Coronavirus “halved” clinical examination in Russia

“In connection with the COVID-19 pandemic, in just 9 months of this year, the proportion of the adult population who underwent medical examination decreased both in Russia as a whole and in its individual regions by more than half compared to the same period of the previous year (January-September 2019) – this is the conclusion made by the chief oncologist of the Russian Ministry of Health, academician of the Russian Academy of Sciences Andrei KAPRIN during the recent online conference “Russia – EU: Designing Health Systems of Tomorrow”. – The diagnosis and screening of malignant neoplasms should not be delayed even in an emergency like the COVID-19 pandemic. Otherwise…”

What “otherwise” threaten the ill-timed pathologies (not only cancer) for people who are also under the hard blow of the coronavirus? Will the deadly covid “zero” the medical examination in 2021? Will it take place at all?

The respite did not last long

The solution lies with the regions

As you know, free all-Russian medical examination was restored in 2013. People took this as a blessing, and tens of millions of citizens underwent routine preventive medical examinations. This allowed them in the early stages to identify serious diseases that did not manifest themselves in any way, but in the future could even lead to death. By the way, thanks to the medical examination in 2019, 2 million (!) Diseases were identified in Russians – this figure was announced at a meeting of the Government of the Russian Federation at the end of last year. In the first place are such life-threatening pathologies as cardiovascular and oncological.

But in March of this year, the medical examination was temporarily suspended – “in order to ensure the protection of public health and the non-proliferation of a new coronavirus infection (COVID-19) in the Russian Federation.” Later, in April, by a decree of the Government of the Russian Federation, “the cancellation of medical examination due to coronavirus up to December 31, 2020 was fixed.”

And until July, the citizens of Russia could not pass it. But then the Ministry of Health issued an order in which it was emphasized that “the date of the resumption of medical examination is the date the head of the subject of the Russian Federation removed the restrictive measures on coronavirus.” The temporary order of work of medical organizations in the conditions of the new virus was also adjusted. But with a caveat: if restrictive measures are reintroduced in the region due to COVID-19, then medical organizations should also cancel scheduled professional medical examinations. The amendments entered into force on September 15 and should be valid until the end of 2020.

As the then head of the Ministry of Health of the Russian Federation Mikhail Murashko explained, “clinical examination will be returned in regions with a calm epidemiological situation. At the same time, medical institutions must separate the flows of patients in order to minimize the risks of coronavirus infection. Including there should be a separate stream for those who suspect an infection. Patients, in turn, must observe all safety measures: wear masks and gloves, observe social distance in clinics. “

What we are seeing now.

One of the main decisions is the right of the regions to decide for themselves when to renew it, based on the specific epidemic situation prevailing on the ground. But – only after they move on to the second or third stage of lifting the restrictive measures introduced due to the pandemic.

What does this mean for health workers who need to conduct prophylactic medical examinations? And how to convey it to people?

Photo: AGN “Moscow”

Not everyone knew about the new rules of professional medical examinations

As you know, the summer respite from the coronavirus in Russia did not last long. By the fall, the situation began to become more complicated: the number of COVID-19 cases began to grow sharply. And these “second and third stages of lifting restrictive measures” introduced due to the pandemic, health workers had to master on the go. What are these stages? And did the patients know about them?

– There are special recommendations that make it possible to clearly say at what stage of lifting restrictive measures introduced due to the pandemic, which region is located, – explained at one of the press conferences the chief freelance specialist of the Ministry of Health of the Russian Federation for therapy and general practice, Director of the National Medical Research Center of Therapy and Preventive Medicine, Professor, Doctor of Medical Sciences, Corresponding Member of the Russian Academy of SciencesOksana DRAPKINA… – By the end of September, 79 regions of Russia could resume it after being suspended due to the coronavirus pandemic. We are monitoring the situation. There is a demand for prophylactic medical examination, however, the plan for covering the population is now (at the end of September) fulfilled only by 30% with a little …

It turns out that not even 50% of Russians were able to undergo medical examination in 9 months of this year, but only every third. And why did the rest not come to the doctors, if by the end of September, almost all regions of Russia (79 out of 85) could resume it during the weakening of the COVID-19 pandemic? A third of the population of Russia could not be healthy in an instant. What was missing? Did they not inform the citizens in time that now it is possible to undergo scheduled medical examinations again? Or did the people themselves, for fear of catching the infection, did not go to the doctors?

Probably both. Although the doctors’ recommendations emphasized the need for such notification of Russians. It may be more active to invite older people over 65 years of age, as well as patients from risk groups for coronavirus, to professional medical examinations. After all, the bulk of Russians who are actively undergoing medical examination, and there are aged citizens from risk groups with chronic diseases.

REFERENCE “MK”

According to official statistics, in the first nine months of 2019 alone, more than 49 million people were covered by preventive measures in Russia – 80% of the annual plan. In 2020, over the same nine months, only less than a third of Russians (30%) underwent medical examination in the same nine months. It turns out that tens of millions of residents of our country did not undergo scheduled professional medical examinations. This means that it was not possible to prevent millions of diseases, including the most dangerous ones – oncological and cardiovascular. So it is not clear what caused the health and lives of Russians more harm: a new virus that suddenly fell on their heads or deadly diseases that were not detected in time.

But the fact remains: the medical examination in Russia this year – yes, it seems, and next – will remain “floating”, in some regions it will be canceled for a while, in some resumed. But the rules for its conduct in the context of the coronavirus remain unchanged and binding on everyone. And not only medical workers, but also patients should know about them.

NEW TIME PROCEDURE FOR DISPENSERIZATION IN THE CONDITIONS OF CORONAVIRUS:

at the first stage of lifting restrictions, clinical examination is not carried out;

at stages II and III, examinations are resumed for certain groups of the adult population, but those who are 65 and chronic patients undergo examinations only after all restrictions are lifted;

if it is impossible to separate the flows of patients in the clinic, it is impossible to carry out medical examination until the coronavirus restrictions are completely removed;

those who have had COVID-19 are allowed to undergo medical examinations only after complete recovery, confirmed by laboratory. Coughing, with dyspnea, fever, etc. not allowed for medical examination, just as people who are in contact with covid patients are not allowed;

a prerequisite – wearing protective masks, measuring the temperature of all visitors, sanitizers at the entrance to the medical organization, social distancing, ventilation, disinfection and other sanitary measures;

medical examination is carried out only with an appointment. It is recommended to fill out the questionnaire remotely.

These rules continue to this day.

That the coming year?

Nobody undertakes to make a forecast regarding the resumption of medical examination in full and throughout Russia next year. Basically, the experts I interviewed gave a streamlined answer: “Everything will depend on the epidemiological situation with COVID-19 in each region – it will continue in those regions where restrictions on coronavirus will be lifted.”

But with any prohibitions, including the temporary suspension of preventive medical examinations, if patients need urgent medical attention, it will be provided. This is what happens today. We are talking about routine medical care in hospitals and the necessary laboratory tests (CT, MRI, ultrasound of the cardiovascular system). All this is done, but only in the direction of a doctor. In full, they should provide assistance to patients with oncological diseases, diseases of the cardiovascular and endocrine systems, as well as those on renal replacement therapy (dialysis). And emergency care (for ARVI, influenza, pneumonia, covid) – taking into account the needs of citizens. But in the power of the regions to increase the waiting time for the provision of planned medical care.

All this is enshrined in the government decree of 03.04.2020, No. 432.

The Ministry of Labor also introduced its amendment: working Russians, in order to undergo medical examination, now have the right to use one working day once every three years, retaining their place of work (position) and average earnings. Citizens near retirement age can take two days each year. And if the research was not carried out within the recommended time frame, it can be done later: this right is shifted to a later time.

… Clinical examination is an effective method in terms of preventing morbidity, mortality, and its cancellation can lead to health problems, according to all experts without exception. This should be taken into account by people themselves, especially age-related and those with chronic diseases. Today, one must also take into account that their diseases can be seriously complicated by coronavirus infection. The most severe COVID-19 occurs in patients with diabetes mellitus, pulmonary pathologies, obesity. They need to be especially careful about their health.

Easy to say! Because of the pandemic, chronic patients themselves began to fear face-to-face visits to doctors. And then there is the self-isolation regime must be strictly observed. How to be?

The most advanced people are increasingly resorting to telemedicine services: today you can get a doctor’s consultation without leaving your home. According to the research, 56% of Russians resorted to correspondence consultations before the pandemic, now – 62%. Someone has their own family doctor, who can always be contacted remotely. But not all health problems can be solved over the phone – there are situations when medical examinations are needed.

The answer was prompted to me in the branch number 2 of the polyclinic number 66, to which I am attached. When asked if it is now possible, at the beginning of December 2020, to undergo medical examination, the answer was negative: “It is impossible. Clinical examination has been temporarily postponed. But if you have health problems, you can, by appointment, for a specific day and hour come for a consultation with a therapist at the clinic at your place of residence. You should have a compulsory medical insurance policy and a passport with you. If necessary, the doctor will send you for tests and examinations. We comply with sanitary and hygienic standards: there is a separate entrance for healthy patients, at the entrance there is a sanitizer, and your temperature will also be measured. “

And they added: if there are no urgent problems, it is better not to risk it. Many people do this: they do not take risks. They do not go to doctors even if necessary, for fear of contracting coronavirus. And here is the result: every third of Russians subject to medical examination in 2020 did not pass it. How it will backfire on their health in the future – time will tell.

AND NOW – ATTENTION!

In the remaining weeks of 2020, Russians can undergo free medical examination only in those regions where restrictions have been lifted due to the weakening of the coronavirus epidemic situation. And these are Russian citizens aged 18 to 39, born in 2002, 1999, 1996, 1993, 1990, 1987, 1984, 1981 and beyond (once every three years). But there is also an exception to the general rules: “privileged” patients have the right to undergo health checks every year, no matter how old they are. And these are the invalids of military operations; invalids and participants of the Great Patriotic War; residents of besieged Leningrad; those who have received a disability in concentration camps and other similar places; those who are five years old before retirement; working pensioners. And those who are already 40 years old and older.

And to find out if you can personally undergo a free medical examination in 2021, you need to divide the number of your years by 3. And if this number is divisible without a remainder, then you can. But only if the epidemiological situation associated with COVID-19 allows.