Healthcare in Russia during the COVID-19 pandemic: challenges, systemic issues, and addressing priorities

The new SARS-CoV-2 (COVID-19) coronavirus pandemic has placed unprecedented strains on healthcare systems worldwide. How-ever, the Russian Federation has demonstrated a high level of preparedness to combat the COVID-19 pandemic. First, it was re-flected in the quick reallocation of resources toward the efficient provision of medical care for patients with COVID-19. To that end, temporary hospitals were set up specifically for such patients, and the existing bed capacity was reassigned. In addition, routing schemes for patients with acute respiratory viral infections (ARVI) and community-acquired pneumonia were developed and approved. Also, provisional rules were approved for recording information and maintaining an information resource to pre-vent the spread of COVID-19 using the unified state health information system. Furthermore, from December 2020, our country began a large-scale vaccination of the adult population against COVID-19, and from January 2021, mass vaccination against CO-VID-19 was started. The mobilization of the country's human resources to combat the pandemic and the timely communication of relevant clinical guidelines to physicians enabled an effective response to the challenges of the COVID-19 pandemic. The re-turn of the healthcare system to a normal mode of operation is a high priority at the present stage. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

CLINICAL FEATURES OF THE NEW CORONAVIRUS INFECTION IN CHILDREN

Currently it is about impossible to discuss whether children and adolescents carry the infectious process caused by the SARS-CoV-2 virus only in a mild and asymptomatic form. Ambiguous conclusions can be drawn from the reviewed publications of a number of recent studies in which children and adolescents with complicated course of the new coronavirus infection were under observation. More and more relevant are reports from scientists around the Globe about somatic symptoms that persist after the new coronavirus infection. The purpose of the study was to summarize and analyze the widely available data on the clinical features of the new coronavirus infection in children and adolescents in Russia and worldwide. The bibliographical research was carried out in the reviewed periodicals' databases as follows: PubMed, ScienceDirect, Cochrane Library, Google Scholar, eLIBRARY, and CyberLeninka. The keywords for the search were as follows: COVID-19, children, clinical features, clinical symptoms, post COVID syndrome, long-term symptoms after SARS-CoV-2, physical and mental health, new coronavirus infection, clinical manifestations, cognitive impairment. The reviewed period of publications screened: 2020 to 2022 (to date). In total 152 sources were analyzed, from which 60 most representative studies were selected, that in its turn provide data on the clinical features of SARS-CoV-2 in children during different periods of the disease, starting with the onset of the disease in different age groups. Children are as vulnerable to the SARS-CoV-2 infection as adults but more frequently suffer from the disease in mild forms. The main clinical manifestations during the acute period of COVID-19 in children are as follows: fever, respiratory symptoms (rhinorrhea, nasal congestion, cough, shortness of breath), gastrointestinal manifestations (nausea/vomiting, diarrhea), signs of sensory impairment (anosmia, ageusia), arthralgia/myalgia, weakness, fatigue. At the same time the new coronavirus infection can rapidly progress in a severe/life-threatening form in some children that would require intensive care and respiratory support. In addition, the aggravated comorbid background in the anamnesis of severe/critical cases has a significant value. The cardiological and neurological pathology has a special prognostic value as well. A number of publications have proven the indisputable fact of long-term COVID-19 symptoms in children. According to a number of studies more than 70% of those who recovered from COVID-19 complain of one or more symptoms after the end of the acute period of the disease;in some cases, these complaints can persist for up to 10 weeks, and even up to 6 to 7 months after the recovery (in a number of cases described). The prospect for the in-depth study of the course and consequences of COVID-19 in childhood will provide an opportunity to obtain a clear view on the most frequent clinical features of the disease, factors predisposing to the development of severe/critical/life-threatening conditions, and would allow to develop the clear-cut treatment and prevention algorithms. Copyright © 2022, Pediatria Ltd. All rights reserved.

The calling a doctor in: what an optimal model can be? (publications review).

The primary health care represent the most common segment of medical care in many countries and provides prevention and treatment of diseases, dynamic monitoring of patients with chronic diseases and medical rehabilitation. There is substantial shortage of health personnel to meet health needs all over the world, especially in primary health care. The COVID-19 pandemic exacerbated this problem. It changed workload in primary health care and demonstrated need for new organizational solutions to increase access to primary health care. One of the new transformations in general practice can be redistribution of medical work in primary health care. In this research, five options for organizational models of primary home care were identified. We used "performer (doctor / nurse)", "payment method for the home visit", "frequency of patient visits per week" as indices. There is lack of unified approach in the way how home visits are organized so optimal organizational model of primary home medical care is needed. This will increase access of most demanded type of medical care and ensure rational use of human resources at the primary health care level, especially during COVID-19 pandemic.

Remote monitoring of chronic noncommunicable diseases: potential in the COVID-19 pandemic

Aim. To review the current progress in the use of remote health monitoring (RHM) technologies for chronic noncommunicable diseases (CNCD). To search for data, we used Web of Science, Scopus, Russian Science Citation Index, Academic Search Complete (EBSCO), Cochrain, and PubMed databases. The date range was 5-10 years. The importance of development of RHM technologies and their further study was shown to confirm the evidence of effect of certain RHM systems. New approaches to the integration of the medical community into the international telemedicine strategy are considered. It was established that RHM can potentially decrease treatment costs and reduce the burden on medical organizations. The review analyzes the experience in using RHM in patients with cardiovascular diseases, as well as respiratory and endocrine disorders. The review also summarizes and systematizes the findings of studies on assessing the effectiveness of RHM technologies in clinical practice, including their use in the COVID-19 pandemic. It is noted that despite high interest of the scientific community in the study of RHM technologies, unambiguous results demonstrating the effectiveness of such developments in clinical practice have not been presented.