Borys Todurov: I think that today's hysteria on coronavirus in Ukraine is largely unjustified

Author : News Agency

Respondent : Borys Todurov

Source : 112 Ukraine

Despite this, Director General of the Heart Institute of the Ministry of Health states that most hospitals are not ready to accept a huge number of infected patients
20:32, 24 March 2020

Borys Todurov
112 Agency

- Our guest is Borys Todurov, Director General of the Heart Institute of the Ministry of Health.

- People travel, communicate during the lockdown. Is this dangerous?

- I am not an epidemiologist and not an infectious disease specialist. People cannot help but move. We have not imposed a curfew, there are no restrictions on movement. Public places, the metro are closed, and rightly so, because one person who coughed in the subway car infects hundreds at once. But people need to get to work, including doctors, so cars will drive. And due to the fact that city and intercity transfers are canceled, private cars movement will increase significantly.

- Over the past two days you have had four operations.

- These were emergency operations. We completely stopped planned operations, dispersed our patients. All planned examinations were rescheduled. I think that 80% of people have not yet realized the seriousness of the situation and are still traveling around the city without much need. But 20% are people who travel by necessity.

- Question from the audience: what to do if the cancer operation was canceled?

- There is an order of the Ministry of Health, a resolution of the Cabinet of Ministers that oncological, cardiac and taracal surgery are not canceled or transferred only if the patient’s condition does not threaten his life. If someone canceled the operation and it threatens life, then it is absolutely illegal, such an operation should be done in the medical institution where the patient is being treated.

- They ask why there is no panic in Belarus? Do you think the fear virus is worse than the coronavirus?

- In this situation, yes. I think that the hysteria that exists today about the coronavirus is in many ways not justified. If we take statistics on Ukraine, then 6,000 people die from suicide attempts a year, about 4,000 die under the wheels of cars. I'm not talking about how many die from tuberculosis - more than 10 000, from cardiovascular disease - more than 300 000 a year. And on this occasion, no one has any serious unrest, it seems to be natural. Therefore, if we take such statistics and calculate how many die from a coronavirus and how many have already died, then in general the hysteria is absolutely not justified. But in Belarus there is no hysteria, because it retained the Semashko system, which is clearly focused on prevention, immunization, and all vaccinations. This is practically the system of the Soviet Union, only highly funded and high-tech. In Belarus, there are sanitation facilities, infectious hospitals, which are funded by the state. In Belarus, the management vertical has been preserved, and medicine very clearly cooperates with the border service, the police, and the SBU. And these are all the structures that are included in the event of quarantine, and they must act synergistically.

- Have we got lost in the reforms?

- We did not just get lost, we destroyed the medicine we had. Belarus retained all the advantages that Soviet medicine had, and increased them by introducing new technologies and providing its medicine with good funding.

- Would you like such a path to Ukraine?

- That would be the best way for medicine. There you need to add 20% of private clinics for rich people. And it was necessary to preserve the system that we had, and the training system.

- The audience asks: is it possible to get coronavirus from a dead person?

- Yes.

- And how to protect people after transplantation?

- After transplantation, people are especially sensitive to any infection. There are about 1000 of them in Ukraine now. They need to be completely isolated. These people should be especially careful now, because pneumonia is one of the main diseases that people die from after organ transplants.

- Let's talk about medical reform.

- A person who leads medicine should understand he serves to the fatherland. If we appoint a minister of health who has arrived in Ukraine and has not grown up in this country, hasn’t studied, hasn’t worked in this country for a single day, at any medical institution, doesn’t have a normal education - can we demand from such a person to perform some functions, serve to Ukrainian medicine, Ukrainian patients, take care of Ukrainian doctors? We, our state, initially did not set ourselves the goal of developing our medicine and somehow protecting our citizens. Therefore, the situation that we have is quite natural. There was a foreign citizen in power for three years. She does not have the right to occupy this position according to all our laws, she has not handed over her passport, she has access to state secrets. In the same way, her MPs were illegally appointed, they announced that "they will all die and there is no need to spend 20 million on the treatment of cancer patients." At a meeting of the Accounts Chamber, when Deputy Minister was asked: after all, there were 20 million, why didn’t you spend them on treating cancer patients, he replied that they would all die, 100%, and what's the point of spending this money? And these people have been managing medicine for three years! And today we are reaping these benefits. They adopted laws under the beautiful name of "autonomy", but in fact it is a bankruptcy law. We have adopted laws on reform, which will start on April 1, and we will see all the consequences of this start when district and city hospitals begin to go bankrupt. There were several years of completely destructive medical policy.

- Our viewers ask: is it possible to take prednisolone to increase immunity?

- No. Prednisone is a hormone that lowers immunity. It can be used to treat very serious allergic reactions or to treat general inflammation.

Borys Todurov
112 Agency
- Do doctors now take advanced training courses on helping patients with coronavirus?

- There is a department of anesthesiology at our base at the Heart Institute, and three months ago I offered our services so that people who will receive ALV machines can take short courses. I think that in two weeks it was possible to get ready learning on the stream of patients that we have in intensive care. And we have up to 30 operations per day. We could prepare a competent good anesthetist in two weeks. But not a single person was sent to us for courses. Moreover, today we are the only institution, the only branch in Eastern Europe of the Berlin Academy of Perfusiologists. And we issue perfusiologists international certificates. There are only two such Academies in the world: one of them is Berlin, and we are its branch. We offered our services to train specialists on ECMO - this is the only mean that saves patients with pulmonary pneumonia when pulmonary reserves run out. And also no one came to us from the central bodies. And this is a problem, because you still need to be able to ventilate the patient. People who work in district hospitals, literate, old anesthetists, have never worked on such equipment. We are open, and now we do the emergency operations, we will show, tell.

- What should the medical system in Ukraine look like?

- No one asked me what the health care system in Ukraine should be like. I would keep 80% of state clinics in a clear management vertical of the Ministry of Health. I think that the most logical thing today would be to introduce a state insurance company, review the budget and allocate at least 5% to medicine. Restore normal state order in state medical universities, of which there are 15 today. Reorganize the training system and train personnel according to new methods. But the most important thing is to give priority to medicine in the budget and raise salaries. Sisters should have a salary of at least 30 000 UAH (1071 USD) today, so that we do not lose sisters today, so that they do not leave for Poland and the Czech Republic. Raise the salaries of doctors to such a level that they do not leave for Germany and Poland. The key today is the introduction of insurance medicine, and this should be a state insurance company for most social groups.

- Doctors will be paid up to 200% benefits for work with infected by coronavirus. Are such allowances sufficient?

- I wonder from what fund this will be paid. We have a payroll fund and there are clinics that have now switched to self-financing work - they have become state enterprises. From April 1, they were offered to earn their own salary. From what funds will these 200% be paid? Firstly, this is legal nonsense, because since 2003 there has been a resolution of the Cabinet of Ministers that 300% must be paid in such cases. And suddenly a law appears where this rate is reduced to 200. From which funds can I raise my salary to such numbers? Tomorrow might be an epidemic, and 50 such patients will go to the Heart Institute. 850-900 employees should receive a 200% bonus. We have a salary fund of 103 million, that is, I have to find somewhere else 103 million, plus taxes to them, in order to pay these people, if God forbid it will stretch for several months. Who provided such money in the budget to sign such things?

- People ask why the Ministry of Health does not buy antiviral drugs that are used in China and Italy?

- These are the things that people ask about, this is the result of that destructive work over the past five years, when the administrative vertical of the Ministry of Health was destroyed. Today, each district hospital is left on its own. Today, there is no control over the epidemiological state, the sanitary service is completely destroyed, the state does not manage medicine at least as it was 6-7 years ago.

- They ask how to protect health workers?

- Probably no one could give 100% guarantee today. But you can significantly reduce the risks of the disease, if you follow certain rules of behavior. Any object that you touch is a source of infection, because people who could be carriers have touched these objects. If you touch something with your hands, clothes, it should be washed, disinfected, so as not to get sick by transmitting a drip infection. Drops are the mucous membrane of our mouth, eyes, nose. The man wiped his nose, grabbed the handrail - which means the handrail is infected. You rubbed your nose - and you are already infected too. This chain must be interrupted. The mask you put on may not protect you, but if you are a wearer, it will protect others. Your droplets from your mouth during a conversation, sneezing, coughing will not fly apart. And you will no longer rub your nose with your hand and transmit this virus. Masks, then regular hand washing - after each touch of foreign objects. The distance during a conversation should be about three meters. Simple things save lives: distance, washing hands, wearing a mask, processing those items that you bring into the house with some kind of disinfectant, even with ordinary vodka to wipe objects that other people have touched. And this will already be a guarantee that this virus will not get to your mucous membrane and into your body.

- Since April 1, funding for various programs has been closed.

- During such a situation, re-profiling hospitals and closing some departments, especially infectious ones, is a crime. I know that in the committee 9 out of 10 people voted to continue the reform on April 1. I do not think this is correct. I do not understand this motivation. This is my personal opinion, as a doctor with 30 years of experience, a medical practitioner who knows how this will end. If such a reform entails a failure in medical care, we will lose tens of thousands of people. What does it mean to close a district hospital in the north of Sumy region, where there is 100 km between district hospitals? If such a hospital goes bankrupt tomorrow, the local authorities are not able to keep it on their balance sheets - they are subsidized. This is a crime for today.

Related: Zelensky asks Chinese government to provide Ukraine with extra medical aid

- If you were to lead the industry today, your actions?

Ukrainian cardiac surgeon
Open source
- Over the past three years, such destructive work has been done at the legislative level that I will not envy today any minister who came to this chair. What radical steps can the minister take today if the laws are passed and the minister is the executive branch, he must put these laws into practice? And if the parliament determines that from April 1, everyone will switch to self-financing and earn their own money for salaries, for communal services, for washing, for food, and canceled all the subventions that previously financed these hospitals, what can the minister do today? The Minister may ask to repeal this law on autonomy, having experience behind him and responsibility for people's lives. With the Ministry of Finance, it is necessary to work out the restoration of subventions that were before. Of the 80 billion gold and foreign exchange reserves, today it would be necessary to allocate at least 10 billion for the resuscitation of medicine, to throw this amount in order to really overcome the coronavirus. Provide antibiotics, antiviral drugs, devices. To make a special program for training specialists, today it is necessary to develop a unified protocol for the treatment of these patients. In the regions, ambulance crews need to be equipped so that patients with high fever do not go to the family doctor and do not infect everyone else, and specialized ambulances in anti-plague suits should come to such patients, as in China, to do an express test on the spot. And if it is confirmed, isolate this patient and the people that are already infected. These are the steps that we should have taken three months ago when we looked at what was happening in China. For three months we reported that we have 3 thousand beds in infectious diseases hospitals. But no one thought if there was oxygen, air pressure, in order to connect a servo fan, whether these people even know how to do something to resuscitate these patients. We lost three months, knowing that this scenario could be just like in China, and we practically did nothing. Today it is necessary to raise the question in order to implement the law on the financing of medicine within 5%. Yes, we have a war, there are some priorities, but in the Constitution the only priority is the life and health of our citizens. Follow the law, which was adopted and which is not being implemented: 5% must be allocated from the budget, and under quarantine conditions some other part must be allocated from the reserve in order to pay off at the very beginning. Today we are not ready yet, most hospitals are not ready to accept (if the Italian version is suitable) such a number of infected patients. This is what needs to be done within a week. And after that, you need to engage in systemic education, you need to restore the prestige of doctors in terms of salary, and all other things. And build a strategy for the development of medicine. Indeed, in almost 30 years of independence, perhaps, individual state clinics, like ours, have been built, but we are exploiting the potential of the Soviet Union. And those who say "bad Soviet Union" today, and where are you being treated, guys? You are treated in Soviet hospitals, travel in Soviet cars, and we have trams from that time on. And people who graduated from universities in the Soviet Union are treating you. Therefore, there should be a development strategy both in terms of training and in terms of new technologies. Why haven’t a single university clinic been built in so many years? Private clinics are still developing in some way, but where are university clinics using the technologies adopted in Europe? That's what you need to do - a strategy for the next five years.

- On the Internet people advertise medicine on your behalf.

- These are scammers who use my name. Do not try to buy this rubbish! I applied to the cyber police. These resources are located in Russia, and they cannot reach them.

- People write that in hospitals they are sent on unpaid leave for the period of lockdown. Is it legal?

- It’s illegal.

- Is there an option that coronavirus is very beneficial for someone, in the sense that you can forget about everything systemic?

- The problem of coronavirus exists on its own, and the fact that some political issues are superimposed on this problem is also present. As in any business, there are certain speculations, economic interests that join in with any panic and with any fears. In the poorest medical country, 7% is allocated for medicine. In the richest these are 13%. In Europe, the Institute of Family Physicians has been operating since the postwar years. And family doctors in Europe are not like our family doctors. These are highly specialized, trained people, with good support, with their outpatient facilities, with an extensive network, with very good computer support, with state support, etc. This system has been formed for decades. We want to quickly copy all this on our 2.9% in the Ukrainian budget and introduce European treatment standards. We want to wrap what we have today in a beautiful wrapper. Why is this done? We have already felt the results of this reform.

- How much funding do you have?

- There are absolutely clear numbers. We developed tariffs 10 years ago. Updated them two years ago. According to the results of the Accounts Chamber, which has been working with us for several months, we are financed by 29% of the total required amount of funds. They give us UAH 230 million a year (8,2 million USD), of which more than 100 million goes to salaries, about 20 million to utilities, and we can spend the rest on medicines, equipment, maintenance, washing, ironing, updating what’s already breaking down for repair.

- And where to get 71%?

- Unfortunately, patients are forced to buy a lot of medicine that is spent on their treatment, and so on throughout the country. Patients buy the most expensive supplies that are needed to treat them.

- They say that if someone from rich people is being treated in a clinic like yours, then they make expensive gifts, repairs, for example. Do you have people who helped and removed some kind of problem from your institute?

- Now there are six cars in the clinic. Ambulance is a gift from one of the oligarchs. A car that carries blood is a gift from one of the oligarchs. The tractor that cleans the snow is a gift from the oligarch. A lot of equipment that we have not received for many years is gifts from rich people. More recently, Vadym Novinsky gave us a new angiograph, which costs about 20 million UAH (715 000 USD), because of the four angiographs, we have two.

- And how can this be taken to balance?

- We draw up a tripartite agreement: the payer, we are the receiving party, the selling party. They buy and sell to us as charity, and we put it on balance. In recent days, several wealthy people who do not want me to give their names have been given two breathing apparatus. Today they brought an anesthesia machine, in which we have long had a need.

- And what about the state?

- In the first reading in the parliament, 300 million (10.7 million USD) for equipment was promised for us, because for 13 years we had not updated the equipment. Since its opening, our equipment has depleted its resource both in time and in hours of operation. In the second reading, this money disappeared somewhere. They explained to me that there is no money in the state today. But there are 700 million from the budget for bonuses to someone. I was shocked when I saw that two people who work for a state-owned company received 700 million bonuses. These are three annual budgets of the Heart Institute, which makes 6 000 heart surgeries per year, the most difficult. Last year I did 700 heart operations personally and saved 700 Ukrainians - I did not deserve it?

- You probably knew every head doctor in every regional hospital?

- When I was the chief heart surgeon, for several years, I traveled to each region twice a year. Every Friday - it was a trip to the regional center, and I knew all heart surgeons in all areas and operated on in almost all centers.

- Now where are these people?

- It is impossible to retain good specialists in Ukraine with the tools that the government uses today: neither nurses, nor doctors. The most talented, the young leave in thousands. In three years, 15 trained doctors left the Heart Institute and went abroad. From our successful institution, which works according to European standards, 15 trained specialists with an experience of about 10 years have left.

- How much does a qualified specialist get at your institute?

- Candidate of Sciences, a cardiac surgeon who independently operates, receives 7 000 UAH (250 USD) of salary, working at 1.5 rates.

- I would like smart pharmacists to deal with medicines, and correct doctors to treat.

- In Kyiv, there is the Institute of Genetics and Molecular Biology, which, probably still has the potential to manufacture some kind of drug or vaccines. In fact, things like fighting epidemiological situations are systemic work. For example, smallpox vaccines are still being stored in America. In the event of a bacterial war, America can provide its entire population with vaccination within one day. They keep them, update, store them in special storage facilities. The state takes care of its citizens. And so in everything, not just for smallpox. There is no systematic work here, there are no statesmen who would think about this. In general, medicine has not been a priority for 30 years. We used the potential of the Soviet Union: personnel, facilities, equipment - most hospitals still have X-ray machines purchased in the USSR.

- What is the situation in pharmacies? How many fakes are being sold to people?

- I can’t give you an estimated opinion - I’m not an expert. I only know that in Ukraine there are practically no laboratories for the determination of bioequivalence, and everything that is produced and imported into Ukraine must undergo bioequivalence control, to what extent these drugs correspond to what is written on the package. There are no such laboratories today - there is no state control over what we import, manufacture and sell. And the issue of prices is a matter of morality. Japan is a prosperous country because there is morality. Because most Japanese families have a samurai code of honor on the wall. Serving the Fatherland is the first item in this code. But in our immoral society, laws do not work. And if a person earns today on the misfortune of other people, raising the price of masks 10-20 times, it is immoral. And I believe that this should be criminally punishable. To do this, there must be a state machine that must work. If today such people were shown on TV with words: “This man is profiting from the misfortunes of others,” probably someone would be ashamed, and someone would be scared. But for some reason, not a single such person has yet been shown on television. In the same way as many others that should have been shown. There are special services for this, which should be included at such moments and carry out their work professionally.

One thing has caused tears in my eyes today. Today I held a meeting with our nurses and told them that we were preparing for the worst case scenario. Doctors always talk on the worst-case scenario before each operation in order to be prepared for all sorts of troubles. And I tell them that if there is an Italian scenario, then you will have to work on a rotational basis - in fact, they already work on a rotational basis, for four days each. You do not have to go home, we will arrange your meals here, transport. Several dozen nurses sat, and no one asked me a question: how will they pay us for this, how will they compensate, what will be the preferences, bonuses? There was only one question: can you provide us with some food if we live here for 4–5 days so that we do not starve? This is how doctors behave today in Ukraine. No one said that he would not work with infected patients for 3 000 hryvnias (108 USD). They only asked if we could feed them at this time.

- Once again, please tell the citizens of Ukraine what you recommend to do so as not to help the coronavirus spread?

- We need to break the chain of infection. You need to consider any person you come in contact with as a potentially infected person. The droplets that break from his lips fly about 2 meters. Keep your distance, make less contact with strangers in general. All you touch are potentially infected objects. Therefore, after any touch, wash your hands with any disinfectant. You can use vodka, if you do not have something stronger. It is better to use 70% alcohol. Ingestion of alcohol is not recommended - it reduces immunity. Protein food strengthens the immune system, so protein-free diets, vegan ones, fasts need to be canceled for the duration of the epidemic. Eat meat and protein foods - this enhances immunity. Maximum  physical activity reduces immunity, so limit the maximum load to medium.

A mask is required - in each person we see a conditionally infected person and limit handshakes and kisses with him. Wash your uniform more often if you work in some kind of work clothes, contact other people, and wash it every day. Do not touch your face at all - your hands are always potentially infected.

Minimum contact, mask, hand washing, distance when communicating with other people. If you cannot abide by these rules, at least put on a mask and, if possible, do not touch your face with your "dirty" hands.

- Thank you.

Related: Two new cases of Covid-19 observed in Ternopil region



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