless, we realise that the number of hospitalisations will increase with the number of Omicron cases increasing by orders of magnitude.
What problems do we anticipate with that many cases on our hands? You were correct about the call centres, including the 122 number, and the front desks which deal with providing social support. I have numbers for you. We had 3,000 communication channels for the 122 number last week, but now we have 4,000. By the end of the week there will be 6,000, and 12,000 next week. The number of phone operators will grow proportionally.
I have to say that it is not that easy to take up and resolve this problem as if it were a static environment. This is a dynamic situation. You resolved this problem today, but tomorrow it needs to be addressed again. You need to double the capacity, and double it again the day after tomorrow in order for the system to continue to function.
So, Mr Mishustin, you were correct when you instructed the Government to remain focused on this issue and increase call centre capacity. This includes the technical aspect of the communication channels. Thank you, since, as you directed, the Ministry of Digital Development issued instructions on this to the carrier operators yesterday so they can promptly build up the communication channels. Of course, it is necessary to increase the number of call centres and operators.
In fact, a call centre is a distribution centre that distributes calls and tells the caller where to go and what to do, but outpatient clinics are the main place that 122 callers are redirected to. Last week alone, the number of visits to outpatient clinics doubled. This week, I anticipate it will double again.
Again, next week will show how things will play out, but clearly the demand on outpatient clinics will be overwhelming. So, the bulk of treatment services will be transferred to the doctor-on-duty system for receiving patients with ARVI and COVID-19, in order to cut waiting times, provide medical care in a timely manner and see patients.
Network operators should be instructed to ensure availability of corresponding medicines at pharmacies, because pharmacy visits are also on the rise, something we saw during the previous waves. There will be even more pharmacy visits during this wave.
It has been rightly said that it is necessary to simplify the procedure for sick leave and fit notes so that people can get fit notes without visiting their GP, and avoid adding to the already long queues at doctors’ surgeries. This is also very important.
It is clear that the situation is short-term, it cannot last long, but still it is necessary to do this during this period, during the peak.
Turning now to the pandemic-related restrictions, today we will prolong the restrictions related to switching at least 30 percent of employees to remote work; I have already signed such an executive order. We also recommend employers to switch more employees to remote work, as many as possible, in order to lower passenger flows in public transport as well as contacts.
In addition to this, we are also prolonging self-isolation for the elderly. This is very important, too, because today the active part of the population, those who moved around on holiday or went on tourist trips, are suffering the main impact of the disease. When cases appear among older people, perhaps we will see a different impact. This is why it is important for people in risk groups to take care of themselves. I believe this regime should be introduced everywhere.
We will plan other restrictions only on the basis of developments regarding overload of the healthcare system. I believe there is no need to impose more restrictions while it is working, we will limit the restrictions to those that have already been introduced and, of course, comply with Rospotrebnadzor’s recommendations.
Mr Mishustin, we will keep you and your colleagues informed on developments. You have rightly said that we are the first to face this problem, the first to come to grips with it, as they say, but we will see the full extent of the problem and, of course, share our expertise with our colleagues.
Mikhail Mishustin: Thank you, Mr Sobyanin.
Of course, time is needed to understand how dangerous the new strain is and how it will act. The main thing, recognised by all experts around the world, is that it is necessary to get vaccinated and revaccinated in good time to prevent a severe course of the disease.
I would like to ask all regions and people to focus on this and to get vaccinated, thus protecting yourselves and your loved ones.
The results of today’s meeting will be reported to the President of Russia, and once again we will assess all the measures that have been adopted to see whether it is necessary to do anything else.