How Alexey Navalny survived Novichok
By: Anna Deveaux
Tags: World, Politics, Navalny, Russia, Germany

How Alexey Navalny survived Novichok

The Lancet published a timeline of the clinical course of Alexey Navalny's illness. He is a prominent opposition leader in Russia, after recovering over a long period of time in Germany, Navalny returned home and was immediately thrown in jail.

Photo by Steve Harvey on Unsplash

Clinical timeline

On Aug 20, 2020

A 44-year-old previously healthy man became confused 10 min after boarding a flight in Russia. He vomited, collapsed, and became unconscious. The same day the patient had received atropine in the intensive care unit in Omsk, Russia.

31 hours later

German air ambulance medical crew had access to Navalny. The patient had a heart rate of 44 beats per min, a body temperature of 34,4°C, wide pupils. He did not react to external light, had intermittent muscle spasms. The treatment administered was sedation (propofol), lung ventilation with oxygen.

47 hours later

The patient was transferred by a German air ambulance. The patients’ condition slightly improved, with a slight heart rate normalization of 58 beats per min. Sedation was continued.

55 hours later

The patient arrived at the German clinic Charité deeply comatose. Initially, his heart rate slightly improved; however, the improvement did not last. His heart rate plunged to 33 beats per min. Body temperature was 33,5°C; he experienced excessive sweating and was not reactive to light; body spasms continued. Laboratory tests demonstrated a decreased level of pseudocholinesterase. The patient was started on atropine and obidoxime.

56 hours later

Within an hour of targeted antidote therapy, the patient cholinergic signs returned to normal.

80 hours later

The medical team stopped obidoxime administration. Atropine was continued for ten days.

120 hours later

Navalny developed a fever and was treated by a cooling system for nine days. He still exhibited muscle spasms, mostly in the muscles of the throat and abdomen. His sedation was continued for 15 days. Examination showed the dysfunction of neuromuscular transmission typical for cholinesterase inhibition. The patient was breathing via tracheostomy at that time.

On day 10

The patient’s body started to normalize the level of pseudocholinesterase. It’s value reached normal on day 20. Hemoglobin level significantly decreased, the patient was tested positive for multidrug-resistant bacterial infection.

On day 20

The normal level of Navalny’s pseudocholinesterase recovered.

On day 24

The patient’s lungs’ mechanical ventilation was gradually discontinued.

On day 26

Navalny gradually recovered from delirium and was discharged to a regular ward.

On day 33

A neurological examination showed a tremor. Neuropsychological testing in the Russian language showed subtle impairments in processing speed and verbal fluency, which had fully resolved three weeks later.

On day 55

Navalny was discharged from intensive care and followed a rehabilitation program for a period of 5 months.

On January 17, 2021

Fully restored and rehabilitated by German doctors, Navalny returns to Russia.

On January 22, 2021

Navalny is experiencing a falling vision of an unknown etiology in the Russian jail after surviving a nerve agent attack.