I am publishing a very important document that concerns everyone, but requires professional discussion within the medical community.
I urge all doctors to read it and share their opinion—publicly if possible, otherwise all of this will be implemented.
So, here we have an order from Alexei Khripun, head of the Moscow Health Department. There is no doubt that this document—which largely defines the strategy for combating the coronavirus—was approved by Deputy Mayor Anastasia Rakova, who oversees healthcare, and Mayor Sergei Sobyanin.
The essence of the order is that COVID-19 patients in hospitals will be discharged home for outpatient treatment if they get even a little better. At the same time, doctors are required to "ensure" the patient's voluntary consent to treatment at home.
I am by no means claiming medical expertise, but as a lawyer and politician I see the following problems:
It shifts responsibility for treatment from the doctor to the patient. Let's be honest: frightened, exhausted people—most often elderly—will sign a "voluntary consent" for anything a doctor asks them to. And then if they die—well, they asked to go home themselves.
We remember the first COVID-19 death in Russia. The woman seemed to be almost cured, was sent home, and died two days later.
Overall, this document replaces medicine and the doctor's judgment with an administrative order. There is a doctor, and that doctor decides whether to discharge a patient or not. The doctor bears responsibility for that decision. But now an order is being hung over them: any improvement? Discharge!
How are discharged COVID-19 patients supposed to continue treatment? Who will bring them their medicines, and who will pay for them? Will fully suited-up medical teams go from house to house delivering them? In 99% of cases, if a person has ended up in the hospital, they are seriously ill and have a whole range of other conditions. Those conditions also require treatment and medication. How are they supposed to get that if they have pneumonia and are explicitly forbidden from leaving home?
I do not understand what an "observator" is (a Russian quarantine observation facility). Where is its legal status even defined? What is it? A hospital where no one is treated? A prison pretending to be a hospital?
Overall, this all looks like a bureaucratic reaction to public outrage over the many videos of ambulance queues. Hospital beds need to be freed up, and the most primitive administrative method has been chosen to do it.
Of course, there is some sense in keeping in hospitals those who would die without hospital care, and sending home those who would recover without it. But what does "voluntary consent" have to do with this? This should be decided by a doctor, not by a minister and a mayor.
In short, it would be useful for everyone to read this, if only so they know what advice to give a relative who calls in a panic saying, "I'm really sick, and they want to discharge me—what should I do?"