Nowhere without a test: how patients are currently being hospitalized
Recently, all patients who are hospitalized and scheduled for surgery must undergo PCR tests for coronavirus to prevent the spread of the disease within hospitals. But there is one "but" - who should conduct these tests and by what procedure? It is still difficult to give an unambiguous answer to the third month of quarantine.… De jure
situation 332 ) the government to resume scheduled operations, primarily oncology and cardiology, but with a PCR test previously performed on patients.
All patients, without exception, who will be hospitalized in connection with the planned operation, will first undergo PCR testing on David-19, and then have to go through a phase of self-isolation for 2-3 days, ie according to the plan, the results would like know while the patient is still at home. Also, the Ministry of Health has clearly prescribed the mechanism of biomaterial collection for testing patients with coronavirus and determined that it is a direct function of mobile teams. These teams come to the patient’s home and take material from him for research so that contact persons or people who already have signs of the disease do not leave the house.
Separately, the Minister stressed that all this will be free of charge, the state has such an opportunity and is constantly purchasing the necessary equipment and new additional tests, at the expense of the Stabilization Fund(Stabilization Fund for UAH 124 billion, created by Prime Minister Shmygal through the redistribution of budget funds of the state budget of Ukraine).
"The Ministry of Health has developed an algorithm for testing citizens who come to the planned hospitalization for the treatment of their diseases. According to this algorithm, a person in need of hospitalization undergoes PCR testing at the place of residence, is in isolation for two or three days, and if the test is negative, ie the person is not sick, goes to the hospital. At Okhmatdyt, we had the only case where a patient was tested for coronavirus at his own expense. The Ministry of Health has made the appropriate conclusions. The country has never been quarantined during its existence. All the algorithms we offer are new to us. But we are improving them very quickly, making them convenient. ", - Stepanov explained .
The de facto situation
On the ground, the announced action plan is somewhat different. Thus, hospitals received relevant regulations from the Ministry of Health, according to which they issued their internal instructions on the procedure for consulting patients in the clinic and hospitalization, letters of epidemiological review. But all this only relays the thesis of the Ministry of Health: 1) The patient can be consulted in the clinic and hospitalized subject to additional examination (see the appendix to the Order of the Ministry of Health of Ukraine №1227): PCR is mandatory for persons with immunosuppression; for other groups of ELISA IgMPLR; if ELISA is positive; 2) All patients who go to the clinic and are hospitalized must be filled in " epidemiological review sheet "»Indicating the result and date of PCR and / or ELISA IgM - test for COVID -19 (form attached); 3) At hospitalization of patients with the diagnosis " pneumonia", the raised body temperature or the persons who had contact with patients with COVID -19 performance of the PCR test for a period of up to 3 days is obligatory .
That is, documents on how the Ministry of Health should be provided, and documents with a mechanism on how to do it - no. Where should these tests be conducted? Hospitals do not know anything about it and just wave their hands. In fact, for the third month of quarantine the situation has changed only in terms of expanding the list of commercial laboratories, where at their own expense you can do a PCR test with a price range from 1800 UAH to 3000 UAH, and expect results within 2-3 days.
Orders VS realities of laboratory capacity in the regions of the
domestic health care system were not ready for so many analyzes. Ukrainians have been waiting for the results of PCR diagnostics for several weeks, and virology laboratories work in 3 shifts and without days off. Due to overloading of regional laboratory centers, biological material is transported to neighboring laboratories or to Kyiv .
For example, Lviv laboratories do not have time to process all samples for PCR, and people expect results from a week to two. Huge queues and people willing to take samples.Until recently, there were long lines of people near the admission department of the Lviv Regional Infectious Diseases Hospital to take tests for coronavirus infection. Suspects were standing nearby, as well as those who needed surgery. After all, without a certificate with the result on C ovid -19 is not hospitalized.
Now there is no queue near the hospital, and the tent where the samples were taken was closed. Today in the Lviv region 4 laboratories are testing tests for coronavirus infection. More than 2,500 unprocessed samples are stored in refrigerators. It takes at least 8 days to check them all. But 500 to 600 new samples from all over the region are added every day. Near the laboratories there are queues of cars from the areas where medical workers came to submit the material selected from people for research.
“We conduct 300-400 studies a day. Therefore, we do not have time to rework and give results to people. Those people who are hospitalized or in self-isolation, it does not matter to them how many days to wait for the result, because they are treated. We do only free research, only on official applications. Private laboratories send samples to Kyiv, where they have agreements , - says the head of the Laboratory Center of Lviv region Roman Pavlov.
«Polymer chain reaction is a complex and long process. And people think it’s the same as doing a biochemical blood test. No, it’s not true. The study itself lasts 9-10 hours, and before that you need to prepare the biomaterial itself. Sometimes this process also takes a long time. Sometimes it is necessary to repeat the study, because the sample may not be enough pathogen, so you need to increase DNA and RNA. Therefore, PCR test is not done in 9 hours, it must be understood. And if there are delays, they do not arise because of some of our whims, but because it is a very large amount of work , "- adds Pavlov .
There is, of course, such a cohort of patients who simply do not have that time, those two weeks. Most of them are cancer patients. Their solution is to pass testing in private laboratories, where the answer can be obtained from 2 to 5 days, the cost is more than 2 thousand hryvnias.
In another regional center, Lutsk, the situation is similar - laboratory systems are extremely overloaded. Laboratories work overtime, without days off and almost around the clock, do tests until the third night. All because Ukraine lacks equipment, laboratories and specialists for PCR testing.
According to the specialist of the Center for Public Health Taras Ostapchuk, congestion occurs because not all laboratories have automatic extraction stations. They allow for much more research because extraction is not done manually. It is planned to purchase such automatic stations for all laboratories in the near future.
But in Zhytomyr they decided not to wait for the promised help from the state and found 1.5 million hryvnias for the laboratory in the local budget. After all, 2 weeks ago, due to overload, the regional laboratory did not accept new samples for several days. Biological material was transported to Kyiv. She currently performs 200 PCR studies per day. But with the advent of the new laboratory, it will increase to 800 tests, and the cost will be many times lower than now on the Ukrainian market.
The word of the doctor
The system of preliminary hospitalization in infectious wards of people without infectious pathology is also imperfect, because they are exposed to the danger and risk of getting it there. Infectious disease specialist Yevhen Dubrovsky briefly describes what is happening in Kyiv :
"In the capital, there is an order according to which every patient with signs of pneumonia should be hospitalized ONLY in an infectious hospital. It doesn’t matter if Kovid is there or not. Only suspicion of pneumonia. Theoretically, this is the right step, because among those infected may be a person with coronavirus, which will then infect the somatic department. That’s how it was, that’s how whole hospitals were closed. Therefore, it takes time and space to examine and sort patients to detect contagious Covid before admission to general wards. But in practice this led to uncontrolled flooding, the establishment of an infectious disease hospital. Who ?! Patients with coronavirus? Not at all! There are very few confirmed cases. All the huge, unlimited number of patients are chronic, severe, non-walking patients with a number of comorbidities. Oncology, post-stroke condition, cardiogenic pulmonary edema, congestive pneumonia… All this is now our patients in an infectious hospital. What are they doing here? Waiting for PCR! And then transferred to other hospitals. It takes a day or two. Mass admission every day, then mass transfer to other institutions after receiving a negative result… lost time, exhaustion for the patient, long queues of ambulances for admission, then re-transfers and expectations… horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " And then transferred to other hospitals. It takes a day or two. Mass admission every day, then mass transfer to other institutions after receiving a negative result… lost time, exhaustion for the patient, long queues of ambulances for admission, then re-transfers and expectations… horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " And then transferred to other hospitals. It takes a day or two. Mass admission every day, then mass transfer to other institutions after receiving a negative result… lost time, exhaustion for the patient, long queues of ambulances for admission, then re-transfers and expectations… horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " long queues of ambulances, then transfers and expectations again - horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " long queues of ambulances, then transfers and expectations again - horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! ", - Dubrovsky emphasizes .
Therefore, now hospitalization and testing is not a story about the effectiveness of preventing the spread of the disease, but a story about the method of trial and error and testing of office paper orders in the field of medical ward realities. Write little, you need to provide. And the results will be when these big offices with pseudo-specialists who approve "correct" orders that work at least on paper, and not in practice, finally begin to hear and listen, listen and hear those little chambers in which not thanks, and in spite of the whole irrational system, really competent and qualified people, professional doctors, save lives every day, 24 hours a day, 7 days a week.
Author Kateryna Stebelska
Other news and articles
situation 332 ) the government to resume scheduled operations, primarily oncology and cardiology, but with a PCR test previously performed on patients.
All patients, without exception, who will be hospitalized in connection with the planned operation, will first undergo PCR testing on David-19, and then have to go through a phase of self-isolation for 2-3 days, ie according to the plan, the results would like know while the patient is still at home. Also, the Ministry of Health has clearly prescribed the mechanism of biomaterial collection for testing patients with coronavirus and determined that it is a direct function of mobile teams. These teams come to the patient’s home and take material from him for research so that contact persons or people who already have signs of the disease do not leave the house.
Separately, the Minister stressed that all this will be free of charge, the state has such an opportunity and is constantly purchasing the necessary equipment and new additional tests, at the expense of the Stabilization Fund(Stabilization Fund for UAH 124 billion, created by Prime Minister Shmygal through the redistribution of budget funds of the state budget of Ukraine).
"The Ministry of Health has developed an algorithm for testing citizens who come to the planned hospitalization for the treatment of their diseases. According to this algorithm, a person in need of hospitalization undergoes PCR testing at the place of residence, is in isolation for two or three days, and if the test is negative, ie the person is not sick, goes to the hospital. At Okhmatdyt, we had the only case where a patient was tested for coronavirus at his own expense. The Ministry of Health has made the appropriate conclusions. The country has never been quarantined during its existence. All the algorithms we offer are new to us. But we are improving them very quickly, making them convenient. ", - Stepanov explained .
The de facto situation
On the ground, the announced action plan is somewhat different. Thus, hospitals received relevant regulations from the Ministry of Health, according to which they issued their internal instructions on the procedure for consulting patients in the clinic and hospitalization, letters of epidemiological review. But all this only relays the thesis of the Ministry of Health: 1) The patient can be consulted in the clinic and hospitalized subject to additional examination (see the appendix to the Order of the Ministry of Health of Ukraine №1227): PCR is mandatory for persons with immunosuppression; for other groups of ELISA IgMPLR; if ELISA is positive; 2) All patients who go to the clinic and are hospitalized must be filled in " epidemiological review sheet "»Indicating the result and date of PCR and / or ELISA IgM - test for COVID -19 (form attached); 3) At hospitalization of patients with the diagnosis " pneumonia", the raised body temperature or the persons who had contact with patients with COVID -19 performance of the PCR test for a period of up to 3 days is obligatory .
That is, documents on how the Ministry of Health should be provided, and documents with a mechanism on how to do it - no. Where should these tests be conducted? Hospitals do not know anything about it and just wave their hands. In fact, for the third month of quarantine the situation has changed only in terms of expanding the list of commercial laboratories, where at their own expense you can do a PCR test with a price range from 1800 UAH to 3000 UAH, and expect results within 2-3 days. Orders VS realities of laboratory capacity in the regions of the
domestic health care system were not ready for so many analyzes. Ukrainians have been waiting for the results of PCR diagnostics for several weeks, and virology laboratories work in 3 shifts and without days off. Due to overloading of regional laboratory centers, biological material is transported to neighboring laboratories or to Kyiv .
For example, Lviv laboratories do not have time to process all samples for PCR, and people expect results from a week to two. Huge queues and people willing to take samples.Until recently, there were long lines of people near the admission department of the Lviv Regional Infectious Diseases Hospital to take tests for coronavirus infection. Suspects were standing nearby, as well as those who needed surgery. After all, without a certificate with the result on C ovid -19 is not hospitalized.
Now there is no queue near the hospital, and the tent where the samples were taken was closed. Today in the Lviv region 4 laboratories are testing tests for coronavirus infection. More than 2,500 unprocessed samples are stored in refrigerators. It takes at least 8 days to check them all. But 500 to 600 new samples from all over the region are added every day. Near the laboratories there are queues of cars from the areas where medical workers came to submit the material selected from people for research.
“We conduct 300-400 studies a day. Therefore, we do not have time to rework and give results to people. Those people who are hospitalized or in self-isolation, it does not matter to them how many days to wait for the result, because they are treated. We do only free research, only on official applications. Private laboratories send samples to Kyiv, where they have agreements , - says the head of the Laboratory Center of Lviv region Roman Pavlov.
«Polymer chain reaction is a complex and long process. And people think it’s the same as doing a biochemical blood test. No, it’s not true. The study itself lasts 9-10 hours, and before that you need to prepare the biomaterial itself. Sometimes this process also takes a long time. Sometimes it is necessary to repeat the study, because the sample may not be enough pathogen, so you need to increase DNA and RNA. Therefore, PCR test is not done in 9 hours, it must be understood. And if there are delays, they do not arise because of some of our whims, but because it is a very large amount of work , "- adds Pavlov .
There is, of course, such a cohort of patients who simply do not have that time, those two weeks. Most of them are cancer patients. Their solution is to pass testing in private laboratories, where the answer can be obtained from 2 to 5 days, the cost is more than 2 thousand hryvnias.
In another regional center, Lutsk, the situation is similar - laboratory systems are extremely overloaded. Laboratories work overtime, without days off and almost around the clock, do tests until the third night. All because Ukraine lacks equipment, laboratories and specialists for PCR testing.
According to the specialist of the Center for Public Health Taras Ostapchuk, congestion occurs because not all laboratories have automatic extraction stations. They allow for much more research because extraction is not done manually. It is planned to purchase such automatic stations for all laboratories in the near future.
But in Zhytomyr they decided not to wait for the promised help from the state and found 1.5 million hryvnias for the laboratory in the local budget. After all, 2 weeks ago, due to overload, the regional laboratory did not accept new samples for several days. Biological material was transported to Kyiv. She currently performs 200 PCR studies per day. But with the advent of the new laboratory, it will increase to 800 tests, and the cost will be many times lower than now on the Ukrainian market.
The word of the doctor
The system of preliminary hospitalization in infectious wards of people without infectious pathology is also imperfect, because they are exposed to the danger and risk of getting it there. Infectious disease specialist Yevhen Dubrovsky briefly describes what is happening in Kyiv :
"In the capital, there is an order according to which every patient with signs of pneumonia should be hospitalized ONLY in an infectious hospital. It doesn’t matter if Kovid is there or not. Only suspicion of pneumonia. Theoretically, this is the right step, because among those infected may be a person with coronavirus, which will then infect the somatic department. That’s how it was, that’s how whole hospitals were closed. Therefore, it takes time and space to examine and sort patients to detect contagious Covid before admission to general wards. But in practice this led to uncontrolled flooding, the establishment of an infectious disease hospital. Who ?! Patients with coronavirus? Not at all! There are very few confirmed cases. All the huge, unlimited number of patients are chronic, severe, non-walking patients with a number of comorbidities. Oncology, post-stroke condition, cardiogenic pulmonary edema, congestive pneumonia… All this is now our patients in an infectious hospital. What are they doing here? Waiting for PCR! And then transferred to other hospitals. It takes a day or two. Mass admission every day, then mass transfer to other institutions after receiving a negative result… lost time, exhaustion for the patient, long queues of ambulances for admission, then re-transfers and expectations… horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " And then transferred to other hospitals. It takes a day or two. Mass admission every day, then mass transfer to other institutions after receiving a negative result… lost time, exhaustion for the patient, long queues of ambulances for admission, then re-transfers and expectations… horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " And then transferred to other hospitals. It takes a day or two. Mass admission every day, then mass transfer to other institutions after receiving a negative result… lost time, exhaustion for the patient, long queues of ambulances for admission, then re-transfers and expectations… horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " long queues of ambulances, then transfers and expectations again - horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! " long queues of ambulances, then transfers and expectations again - horror, fatigue, irrationality. Doctors fall off their feet. It is impossible to work effectively when a city of 7 million, like a millstone, grinds through one hospital! Insulators in every major hospital should be deployed immediately. Floors, buildings for sorting and examination of patients in each support facility should be separated. Do PCR in outpatient clinics quickly, not 10 days! ", - Dubrovsky emphasizes .
Therefore, now hospitalization and testing is not a story about the effectiveness of preventing the spread of the disease, but a story about the method of trial and error and testing of office paper orders in the field of medical ward realities. Write little, you need to provide. And the results will be when these big offices with pseudo-specialists who approve "correct" orders that work at least on paper, and not in practice, finally begin to hear and listen, listen and hear those little chambers in which not thanks, and in spite of the whole irrational system, really competent and qualified people, professional doctors, save lives every day, 24 hours a day, 7 days a week.
Author Kateryna Stebelska
Other news and articles