Medicine • 22 July, 2020

Number of ambulance calls reduced by 23% in two weeks

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At the selector government session chaired by the Prime Minister Askar Mamin, the anti-epidemiological measures taken in the country and the progress in the execution of the Head of State’s instructions given on July 18, 2020, were considered. Minister of Healthcare Alexey Tsoy reported on the current situation in the country in the fight against coronavirus infection.

As the minister informed, over the past week, there has been a tendency towards stabilization of morbidity and mortality from COVID-19. The morbidity situation is at the level of 1500-1600 people per day.

“For three weeks of this month, the total bed capacity has been increased from 30.4 thousand to 49.7 thousand infectious and provisional beds. The growth of the hospital bed was 19.3 thousand, including additionally deployed 5.3 thousand infectious beds. Thanks to this, the availability of medical care to patients in need has been significantly increased,” said Tsoy.

In provisional hospitals, bed occupancy decreased by 20% from the critical level of employment (89%) due to additional 14 thousand beds opened and amounted to 69%. The occupancy rate of intensive care beds is 67% today. Before the introduction of quarantine, this figure was 91%.

Thus, as the Minister of Healthcare assured, in pursuance of the instructions of the Head of State, a sufficient number of inpatient beds are currently deployed to treat patients with COVID-19 and pneumonia.

At the outpatient level, 2,962 mobile Primary Healthcare teams have been established to provide home care. By the end of this month, the number of brigades will be increased to 3,500.

The number of Call-centers in polyclinics was increased by 16%, in which qualified doctors-consultants, paramedics and students of medical universities were attracted.

“Today, infectious and provisional hospitals have 1,958 ventilators, together with akimats, more than 4,183 devices are additionally purchased (of which 3,105 are from a domestic manufacturer), and more than 21,000 beds will be connected to oxygen, of which 17,762 points will be equipped with oxygen concentrators, 6,237 at the expense of sponsors,” Tsoy informed.

Fifty-nine public and private laboratories are involved with a throughput capacity of 32 thousand tests per day. The maximum retail price for a disposable medical three-layer mask has been reduced by 28%. A reserve of personal protective equipment for first line workers (doctors, law enforcement officials) has been formed until August. 7.2 billion tenge was allocated from the government reserve for these purposes.

“At the expense of these funds, 41 million masks, 27 million gloves and 379 thousand protective suits, as well as 1.2 million PCR tests were purchased. A similar reserve of PPE (personal protective equipment) is formed from September to February 2021,” the head of the department said.

As Tsoy stressed, the Head of State instructed to develop measures to improve the situation in the countryside. To provide medical care to patients with PCR-positive cases of coronavirus infection and pneumonia, 2.5 thousand infectious and 11 thousand provisional beds were deployed at the village level.

“To provide outpatient care in the village, 1,493 mobile teams have been created and are functioning, which covers 94% of the needs. There are 641 ambulances involved in the village. Additional requirement of 141 machines will be covered by ongoing financial leasing agreements by the end of this year,” Tsoy assured.

At the same time, 53 X-ray machines will be purchased for regional hospitals. Additionally, it is planned to supply 100 medical points within 3-4 months, which will be equipped with all the necessary equipment for a comprehensive examination of rural residents.

In general, as the minister noted, taking into account the operational measures taken over a two-week period, the following positive results were achieved:

  • daily increase in COVID-19 infection has been reduced from 4% to 2.1%;
  • number of people recovered from COVID-19 increased by 60%;
  • number of ambulance calls reduced by 23%;
  • employment of provisional beds was reduced by 20% and resuscitation beds by 6%.

Regarding the instructions of the Head of State to take measures for high-quality planning and procurement of medicines:

  • simplified certification and registration procedures, as well as single import procedures
  • retail saturation with medicines is carried out by accelerating deliveries with special cargo boards
  • special Stabilization Funds have been formed in the regions.
  • list of outpatient drug supply is being expanded
  • monthly supply of medicines is being formed (until July 22, 2020, medicines will be shipped to medical organizations in the amount of a monthly need)
  • republican stabilization fund will also be created on the basis of SK-Pharmacy LLP.

It is worth noting that the Head of State ordered to increase the capacity of laboratory research to 40,000 PCR tests per day, which means 215 tests per 100 thousand population. Today, the actual testing capacity is 32 thousand trials per day. The capacity deficit is 8,000 studies per day. The following solutions have been developed:

First. The use of laboratories of the veterinary service — 5,200 thousand tests per day (26 sets of PCR equipment), with the involvement of 67 specialists of the veterinary service — from Aug. 1, 2020. Thus, the shortage of PCR testing in the regions will be leveled at the expense of the laboratories of the Ministry of Agriculture.

Second. Purchase of 20 sets of PCR equipment and 8 equipped mobile laboratories — 20.5 thousand, including mobile (4.8 thousand tests per day). Estimated delivery date — Aug. 30, 2020.

Third. Increasing the capacity of modular laboratories in Nur-Sultan and Almaty — by 8 thousand.

Thus, the power of testing will be brought to:

  • by Aug. 1, 2020, by attracting laboratories of the Ministry of Agriculture up to 35.6 thousand per day.
  • by Sep. 1, 2020, taking into account the re-equipment of the laboratories of the Ministry of Healthcare and local executive bodies up to 64 thousand per day

At the same time, taking into account the forecast of the epidemiological situation by the end of the year and an increase in the capacity of PCR laboratories, it is necessary to additionally allocate from the Republican budget:

  • 42 billion tenge to pay for PCR testing services;
  • 170 million tenge to pay for travel expenses for 67 specialists of veterinary laboratories involved in research.

In addition, regional akims need to ensure the allocation of vehicles and payment for services for the delivery of material for research from rural areas.

According to the instructions of the Head of State, the ministry has developed a draft Plan for the phased resumption of the provision of planned medical care to the population, including high-tech.

“The draft Plan provides for two stages of the resumption of routine medical care, depending on the narrow profile of the provision of services to the population and on the degree of involvement of medical organizations in the fight against COVID-19. If the bed occupancy of hospitals is less than 50%, after appropriate disinfection, it is planned to open profile and planned beds by 50%, subject to sanitary and epidemiological requirements,’’ Tsoy summed up.

Akim of Nur-Sultan Altai Kulginov, in turn, noted that due to the introduction of strict quarantine, today the situation in the capital is stabilizing. The number of people infected with the coronavirus is 8,619. 5,511 people were cured, 212 died. 2,262 people are receiving treatment in hospitals. The number of patients in serious condition has decreased by 30%. The number of infectious diseases and provisional hospitals increased from 3 to 16. The number of beds in them is from 1,051 to 3,911 beds. There are about 1,000 places in the reserve.

"If at the beginning of the quarantine there was only one laboratory where 300 tests were carried out per day, today there are 9 laboratories with the ability to conduct up to 5,000 tests per day," said Kulginov.

In general, more than 270 thousand PCR tests have been carried out to date. Additionally, 300 oxygen concentrators and 150 fluometers were purchased. By the end of July, 500 specially equipped beds, 100 ventilators, 264 oxygen concentrators, 350 fluometers, 3 oxygen tanks, 100,000 personal protective equipment, 2 computer tomographs will be delivered. X-ray machines and computed tomographs work in 17 medical institutions of the capital. In total, almost 20 thousand chest studies were carried out in June-July.

“From today, the work of all computer tomographs in Nur-Sultan will be switched to round-the-clock mode,” Altai Kulginov said.

Akim of the Karaganda region Zhenis Kassymbek reported that according to the operational information for July 21, in hospitals of the region, 2,520 patients are receiving treatment. Since the beginning of the epidemic, 62% have recovered. The increase in cases is less than 2%.

“Analysis over the past 2 weeks shows that the overall epidemiological situation is improving. Currently, the daily discharge of patients is higher than hospitalization. The bed occupancy has decreased to 50%. Two weeks ago, this indicator was 80%,” said Kassymbek.

Ambulance calls for the last week for a viral infection and its complications (pneumonia) have decreased by 3 times. Work has begun on the gradual restoration of planned hospitalization. For the convenience of citizens, the Online Consultation project was launched through the Damu-Med mobile application, the total number of users is about 400 thousand.

There is a massive preparation for the autumn-winter period. The bed fund was increased to 4,486. The provision of hospitals with modern medical equipment continues.

In the first months of the pandemic, 47 ventilators, 160 oxygen concentrators, and 416 pulse oximeters were purchased in addition to the existing 120. Currently, 90 ventilators are being purchased, 10 of which will be delivered this week.

“To provide patients with oxygen, 1,500 concentrators were purchased, and centralized systems for supplying medical gases were installed at 5 facilities. There are 17 computed tomography rooms. By Oct. 5, 2020, more will be installed — in Shakhtinsk, Karaganda, Balkhash, Zhezkazgan and Satpayev. In addition, we are purchasing 25 modern digital X-ray machines,” the akim of the Karaganda region said.

Increased coverage of the population by testing. Four PCR laboratories have been deployed in Karaganda, Zhezkazgan and Temirtau, with a total capacity of 4.5 thousand analyzes per day. At the end of August, the fifth laboratory will be opened in Balkhash.

Preventive tests have been carried out at industrial enterprises since March, all workers undergo pre-shift PCR testing. This ensures the smooth operation of the industrial sector of the economy. A total of 150 thousand tests were carried out.

Hospitals are provided with personal protective equipment for two months. Currently, a strategic stock of drugs and medical products is being formed for operation in the autumn-winter period (in the conditions of a possible second wave of coronavirus infection).

Also Kassymbek noted that today there is no rush for medicines in the pharmacy network. Prices do not exceed the maximum permissible. Medicines are actively shipped to the region.

“However, there are still questions about the stability of supplies. To do this, we are working on logistics with an increase in the volume of supplies by 3 times. On July 18, an aircraft arrived with 17 tons of necessary medicines from the Russian Federation,” said Kassymbek.

In addition, work continues to identify violations of quarantine measures. There are 57 interdepartmental mobile groups operating, 444 raids were carried out, and 2,241 facilities were checked. As a result of 142 registered violations, 72 facilities were brought to administrative responsibility, 2 were closed.

Much attention is paid to information work. A network media plan is developed weekly, which includes a three-level distribution of thematic materials. Leaders of public opinion, doctors, and deputies are involved in campaigning work.

Briefings are regularly held at the site of the regional communications service. Since the beginning of the year, 71 briefings have taken place. Answers to all materials are published according to the “rules of the golden hour”.

Akim of Aktobe region Ondasyn Urazalin said that as of July 21, 2,753 cases of CVI were registered in the region. To date, 1,172 patients (42.8%) have been discharged, 89 people are undergoing treatment. There are 18 lethal cases. In the region, 7,773 cases of pneumonia were registered, of which 4,987 are recovered patients. As of July 21, there are 2,786 patients in round-the-clock and day hospitals. Number of fatalities reached 317.

There are four laboratories in the region with the ability to conduct 600 PCR tests per day. To date, about 130 thousand laboratory and express tests have been carried out, as a result, the coverage of the population with tests amounted to 12,606 per 100,000 population.

“In general, since the beginning of the pandemic, the number of beds has increased by almost 4 times. Today in the region there is an opportunity to simultaneously accommodate 3,988 people, of which 337 are infectious, 2,636 provisional, 1,015 reserve beds. As of today, there are 1,173 vacant beds, the occupancy of beds is 54%,” Urazalin noted.

In the region there are 16 devices for computed tomography and 63 X-ray devices, including 2 mobile medical complexes with the possibility of mobilization in the region. There is no additional need for CT and X-ray machines. In addition, 186 ventilators are available, including 81 stationary and 105 portable. Additionally, 15 more ventilators were purchased, delivery is expected in the near future. All provisional hospitals are fully supplied with oxygen and Bobrov's apparatus. TNC KazChrome forces fill more than 500 cylinders with oxygen on a daily basis free of charge.

In total, about 2,400 medical workers were involved in the fight against CVI during the pandemic. In June alone, medical workers received allowances in the amount of 536 million tenge.

In addition, tangible support to doctors during a pandemic was provided by the faculty of Ospanov Medical University. So, about 200 residents and 100 faculty members are involved in work in provisional hospitals.

According to the Akim of Aktobe region, provisional and infectious diseases hospitals are replenished with medicines twice a week by the SK-Pharmacy. In addition, to date, 117 thousand of the most popular imported medicines for 25 types have been delivered from the Orenburg region at the expense of the local budget, which made it possible to provide an adequate supply of medicines and PPE for all medical institutions for at least 30 calendar days.

“To solve the problem of availability of medicines in pharmacy chains of the region, it was decided to allocate 500 million tenge of extra-budgetary funds to replenish the working capital of the network of local pharmacies. There is a written agreement with pharmacy chains on a trade margin of no more than 10% of the cost of medicines,” Urazalin said.

In order to fulfill the instructions of the Head of State on the production of medicines, at present, according to the signed memorandum, the production of the antiviral drug Grippovir has been organized on the basis of TK-Pharm LLP.

“We provided assistance in obtaining raw materials from China (at the expense of extra-budgetary funds, a preferential, repayable, interest-free loan in the amount of 75 million tenge was issued. We purchased 200 kg of Uminofir). If earlier 5 thousand boxes of the drug were produced per week, now the volume of production has increased 4 times and reaches 20 thousand boxes per week,” said the akim of Aktobe region.

In primary health care organizations, 152 mobile teams have been created and are working. Work has been intensified to clarify the situation in the region. Explanatory work is carried out 3 times a week live on all social networks.

For counseling of outpatient treatment at home, an open round-the-clock call center was established on the basis of Ospanov Medical University.

About 200 monitoring groups have been created in the region. More than 8,600 inspections of various objects were carried out, 3,106 notifications were issued.

In addition, in the region 6 organizations provide funeral services for burial, the cost of services on average is about 80 thousand tenge. Burial service prices have not changed over the past 2 years. Burial places are provided free of charge.

Thanks to the measures taken, a decrease in the incidence is noted. Since the beginning of the month, the occupancy of bed places has dropped from 78% to 54%. In this regard, 1,015 beds were transferred to the reserve.

“Also, at the peak of morbidity, the ambulance service received about 2,600 calls per day, about 160 patients were delivered to the hospital, currently about 1,800 calls are received per day, 60-70 patients are delivered, a decrease of more than 2 times. The corresponding work will be continued. The situation is under constant control,” Urazalin concluded.

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