Rafael Shavaliev, chief physician at Republican Clinical Hospital: “We've just learned to live with COVID-19"
How the hospital is finishing the pandemic year, what kind of vaccine it got, and what the “neurocovid” is
In the near future, the Republican Clinical Hospital of Tatarstan expects the delivery of a coronavirus vaccine. This was reported by the chief doctor of the Republican Clinical Hospital, Rafael Shavaliev. The head of the clinic also told about the work of Covid-19 units during the deteriorating coronavirus epidemic and the seasonal growth of viral respiratory infections, unusual complications of COVID-19, which the doctors themselves could not avoid, and about innovations in treatment, despite the difficult situation.
How it is easier to cope with the illness and what “neurocomic” is
The chief doctor of the Republican Clinical Hospital admitted that he had recently had a new coronavirus infection. Sleep disorders and stress failed, so his immune system failed.
“I got sick myself because I didn't sleep for two days — I had a difficult patient. We need to get enough sleep, prepare our immune system — there is no other option. The main way to strengthen the immune system is a healthy sleep, good balanced diet, and most importantly — do not panic," says Rafael Shavaliev.
Another tip on how to protect yourself is not to neglect masks, since it has already been proven that the main method of infection occurs through the respiratory tract. The doctor advised to protect the respiratory system, wash the nose more often — the virus enters the body through it.
Another key to quickly and easily overcome the disease is early diagnosis: if you feel a sore throat, malaise, it is better to immediately do a test for coronavirus, says Shavaliev. Doctors of the Republican Clinical Hospital working in the fight against Covid-19 already have proven treatment technologies and necessary drugs in their service. If measures are taken in time the first two days after the malaise, then the progression to severe cases are excluded, he stressed.
Having been studying the course of the disease since the spring, doctors of the Republican Clinical Hospital came to the conclusion that the new virus mainly affects blood vessels, and their dysfunction in turn affects the normal functioning of other organs, including the brain — the so-called “neurocovid” develops (neurological complications of COVID-19 — editor's note).
“It is depression, aggression, and other behavioural manifestations," explains the chief doctor. “For example, I get a call from relatives of a sick person and say: 'You do not approach the patient' — 'Why? We do. I go into the “red” zone, approach this patient, say: 'Hello. How are you doing?', he looks at me: 'Good' — 'Are you receiving treatment?' — 'Yes, I am.' I go out into the corridor, call his relative, and suggest that he contact this patient now. He immediately gets a call, and he says that no one came in, nothing is being done. Five days later, he recovered, then worked with us as a volunteer and helped us. That's the situation.
Loss of sense of smell can last for months
What is the most unusual manifestation of Сovid-19 that the doctors of the hospital had to face, the journalists asked. According to Shavaliev, a very serious complication that is difficult to stop is blood clots in the heart and damage to the renal vessels. Colleagues-heart surgeons from the Interregional Clinical and Diagnostic Centre also joined in solving this problem.
“I myself, when in the “red” zone, my mission is only explanatory, because the neurocovid is so acute. For almost every patient who goes into the second phase (the first phase is the penetration of the virus, fever, sore throat, that is, regular viral respiratory infections), you do not know how the disease will continue. Now, however, we have learned to predict which scenario the disease will develop.
According to the chief doctor of the Republican Clinical Hospital, in the entire history of the existence and study of viruses, there has not been a single infection that would so damage the function of smell in humans. . . Interestingly, the cells themselves remain intact, but the interaction of different areas of the brain is disrupted. One of our doctors has been ill for three months and has recovered, but he still perceives odors differently — not the same as before Covid-19.”
The coronavirus pandemic has made its own adjustments to the development of the so-called medical tourism. Those who come to the Republican Clinical Hospital for treatment from other regions have become much fewer. But if earlier they came just for a check-up, today patients are purposefully going to a certain doctor or doctors.
“We have very good surgery, arrhythmology, neurology, cardiology, we are strong in multidisciplinary approach. We have all high-class specialists gathered in one place. The other day a patient came from Irkutsk, he is very ill. Our 15 specialists looked at it and found the primary source of all diseases — the lack of one enzyme in the liver leads to changes in the entire body: gout, myocardiopathy, respiratory problems, and so on. These cases are targeted, and here we do not pursue the goal of making money — we need to help the person who came here for this. We mainly work in this direction on weekends, since these are extra-budgetary sources.
Innovations in treatment
Despite the difficult situation with Covid-19, the clinic continues to study new medical developments and introduce innovative treatment technologies. The Republican Clinical Hospital continues scientific and practical activities in many areas of medicine. The Covid-19 hospital employs only a fifth of its staff, while the remaining three thousand doctors are busy with their immediate tasks. There are new developments in the field of endoprosthetics, abdominal surgery, endocrinology, doctors successfully cooperate with scientists of the Kazan Federal University. For example, last week the Republican Clinical Hospital worked on the introduction of a new technology for the treatment of urological diseases. Iskander Abdullin, a classmate of Rafael Shavaliev, talented doctor and one of the leading Moscow urologists, introduced the innovative method to doctors.
“We are actively developing endoscopic technologies for diagnostics and surgical interventions, that is, large, complex operations on the stomach or intestines are now performed using laparoscopy — this is subtotal resection of the stomach for tumors and obstruction, large operations on the large intestine. The treatment methods themselves have not changed: if there is an obstruction, then it should be eliminated, if there is bleeding, then this area should be removed, if it is impossible to stop it. But previously, all this was done with large cavity incisions, but now we are moving away from this in order to ensure a speedy recovery and restoration of a person's ability to work. With scars, with commissures, a person will always be limited somewhere. This is a rather complex surgical intervention, when, for example, in the depth of the organs you need to link something together, sew it together. But we know how to do it.
Today, liver transplantation for Republican Clinical Hospital surgeons has become a routine process, the chief physician admitted, although not so long ago it was considered a unique operation. This year, 15 such liver transplants were performed, and a total of 60 transplant interventions were performed. All planned and urgent operations that were performed in the trauma centre, which is now converted into Сovid-19 units, are also performed.
“Covid-19 isn't bothering us. We've just learned to live with Covid-19 because the big problem now is the post-Covid-19 story. Covid-19 is Covid-19, it passed, but the trace remains in the form of damage to blood vessels, lungs, nervous system — they then, after some time, can make themselves felt, after a month, two or three. We now need to learn how to monitor these patients — we need to conduct a medical examination for them.
Due to complications after coronavirus, special attention is paid to the rehabilitation of such patients, for which a rehabilitation unit and a third-level vascular centre have appeared as part of the Republican Clinical Hospital.
“We also accept serious patients, not only in the Interregional Clinical and Diagnostic Centre. The team led by Andrey Teregulov works very well on brain vessels. This is the son of Liliana Efimovna Teregulova. You know, I believe in dynasties. Why? In medicine, the most important component is motivation: you want to help, you feel that you are in demand, or not. You can easily refuse, saying that I can't do it, go to another doctor. And you can live like this all your life, not be responsible for anything, there will be no complications, ratings and statistics are great, but you will not try to introduce new methods of treatment — this is a huge risk. The dynasty gives you the opportunity to form a very early motivation to help others.
Republican Clinical Hospital is waiting for a coronavirus vaccine
In the near future, the hospital is waiting for the receipt of an anti-Covid-19 vaccine. Whether it is possible to say that a vaccinated person is protected and will not get sick is a question that is a concern to many people today. So far, there are no large randomised studies on the impact and effectiveness of the vaccine, said Rafael Shavaliev. Nevertheless, he believes that if you go through all the stages of two-stage vaccination, then yes — vaccination will help.
“The most important task of the vaccine is to develop and stimulate the body so that the body learns to synthesise its proteins. This can be done on carriers of adenovirus infection or other viruses. Americans are following the path of growing Covid-19 in other organisms and making a vaccine on this carrier.
Besides, you can protect yourself from coronavirus and other infections by strengthening the immune system, the doctor says: “Now we need to learn to live in the age of viruses, take care of ourselves and our loved ones. Immunity is an immunoglobulin, which in turn is a protein that recognises a foreign protein that enters the body from the external environment or foreign RNA. The important thing is good nutrition, immunoglobulin needs protein food. Healthy diet is a food rich in meat and fiber. Vegetarians and vegans are now at risk, they have a faster second, more severe phase of the disease. Because plant proteins are unable to compensate or substitute for animal protein.”