Infectious disease specialist Olga Golubovska: in Ukraine there is a prejudice to antiviral drugs - the only salvation of viral diseases

In an interview with UNN, Ukraine's chief infectious disease specialist, honored physician, professor Olga Golubovska told about the problems that medical professionals have to face every day and whether another pandemic awaits us in the future, as well as why Ukraine may not be ready to fight back. But we began our conversation with a problem that worries many people - antibiotic resistance, which our military is facing.

- The Time recently published a piece highlighting a superbacterium that has emerged in Ukraine as a result of the war. This bacteria eludes antibiotics. The article tells the story of a young fighter who had to have his leg amputated because no antibiotic could stop the infection from developing.

We always have a problem when it appears somewhere in the media. Naturally, this problem has existed for a long time.

- How long?

To begin with, this is a problem of global significance. Alexander Fleming, who won the Nobel Prize for the discovery of penicillin, said that microbes will adapt and if mankind does not learn to use his discovery correctly, we will come to the problem of resistance. This is an example of how much a person who knows his business can predict a situation. After all, against that backdrop of euphoria, when the lethality from bacterial infections actually declined so much that the then US Secretary of State generally declared that "the book of infectious diseases may be buried" (now quoted in many documents on antibiotic resistance), Fleming predicted the problem. He warned and he was right - bacteria are developing resistance to antibiotics, and faster than we can predict.

Pharmacology is evolving, new classes of antibiotics are appearing, including because resistance is developing, but it is moderate, let's say. Pathogens are adapting, and they are adapting faster than we realize and can appreciate. Pathogens are smarter than us in their ability to adapt.

So the problem of resistance is not something new. But it came to a head in 2009 when a mutation called New Delhi Beta Lactamase was first identified. Then a 7-year-old child in England died of a urinary tract infection caused by E. coli. After the death, an investigation was launched. It turned out that this E. coli was resistant to all but two antibiotics. But those two antibiotics were the ones that couldn't be used for the urinary tract disease. At that time it was a real shock to the scientific community, because this had never happened before.

- Was any action taken?

Yes. The World Health Organization has carried out actions aimed at reducing the use of antibiotics in medical practice, because we definitely have abuse, we know that. And at the same time, scientists began to study the reasons why this happened. And they came to some unexpected conclusions.

- Which one?

It turned out that the use of antibiotics in medical practice to treat people does not compare to the use of antibiotics in agriculture - a thousand times more of them were used than in medicine. A thousand times! In Europe, in 2006, they banned the use of antibiotics as growth stimulants in livestock farming. I am not ready to say how things are in our country, but something tells me that the situation is much sadder than it should be. And in 2011, the World Health Day was held, which is annually celebrated in early April, the day of the creation of the World Health Organization, and it was entirely devoted to the problem of antibiotic resistance. As a result of all the actions and measures, the use of antibiotics at the outpatient stage was reduced by about 25-30%. But the problem, of course, remains. The COVID-19 pandemic has brought a lot of negative effects to this situation. And infectious disease specialists say that the world of microbes has changed a lot. We now live in an era of viral infections - severe viral infections dominate. And all the recent pandemics are not caused by bacteria - they're caused by virus. And those pandemics that are predicted, the so-called "disease X" - all the predictions are based largely around viruses. And we don't have a lot of resources to treat viral infections, unfortunately.

- Antiviral drugs ...

We always say that if you want to save your life, use antiviral drugs. But they need to be administered in time. And we have opposition in society to their use, prejudice - they say they are toxic. Some fairy tales are told, which have nothing to do with the case, because only antiviral therapy helps. But to take an antibiotic - no problem. Drinking antipyretics is the same.  But to take antiviral drugs is a tragedy, they start blaming the pharmaceutical companies. And you just look at the side effects of antibiotics. Aren't you scared to take them at all? Or paracetamol. All over the world during the covida pandemic, antibiotics were used almost from the first day of the disease. Moreover, one does not help, let's add another, and when a person has already reached intensive care (because antibiotics do not work on the virus), it was already very difficult to treat. And it is still difficult even for doctors to break this paradigm. Yes, when a patient is already hospitalized in serious condition, when he is in intensive care and there is already a different flora - we were forced to use and combine various antibiotics, because the patients are seriously ill, and also receive immunosuppressive therapy for covid. And, of course, this also could not but affect the problem of resistance.

This problem exists all over the world. But we have another problem in our country - the problem of counterfeit medicines, counterfeit antibiotics. Perhaps it would be more accurate to say ineffective. There have been cases in practice when we use antibiotics and there is absolutely no effect. For example, we send a patient to Germany - we have had such cases with severe covid patients, with severe concomitant diseases - and they use the same therapy and there is an effect. Everything goes away, the person recovers. And foreign specialists themselves tell us that you have a problem, apparently, with the quality of drugs, or falsification. And now there is a war, a huge number of wounded. And these wounds are often burn wounds - it is much easier for bacteria to multiply in such wounds than in wounds that are open. And that leads to this being the biggest problem in the military right now. In the military, antibiotic resistance is the number one problem. And we have the problem of infectious diseases in the war has become very acute. And it's scary.

In addition to the New Delhi Beta Lactamase mutation that I mentioned, in 2015 another mutation was identified in microbes that determines panresistance to all antibiotics in general. And experts still believe, and I agree with them, that we could slip into a pre-antibiotic era. That would be a really scary phenomenon. The problem of antibiotic resistance that most people can't see is called this kind of silent pandemic. Complicating this all is the fact that there has been no new class of antibacterial agents for 20 years. Within the already known classes, new antibiotics are emerging, but there is no new class. They're just being developed now. So, yes, there is a problem.

- But it's not only Ukraine's problem?

No. The first mutation was found in Britain. The other thing is that this bacterium is rarely found. And experts all over the world are very afraid of the spread of this mutation. Now the world has changed, people are mobile, traveling around the world with their problems, including "spreading" resistance factors. For example, this is how New Delhi spread.

- What about the coronavirus? New strains have appeared - what is the situation in Ukraine?

You know, my opinion is that in general the problem with coronavirus has been solved. The problem remains only in the misunderstanding that antiviral therapy should be used - that is, there is a solution, there is a treatment. But in our country, no matter how many lectures and stories you give, everyone feels obliged to interpret the available international recommendations as they wish. Once a medical doctor told me that she is quite experienced, that she has been working as a pulmonologist for 19 years and she knows that in case of non-severe course of covitis only symptomatic therapy is used. I immediately have a question for these doctors who claim this. And how can they assess what the course of the disease will be, if the patient came to them on the first day or the second? They can only assess the patient's condition at that moment. Next, you have to understand, being a physician, that COVID remains by far the most understudied virus of the entire respiratory group, because it is recent. The most studied virus from this group is influenza, which is the most studied virus after human immunodeficiency virus. And that gives us surprises. Last flu season, hospital mortality was higher than covid mortality. Influenza, which has specific therapies. And covid is a poorly understood disease. The persistence of this virus has already been proven, that is, long-term persistence in the human body. A virus that induces long-lasting immune reactions that persist for months and may be the cause of the development of post-covidic disorders. There is already a lot of research that the early use of antiviral therapy, among other things, prevents post-viral disorders, you know? And experts around the world have concluded that antiviral therapy for covida is indicated for everyone in general. But, since the resource is limited, it is given first of all to risk groups. And here it is very important - the doctor must know the patient, control the peculiarities of the course of the disease and be able to assess the severity of the course - this is a big problem, because they often rely on the subjective assessment of the patient's well-being.  And we have different people: one complains endlessly and there is nothing serious, and the other and half-dead will not complain. Therefore, early prescription of antiviral therapy - only so. And it is impossible to create opposition to it in society. Only early antiviral therapy saves. This applies to covida and flu and everything that awaits us.

WHO officially warned at the World Health Assembly in 2021 that there will be a new pandemic. And if people realize that only antiviral therapy saves and see the effectiveness of such therapy, especially if it is applied on the first day, or better - in the first hours of the disease, then they will not need to take antibiotics, they will not need resuscitation, they will not need even antipyretics. And people, because of doctors misunderstanding the problem, are afraid of antiviral therapy. And it is necessary - only it saves. That's what the problem with Covid is - misunderstanding, and also in diagnosis - to apply therapy you need to diagnose.

- He's also "slipping away."

Yes, it can be difficult to make a diagnosis when the disease has an atypical course. How can it be diagnosed if both colic and flu start in the same way - with a rise in body temperature? For example, we need rapid tests. Test for both the flu and the covid. They can slip up, yes. But then already consult a doctor, if there are symptoms, and the tests are negative - then the doctor takes responsibility and makes a diagnosis. But I will say that we have a lot of patients with covida in different regions - there are regions where hospitals are full of patients with covida - and most of them have positive tests. If there is a virus, the test is more likely to be positive. But if there are symptoms and the test is negative - then you need a doctor to make a diagnosis. Moreover, by and large, if the test is positive, the patient does not need a doctor, unless he or she is a problem, not a risk group, of course. For example, in the US, licensed pharmacists are allowed to do a test when there is an increase in the incidence of either flu or COVID, and if it is positive, then immediately issue antiviral drugs. After all, imagine a family doctor who has 2 thousand patients, and the number of patients is growing and colossal, how can he listen to 200-300 people a day? I'm not even talking about examining them. This is not realistic. That's why I support this approach, it is what saves lives. A person immediately begins taking an antiviral drug and it gets better. But therapy should be started in the first five days of illness. The longer the use of an antiviral drug is delayed, the less effective it is, because the most dangerous period of an infectious disease is, as a rule, the first week, when there is no specific immunity yet. Severe COVID is an exception, all serious problems there, respiratory failure begin in the second week, but all these immune processes are also virus-induced. Therefore, it is necessary to eliminate the cause as quickly as possible - only by eliminating the cause, in this case the virus, will we solve the problem. And with this approach, we can prevent serious consequences for the body.

That is why I say that with Covid, the problem remains in the diagnosis and in the bias of the doctors. And another point is that everything has to be timely - and here it is the responsibility of the patient to apply in time, not to sit for 3-4 days with a fever of 38-39, especially knowing that they belong to risk groups. You can't do that - you need to seek help in time.

Early diagnosis in general is very important precisely for timely treatment, and this is the initial period, not resuscitation. It was very evident with covis. When oxygen was in trouble. Terrible things were happening - a person with respiratory failure was sitting and waiting to be connected to oxygen, when the bed was free... when someone died. And with timely use of antiviral therapy, when the drug is started in the first five days, we have almost 90% prevention of respiratory failure. I have a question, on what basis have we got such graveyards of patients? At the expense of simply erroneous recommendations of someone else? And it is not necessary, in my opinion, to graduate even from a medical university to understand that antiviral therapy should be started from the moment of the first clinical symptoms, not in the intensive care unit. This has never happened. COVID is the first disease that was started from the ICU. Never in my life have we ever had that at all. It's a big policy.

- Well, yes, these scandals that are going on now, both on vaccinations and recommendations...

Politicians should mind their own business. I remember politicians writing letters to the WHO regional office that we were buying unproven medicines. And these were the medicines that we had in the protocol. And there was no proven data at that time - and there could not be for obvious reasons, because the procedures for obtaining evidence are very long, and the patient is sick now. And how much our Minister (then Minister of Health Maxim Stepanov - ed.) got then, and all of us got to all the specialists. And then a year later all the evidence came, which shows significant survival from those drugs that were introduced in our protocol, and at least someone apologized, not even to us, the specialists, but to those people who lost their relatives and friends...

- Yes, a terrible period was, although, against the background of war and everything else, it appears that COVID was not so and terrible . But now another one attack appeared - West Nile fever. How did it get to Ukraine and why is it spreading?

I once consulted at a medical institution in Kiev. I was called to see a serious patient, and I diagnosed West Nile fever on the basis of clinical data, we already had experience. The doctors were very surprised, we have Dnieper, not Nile....

The BBC once made an excellent movie about this disease, as it was defined when it first "came out" of Africa in 1999 and appeared in New York City. Once upon a time, when it was discovered in the middle of the last century, the disease was really only sporadic on the African continent. When the disease was discovered and started to be investigated, serologic studies (methods of studying the interaction of antigens with antibodies in the blood serum - ed.) were conducted, the level of antibodies in the indigenous population was investigated and it was found that here in the West Nile River Valley the largest number of people have antibodies. They don't even get seriously ill. Up to 47% of the population somewhere in the West Nile Valley have antibodies, that's why they named it West Nile fever. It's caused by a virus and it was really characteristic of that region. But in 1999, there was an outbreak in the United States. And now that there's an increase in the incidence there, the services are spraying repellents and the police are alerting people to stay indoors for a while. Nothing surprising, and I'm not being facetious, as I'm sometimes told. It's not about hyping, it's about the fact that the U.S. has had some dramatic outbreaks of this disease and all the measures are aimed at reducing the risk of infection. One of these outbreaks was in '99 when people suddenly started dying. And there were over 6,000 people who got sick, and over 1,500 of them died. Everything happens in a short period of time - the disease is seasonal. Now the cold weather will start, the mosquitoes  will disappear, and this West Nile fever will disappear.

- That is carried by a mosquito?

Yes, it's mosquito-borne. It is carried by several mosquitoes, and we have them all in Ukraine. The Culex mosquito, which is widespread here, also transmits it. The natural reservoir of infection is migratory birds. They may not get sick. Although not only birds, but practically all mammals can transmit it. And some birds do get sick, especially crows. And I have seen reports and deaths of crows near Kiev. And people say that there are a lot of dead birds on the street - it's West Nile fever. One patient I counseled had several chickens die in her farm. This is already an epidemiologic history. In the USA in 1999, when they didn't know what was going on, the answer literally fell from the sky - birds started dropping dead and epidemiologists started to investigate, look for the causes and came to the conclusion that it was West Nile. One patient I consulted had several chickens die on her farm. This is already an epidemiological anamnesis. In the US in 1999, when they did not know what was happening - the answer literally fell from the sky - birds began to fall dead and epidemiologists began to investigate, look for reasons and came to the conclusion that it was West Nile. Although initially another diagnosis was mistakenly established, and in PCR - St. Louis encephalitis.

Now West Nile fever is widespread and endemic, that is, characteristic of the region, local almost throughout Europe. And in Ukraine before the war there were 20 foci of this disease. It was there before. And we used to diagnose it before. I remember back in 2018 from one private clinic took a young man. He came from Cyprus, there was a major outbreak in Europe at the time, and  he was diagnosed. So we have cases for not the first year, but now it is a lot - we have never seen an outbreak like this before.

- And what is it caused by? Heat?

Yes. Again, this is an example of evolution and adaptation of pathogens. The climate is changing, the immune landscape of mankind is changing, partly because of the coronavirus and everything that's associated with it. So we've become more susceptible to many diseases, not just infectious diseases. Unfortunately, you know, there's a surge in oncology being investigated globally, there's a lot of autoimmune diseases. And the pathogen immediately adapts. It's a virus. And viruses. Do you realize how nature works? The more highly organized a creature is, the less adapted it is to life in this world. And the simpler they are, like viruses, the scarier they are. Viruses are scarier to us than bacteria. Viruses adapt more quickly. Viruses generally occupy an intermediate position between the living and the dead - they come to life only in some organism. There are viruses that even affect bacteria - bacteria also suffer from viruses.

A virus is a nucleic acid with a shell that "comes to life" only in some organism. And viruses adapt very quickly, change their properties, gain aggressiveness, virulence, we call it, and so on. But an even simpler organization of pathogens, the so-called prions. If a virus is a nucleic acid, then prions are a sequence of amino acids that have infectious properties. And these are all 100% fatal diseases. They're all slow infections, kuru disease, for example.

As for West Nile fever, the outbreak is very serious, I believe. The disease is poorly diagnosed. A person is a dead end for the virus, and a person is not contagious, thank God, for others. That is, even if a mosquito flies in, bites a sick person, then a healthy person, the virus cannot be transmitted. This is the biology of the pathogen.

There is no specific prophylaxis, there is no vaccine for people. Only nonspecific, repellents, insecticides should be used, the breeding places of these mosquitoes should be destroyed, they should be eliminated. And we destroyed the sanitary-epidemiologic service, no one has restored it. Let them not tell tales, because the system of epidemiologic surveillance has not been restored, as it was. Its functions have not been transferred anywhere. Before that, entomologists began to be destroyed. They practically don't exist, people who deal with these vectors. So we don't know...

In the United States back then, in 1999, when they didn't know what was going on and not everyone even believed in the possibility of an epidemic in a city as prosperous as New York, but epidemiologists began to study what was going on. And what did they notice? That there were a huge number of mosquitoes that could be the vectors. Then they started doing door-to-door canvasses, asking owners of private houses to drain water tanks, draining ponds with standing water, providing everyone with insecticides. Gambusia fish, which eat mosquito larvae, were put into the sewage system. And so they significantly reduced the vector population. And that indirectly reduced the likelihood of getting sick.

And there was a very interesting story back then. One veterinarian was thinking about the fact that a lot of dead birds, back then even in the New York Zoo, birds were dying en masse, including exotic birds. And the vet decides to call  CDC - Center for Disease Control and Prevention and asks them to start investigating the mass deaths of birds in order to find out if they do not have a virus. And the CDC says no, we're dealing with people. You see, they also have such a division, which you cannot do - in the issue of biosafety you need a holistic, integrated approach, there should be an exchange of information. And then this veterinarian turned to the U.S. Army Institute of Infectious Diseases. She gave them a dead bird, and just a day later, a man calls her and says, don't refer to me, but I will tell you that it is West Nile fever. Everybody was in complete shock. By the way, this is a pathogen that belongs to the third group of biological hazard. This is a very serious group, and the last one is the fourth group, where the Ebola virus and biological weapons are. By the way, after the outbreaks in the US, every blood donor is tested to see if he or she is a carrier of the West Nile fever virus.

It's a very dangerous virus. It's more dangerous than covis. Unfortunately, there is no specific treatment, there is no antiviral therapy, no antiviral therapy has been developed, and there is not even a hint of antiviral therapy yet.

- And why in so many years nothing has developed?

Because what is being researched is what can generate a lot of revenue. Look at what diseases we have the most researched. According to the World Health Organization, HIV, tuberculosis, malaria, and now viral hepatitis are declared global problems of mankind. Because there are a huge number of people sick around the world. There are a lot of drugs being researched, and all of them are good, these drugs are wonderful. But for such pathogens, you have to spend a huge amount of money to study something, and there is no such profit. That's why they don't do much research.

But the good thing to say is that a huge number of people are not seriously ill. That is, we simply do not diagnose them at all. A person may just have a fever and malaise. There are people without catarrhal syndrome, without anything. It's a mild form. There could be conjunctivitis. Very rarely respiratory syndrome. And only about one percent develop the most severe form of the lesion. We call it the neuroinvasive form. It's very severe, actually. There are several variants. And we already have methods, although there are no recommendations on treatment, nothing. But we have worked very quickly. And we have very good treatment results. There are cases when a person enters a brain coma, but we have good results of therapy here too - the main thing is to start treatment quickly, not to wait and not understand what happens, and then only call a specialist-consultant. No! Right away. Infections, any infections, should be treated immediately, if there is etiotropic therapy, if a person is in intensive care, emergency condition, it is necessary to treat immediately and get an answer immediately. If there is no response, you have to change the therapy and make it happen. This is the only thing that helps.

- Your prediction, that concerns smallpox monkeys. Is it a future pandemic?

There will be a pandemic 100 percent.

Regarding monkeypox, in March 2021, NTI, an international non-profit organization funded by Bill Gates and Ted Buffett that works to prevent possible biological threats, held a fictional exercise in conjunction with the Munich Security Conference. And the "legend" of the exercise was a pandemic of smallpox in monkeys. And the results were published on the NTI website. According to the scenario, it started in the fictional country of Brinia in May '22. Then there were four waves and the final result was a pandemic 10 times worse than covid. And in May '22 there was an outbreak of monkeypox in Britain, and the first two waves went exactly like that scenario. But I don't want to talk about conspiracy theories. No. I was once asked about the coronavirus, whether it was artificial or not. I'm not a microbiologist. I send everybody to Luc Montagnier - Nobel laureate, discoverer of HIV infection (hypothesized the artificial origin of the SARS-CoV-2 virus - ed.). He had many studies during his lifetime, many students all over the world - why can't we trust him?

But as a clinician, I think we have to go with what we have. There are things that we cannot influence in any way, but we have to be prepared. There have been cases of monkey pox in Ukraine, we had such patients, yes. It's a very unpleasant disease, unfortunately. But, by the way, surprisingly, but the CDC  immediately wrote a protocol where 4 drugs and 3 of them are antiviral drugs without a single study. It's a very interesting situation. I ask, couldn't that have been done under covid? We were required to prove it. When people were dying in droves, we needed proof. Without proof, we won't treat. You know that I am the founder of evidence-based medicine in my field. But that phrase, "evidence-based doctors," I find it terrifying. Because it makes me want to ask them, what do you mean? Is it that when there is evidence, you are a doctor, and when there is no evidence, you are not a doctor?

There are situations where evidence-based medicine cannot be applied a priori. The first is when there is a new pathogen, because as an infectious disease specialist, I know that every one and a half to two years there is a new pathogen in the world. It can be regional, like the Zika virus in Brazil. It can be old, like Ebola, but acquire new forms, for example, in West Africa cannot still overcome the Ebola epidemics. Do you understand? So I know that new things are emerging. And if there is a new global... And we were officially warned about the pandemic in 2018, they said that a new pandemic was waiting for us, caused by an unknown virus. And at that time we had the SES collapsed. You remember, we met the pandemic without a chief sanitary doctor. And we lost specialists. And now in 2021, they have officially declared at the global level that there will be a pandemic. Therefore, we can only be prepared - write a treatment protocol that will be based on the opinion of experts who understand the patterns of the infectious process.

By the way, thank God, all the pandemics that we have had have come to us, not started here. Therefore, when it comes to us, we already have the experience. And when we had Covid, we did not invent the protocol from scratch - we took the developments, we took those methods that have shown their effectiveness. For example, tocilizumab - first it showed its effectiveness in China, then in Italy - they widely described it, because it is a more open country. And it became clear that this is a drug that saves people. And we also included it in the protocol, and then we found deputies who complained to the WHO that we were buying unproven drugs. Do you understand? And how could it be otherwise at that moment? A year and a half passed and WHO recognized this drug.

- And did deputies, when sick with covid, call you?

When their parents and relatives were ill, they applied. I saw that they were uncomfortable, but their relatives were sick, they were sick themselves. But we have never discussed (statements against doctors - ed.), we have never discussed these issues. But nobody apologized either. No. Frankly speaking, I don't demand an apology. I'm somehow used to solving my own problems in life.

- But I remember this period of bullying...

This was bullying at its finest. Manipulative.

- And yet they came and without starting with an apology asked for help?

You know, I'm the kind of person who can pretend I don't know. And there's a good saying that apologizing by itself doesn't solve the problem. And, you know, journalists are often servile. I remember recently, by the way, there was an order when I was advocating for the treatment of hepatitis C. You remember, don't you? When under Suprun our patients were deprived of hemodialysis the only possible treatment, and then they pinned on me some conflict of interest, which I did not have. And they inflated this conflict of interest, not the problem that they deprived hemodialysis patients of treatment.

- Substitution of concepts.

So, I know that there was an order for a fairly well-known program, I won't name it, and a journalist came to my office. I am always open and happy to try to convey my point of view, including through journalists. Another thing is that I realize that my words can be manipulated, but I do what I think is necessary professionally. There is a good expression sapienti sat - enough is enough for the intelligent, someone will understand. And when I began to explain the problem, I saw that he was very uncomfortable, just ashamed to be in my office. And as he did not provoke me with different questions, I gave him answers to all the questions. And then the program came out. They still mentioned me in some line. But what they wanted to stir up didn't happen, because there was no real subject. [...

But I am more surprised, to put it mildly, by our deputies... There are some boundaries! You are, after all, people's elected representatives. This is not about whether you stole something or not. We're talking about hundreds of thousands of people's lives that you forbid to treat with your laws. I don't know if it's ever happened in the world, but we had a coronavirus pandemic. I do not remember such a thing at all in my life, that these bans were at the level of politicians. But we were very much supported by the National Security and Defense Council, and I want to thank them. They supported us in this story with the protocol (of treatment - ed.). You remember this story with the protocol, don't you? When it was impossible to withstand these mass deaths, instead of developing treatment methods that were available in the world and approving the protocol, everyone ran and bought breathing apparatuses. And the unfortunate doctors were slapped on the wrists for secretly prescribing life-saving drugs that were prohibited, and they prescribed them to save your lives, the lives of your family and friends. Do you understand? And at some point, no matter where I turned, no one heard, no one saw... And then I was forced to record a video message. And I am grateful to your publication for publishing it. Although at that moment I did not know how it would end for me. But there was no other way out. And it was no longer possible to endure these deaths...

Chekhov has a phrase: "A doctor has disgusting days and hours, God forbid anyone to have them. It is true that among doctors, ignoramuses and boorish people are not rare, as well as among writers, engineers, and people in general, but those disgusting hours and days of which I speak, happen only to doctors. For this, speaking in good conscience, they should be forgiven a lot". Do you understand? I even tell my students that when a patient will die in your arms and you will realize that you did everything you could to save the person, but you will still recheck, look, search - maybe you could have done something differently? Maybe there is something new. And you remember mostly not those you saved, but those who died, who you didn't save. No one can escape that. A doctor can't look at death calmly. We cried, especially when our colleagues were leaving... You have to be a scumbag to look indifferently at this cemetery of patients... But these office workers - for them it's just numbers. That's probably why they allow themselves such things.

Back to your question about a future pandemic. There will be one. Whether it will be monkeypox or not, I don't know. But there is already a treatment protocol for smallpox, and it includes antiviral drugs. The other thing is that we don't have those drugs. That's a problem.

- Future flu season, what will it be like?

Usually, if it's been a really rough season, the flu gives us a few years off. Usually. But we'll see. Last flu season was really bad. But we can get something without the flu. And now infectious diseases have changed. So we need to be prepared. But perhaps I will repeat myself, whatever anyone says about our medicine - our doctors are good, medicine is not as bad as some people say.