In the 12 days that Vyacheslav Semenenko spent at a Lviv emergency care hospital receiving treatment from COVID‑19, he saw six people die and two taken to the intensive care unit.
Of all the people with whom he shared a five-bed hospital room, he was the only one who recovered during this period.
“A person dies, they are taken away, and in 20 minutes a new patient occupies the bed,” Semenenko told BBC Ukrainian after a Facebook post he wrote about his hospital experience went viral.
He described how five patients shared four oxygen concentrators, and sometimes patients from other rooms were brought in “to breathe.” Exhausted nurses and medical assistants were far outnumbered by patients and struggled to attend to every one of them. Moans and cries of pain could be heard everywhere, he said.
“Medical personnel do everything they can. Twenty-four hours on the run,” Semenenko said. “But they can’t help everyone. There are too few of them.”
As Ukraine continues to grapple with COVID‑19, the situation Semenenko saw in Lviv is not unique. More hospitals across the country are struggling to treat the soaring numbers of severely ill patients. They report shortages of beds, oxygen and medical staff.
Since the beginning of November, around 1,500 people have been admitted to hospitals each day. For two days in a row, Nov. 18 and 19, the country recorded a record number of fatal cases, bringing the total death toll in Ukraine to 10,369.
According to amended state protocol, only patients with severe or extremely severe forms of COVID‑19 confirmed by a PCR test are subject to hospitalization.
And getting into a hospital is becoming harder.
Kyiv resident Oleksandr Kondratenko told the Kyiv Post that his elderly mother, who had a high fever and pneumonia, spent two days in the corridor of a crowded city hospital alongside non-coronavirus patients, waiting for her PCR test result to confirm COVID‑19.
“The hospital’s chief doctor told me that infectious disease hospitals in Kyiv are all full, and those with confirmed COVID‑19 are transferred there as soon as a bed becomes available,” he said.
Kondratenko desperately searched for a vacant bed for her in a different hospital that took COVID‑19 patients. Four hospitals he checked were full. Then, his mother’s test came back positive and she was sent to the intensive care unit of a COVID‑19 hospital and was put on oxygen. On that day, Kondratenko said, he counted 17 ambulances lining up outside the hospital to drop sick people off.
A female medical worker holding a medical oxygen cylinder talks to a man next to a private ambulance vehicle outside of the infectious disease ward of Kyiv’s Oleksandrivska Clinical Hospital on Oct. 29, 2020. (Volodymyr Petrov)
Hospitals under strain
It’s not only patients who are struggling. Authorities admit that the medical system is under great strain.
“If nothing is done, by mid-December, the health care system will not be able to admit patients any more. There will be no space in hospitals, not even in the corridors,” Prime Minister Denys Shmyhal said on Nov. 11, before the government imposed a “weekend lockdown.”
Now, non-essential businesses must close on Saturday and Sunday. But in many big Ukrainian cities, local authorities are ignoring the measures. Few view them as effective.
According to the official data, 53% of the total 52,311 beds designated for COVID‑19 patients across Ukraine are currently occupied. Before the government increased the number of beds by repurposing more hospital departments or entire hospitals, the bed occupancy in many regions was over 70–80% by the end of October.
But adding hospital beds is not enough, doctors say.
There are shortages of medical workers and medical oxygen, which is vital for the survival of COVID‑19 patients who have low blood oxygen saturation. And the surge in demand has put a strain on the limited suppliers of medical oxygen.
Of all hospital beds for COVID‑19 patients, fewer than 20,000 are connected to oxygen pipelines or oxygen concentrators.
The government has recently allocated Hr 895 million ($31.7 million) for connecting hospital beds to an oxygen source. This money is being taken from the COVID‑19 fund — specifically, the larger portion of the fund that had earlier been allocated for road repairs under a widely criticized presidential project. Earlier in October, Hr 572 million ($20.2 million) were allocated for the same purpose and the government began licensing local producers of medical oxygen.
Doctors say it’s too little, too late.
While the lockdown in spring bought the Ukrainian government time and prevented the collapse of the unprepared health care system in case of a serious outbreak, many doctors feel more could have been done in the previous months to prepare for the new wave.
“All wards could have been provided with oxygen, and the ICU could have been expanded. This work is just beginning,” said Volodymyr Korsunov, who divides his time between working as an anesthesiologist at a Kharkiv Oblast infectious disease hospital and teaching at a medical academy.
“The reserve of medical personnel has not been prepared. Medical interns could be deployed nationwide and for a salary.”
The hospital where Korsunov works is exclusively designated for COVID‑19 patients and is overburdened. Originally intended for 290 patients, it takes between 270 to 300 patients on average. The situation is particularly bad in the intensive care unit. It has only 12 beds, but up to 40 patients need intensive care. Those patients are accommodated in general wards. For all of them, there are three anesthesiologists.
“The ICU is always full,” Korsunov told the Kyiv Post. “If a patient dies, the bed is occupied by a new one.”
Ivan Chernenko, anesthesiologist at Rozdilna District Hospital in Odesa Oblast, shares that sentiment.
“Early on, doctors and volunteers warned that there would be issues with oxygen,” he said. “It is not a quick job to build oxygen infrastructure. There are strict technical regulations.”
Chernenko’s hospital has a 45-bed COVID‑19 unit that, by current standards, is not yet critically full — it is only 70–80% occupied, he said. There are around 15 oxygen concentrators and an oxygen pipeline was installed in September.
Like Korsunov, Chernenko says the government failed to mobilize medical personnel. He also criticized its policy of opening COVID‑19 units in hospitals that simultaneously treat other patients. This stretches the staff resources thin, he said. Instead, it is better to turn entire hospitals into COVID‑19 medical centers and concentrate resources — oxygen and staff — there, he said.
For now, Chernenko and the three other anesthesiologists each work 48- to 72-hour shifts and cover for an infectious disease specialist who is on maternity leave.
“It’s very hard physically,” he told the Kyiv Post.
A medical intern from Sumy, who asked not to be identified by name, fearing reprisals, said that the 30-bed COVID‑19 ward in her hospital is so full that patients are housed in the bathroom.
“They want to open another ward. But they need to provide it with oxygen and find staff,” she told the Kyiv Post.
The intern works in a general ward, where medical workers receive neither protective gear, nor salary bonuses like those treating COVID‑19 patients. But they too are at a high risk of infection. All patients with clinical symptoms of COVID‑19 who test negative are admitted to their ward, next to people with other diseases.
The intern blames this problem on flawed testing that yields false negative results and long waiting times for a free test at state labs. To tackle delays and backlogs, the government began paying private labs for testing this month.
Over a month-and-a-half ago, she and the other five doctors in her ward contracted COVID‑19 allegedly from one such patient who had tested negative and later died. After the outbreak, her ward received masks.
Recovering COVID‑19 patients who are no longer considered infectious but still have breathing difficulties are also moved to the general ward. There is only one oxygen concentrator there and it is being shared, she said.
The government “could have done a lot over the summer,” she said. “They could have involved private labs earlier and supplied all hospitals with protective gear. All medical workers are at risk.”
Read more: Private, public labs struggle to keep up with testing demand
The billboard with a portrait of Ukrainian infectious disease doctor Ivan Venzhynovich seen on a street in Kyiv on Oct. 2, 2020. Venzhynovich died on Sept. 30, 2020. (Kostyantyn Chernichkin)
Compensation
Health care workers remain the single group most at risk of contracting the virus. Over 28,000 of them have been infected with COVID‑19 since the start of the pandemic. At least 258 have died.
Ivan Venzhynovych, an infectious disease doctor at the Pochaiv hospital in Ternopil Oblast, became an unexpected symbol of medical workers’ struggles during the pandemic.
Earlier this year, the Associated Press photographed Venzhynovych gazing out from behind a mask and face shield. Then, in May, his exhausted face appeared on billboards around Ukraine thanking medical workers for their service to the country.
But Venzhynovych’s story did not have a happy ending.
In late September, the 51-year-old doctor died from pulmonary embolism, or blood clotting in the artery of a lung, shortly after being hospitalized with pneumonia, which his colleagues believe was caused by COVID‑19.
Despite presenting all the clinical characteristics of COVID‑19, Venzhynovych tested negative. That rendered his family ineligible for state compensation of Hr 1.5 million (nearly $56,000).
So far, the families of 22 medical workers who died from COVID‑19 have received compensation ranging from Hr 219,000 ($7,780) to Hr 1.5 million.
Thirteen more families are on the waiting list. The Social Insurance Fund is investigating 111 other cases to determine whether a deceased medical worker was infected with the coronavirus at work.
Receiving compensation is not easy.
In late June, Cherkasy-based surgeon Ihor Haida lost his father, Oleh Haida, to pneumonia and respiratory failure caused by COVID‑19. His diagnosis was confirmed by a PCR test.
Two commissions established that the elder Haida had contracted the virus while seeing patients at a local polyclinic where he also worked as a surgeon. One of those patients appeared to have infected him with the coronavirus.
The Social Insurance Fund, however, filed an appeal in court claiming the evidence was insufficient. The legal dispute continues.
“They do not want to pay us Hr 1.5 million in compensation for unknown reasons (and they’re) hiding behind bureaucracy,” Ihor Haida told the Kyiv Post.
Read our previous coverage: Ukraine’s medical workers bear the brunt of the pandemic
Editor’s Note: The date and cause of death of Ivan Venzhynovych have been corrected.
