Inside Russias largest emergency room as COVID-19 deaths soar

For more than 200 years, Russia's largest emergency department has treated some of Moscow's most critically ill.

Its patients have included victims of the Napoleonic wars and deadly terrorist attacks in the 90s and 2000s. Now five floors of the Sklifosovsky Institute for Emergency Medicine have been turned into a red zone, where some 100 COVID-19 patients are cordoned off from the rest of the hospital.

Some are on oxygen. Others are on ventilators. But all of them are unvaccinated, says Dr. Yevgeny Ryabov, an administrator in the hospital's COVID department.

"This is some kind of indifference and, to some degree, ignorance," he told CBC News as he did morning rounds on Monday with a large team of doctors and nurses.

CBC was invited into the hospital's red zone this week to see how staff are trying to treat an unprecedented surge in infected patients â€" a deluge which one official described as a weight caving in on the health-care system.

Five patients are shown in an intensive-care unit at the Sklifosovsky Institute in Moscow. The youngest patient when CBC visited was 28. (Corinne Seminoff/CBC )

While the entire country has rolled out various COVID-19 restrictions, including a national non-working week and a partial lockdown in Moscow, it hasn't been enough to motivate half of Russia's adult population to get vaccinated, even as deaths have reached record levels.

Russia's national coronavirus task force has reported more than 1,100 COVID-19 deaths each day for the past week, but some in the health sector suggest it is a dramatic underestimate of the total loss and the scale of the ongoing crisis. 

Inside the red zone

Before doctors and nurses are allowed to enter the red zone at the Sklifosovsky Institute, they have to put on several protective layers, including a gown, hood, goggles, a respirator and two layers of gloves. 

The rounds on Monday started at 8 a.m. â€" earlier than normal because staff wanted to attend a memorial for a retired colleague who recently died of COVID-19.

In the past 18 months, this hospital lost 10 of its current and retired staff to the virus.

WATCH | A look inside a Russian hospital struggling with COVID-19 cases:

Inside a Russian hospital struggling with COVID-19 cases12 hours agoA CBC News crew goes inside one of Russia’s biggest hospitals as it struggles to keep up with COVID-19 cases. 4:17

"This is the most difficult, when you have to bury the people that you know very well," said Dr. Sergei Petrikov, the director of the Sklifosovsky Institute for Emergency Medicine.

He led a large medical team through each room, where they reviewed medical images and charts for patients in various stages of medical distress.

According to Petrikov, none of the patients in the hospital's COVID-19 ward right now are vaccinated. (Corinne Seminoff/CBC)

While some patients were sitting upright, hooked up to supplemental oxygen, others were lying on their stomachs in a prone position in an attempt to try to help their lungs take in more air. 

Several patients were on ventilators, and a few were hooked up to extracorporeal membrane oxygenation (ECMO) machines, which pump and oxygenate a person's blood outside of the body. It is known as a last resort when it comes to life support. 

The unvaccinated 

On each door, a sign listed the names and ages of the people in each room. 

While CBC saw some patients in their 20s and 30s, most in the ICU were older. Doctors said many had complex conditions, including suffering from heart disease and stroke.

Lydia Garilova, 74, said that she never bothered to get vaccinated because she spent most of her time at home alone. But she got sick on Oct. 11, and has been hospitalized since Oct. 19. 

"It's difficult. If I would've known before, I would have gotten vaccinated," said Garilova. "I did not think this would affect me … but unfortunately it did not just pass me by."

Lydia Garilova, 74, told CBC News she didn't bother getting vaccinated because she didn't think she was at risk, as she spent most of her time at home. (Corinne Seminoff/CBC)

Petrikov said he has heard plenty of reasons why some COVID patients didn't get the shot. 

"One of them said he was living in a forest … and nobody was near him. Now he is on mechanical ventilation," he said. 

"One man said that he had a special blood group and people with this blood group never get a COVID infection. Now he is on mechanical ventilation."

While Russia's Sputnik V was the first COVID-19 vaccine in the world to be approved for widespread use back in August 2020 and studies, including one published in The Lancet have pointed to its effectiveness, less than half of the country's 144 million people have been vaccinated to date. 

The vaccine is only approved for use in people over the age of 18 and, according to the website Gogov, which collects and publishes vaccination data from across the country, just 41 per cent of adults in Russia have received two doses. 

Vaccine hesitancy 

Despite the pleas from officials, along with incentives for seniors to get vaccinated â€" including a payment of 10,000 rubles ($175) â€" the country's vaccination rate is only increasing slightly.

Dr. Vasily Vlassov, a professor of health-care administration and economics at Moscow's HSE University, believes part of the vaccine hesitancy stems from the fact that the risk of COVID-19 was downplayed at the beginning of the pandemic.

A report done for Harvard's Nieman Foundation found that early on, state-controlled media in Russia covered conspiracy theories related to the virus. And even when the country entered a strict lockdown, much of the coverage showed how well Russia was handling the emergency, as new hospitals were being built.

In April 2020, during a video conference with Russian President Vladimir Putin, a health official boasted that Russia had one of the lowest mortality rates in the world, and the country sent ventilators and other equipment to Italy and the U.S., where hospitals were overwhelmed.

A woman receives a dose of Russia's Sputnik V vaccine at a vaccination centre in Moscow, on July 7, 2021. As the country battles a deadly fourth wave of infection, Russia's vaccination rate sits at just over 41 per cent. (Dimitar Dilkoff/AFP via Getty Images)

Most of the pandemic coverage in Russia hasn't been as devastating as other countries, Vlassov said.

When India experienced a deadly spike of infections earlier this year, he said the images of grieving families and funeral pyres were everywhere â€" but there hasn't been footage showing the scale of death in Russia during its current devastating fourth wave. 

Another big factor driving the low vaccination rate is distrust in the government and its domestically made vaccine, he said. "Unfortunately, trust in Russia is at a very low level; it is catastrophically low."

During Soviet times, there wasn't much hesitancy, as the national immunization program was mandatory and Russia was proud of its scientific research and vaccine development. 

But global health experts say part of the rise of today's anti-vaccination sentiment can be traced to a column published in a popular daily newspaper in 1988 that suggested "dirty" vaccines were causing weakened immune systems. 

Those arguments continued to circulate in Russia and still resonate with a portion of its population.

While Putin was vaccinated with Sputnik V, he didn't receive his shot until March 2021 â€" months after the vaccine was first available. And unlike many other world leaders, he was jabbed off-camera, behind closed doors.

Soldiers with Russia's Rosguardia, or National Guard, patrol Moscow's Red Square on Monday, Nov. 1, 2021. To contain the spread of COVID-19, Russian President Vladimir Putin ordered a non-working period from Oct. 30 to Nov. 7, with most state agencies and private businesses suspending operations. (Alexander Zemlianichenko/The Associated Press) Distrusting doctors 

Unlike in North America, where there is mostly widespread consensus in the medical community around the safety and effectiveness of COVID vaccines, a survey conducted in April by Russia's Levada Centre found just 70 per cent of doctors surveyed trusted Sputnik.

About a quarter of them said they weren't ready to get vaccinated. The survey also found there was less support for foreign-made vaccines.

But Vlassov was confident enough in the Pfizer-BioNTech vaccine that he flew out of Russia to receive it; in recent weeks, there have been several reports about Russians flying to Croatia and Serbia to get vaccinated. 

Vlassov said he believes that if Western vaccines were available in Russia, more people would be rolling up their sleeves.

Lack of transparency

Independent demographer Alexey Raksha said the Russian government might be able to convince more people to "take this virus more seriously" and get vaccinated if it were more transparent about the country's pandemic death toll. 

Raksha used to work for the state statistics agency, Rosstat, until he said he was forced to resign in July 2020 â€" in part because of publicly questioning Russia's official COVID-19 data in publications, including the New York Times.

He argues the data released daily by the national coronavirus task force is "distorted" and obscures the true toll of the pandemic.

Alexey Raksha, an independent demographer, said he believes there were more than 3,000 excess deaths in Russia every day in October. (Dmitry Kozlov/CBC)

According to official government statistics, just over 31,000 people died of COVID-19 in October, but Raksha calculates that the number is likely closer to 100,000 based on something known as "excess" deaths â€" a measure of all fatalities above an average baseline, not just those where COVID-19 was labelled the cause. 

Right now, he said, Russia's excess deaths are far higher than what's typically recorded. He says he receives his data from some of Russia's 85 regions, as well as from sources within government ministries.

A recent analysis done by Reuters shows there have been at least 630,000 excess deaths during Russia's coronavirus pandemic, up until September, while a separate analysis by the Financial Times pegs the number at more than 750,000. 

Meanwhile Rosstat has found 462,000 Russians have died from coronavirus and related causes since the start of the pandemic, while the task force, which reports deaths daily,  states just 203,000 Russians have died of COVID-19.

In Oryol, some 350 kilometres southwest of Moscow, health-care workers have also raised concerns that Russia's official statistics aren't matching what they are seeing on the ground. Paramedic Dmitry Seregin told Reuters that in just one day, 26 patients who died after having a COVID-19 infection weren't part of the city's daily statistics.

"I have a reason to assume that officials distorted the numbers and registered them during several days," he said.

State of restrictions

And even as COVID deaths continue to climb â€" 1,189 were announced Wednesday â€" the mayor of Moscow has said that the city's partial lockdown will not be extended past Nov. 7. 

The restrictions, which have been in place since Oct. 28, have closed restaurants and all non-essential stores.

Russia is currently in the middle of the government-ordered non-working week, though one other region, Novgorod, situated between Moscow and St. Petersburg, has announced the non-working days will be extended until Nov. 15.

A health-care worker assists Briar Stewart in putting on protective gear ahead of entering the Sklifosovsky Institute's COVID-19 red zone. (Corinne Seminoff/CBC)

Back at the Sklifosovsky Institute, Dr. Petrikov admits there are days when the hospital has to turn patients away and send them to other hospitals.

He said he believes vaccination is the only way out of the crisis and is disappointed more people aren't getting their shots. But he said it changes very little for his medical staff.

"It doesn't matter if they are vaccinated or not vaccinated," he said. "We do our work."

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