A Russian doctor warns in The New Yorker that it is impossible to know the real situation in a country that claims fewer coronavirus infections than Luxembourg. “But one thing we know for sure: the state is ready to manipulate medical statistics for political purposes.”
Joshua Yaffa, Moscow correspondent writes in The New Yorker:
In the past two weeks, I’ve observed from afar as various places around the world to which I have a personal attachment registered a grim uptick in coronavirus cases, and then, in response, effectively shut down. In Southern California, my mother was the first person I knew to self-quarantine; next were friends in Paris, who, in the span of forty-eight hours, went from eating lunch in cafés and planning a trip to Germany to hunkering down with their young children; then it was the turn of friends and colleagues in New York, where I lived for nearly a decade. During this time, Moscow, the city where I have lived for eight years, has felt like an unlikely outlier. Life here has definitely become stranger, but it is far from completely upended.
Vladimir Putin has offered general assurances that the situation in Russia is “under control,” and, although Moscow’s mayor, a Putin loyalist, has closed schools and cancelled public events, the daily ebb and flow of the city hasn’t changed all that dramatically. I’ve mostly stayed at home, but the metro is still running, and shops and restaurants are open. The luxury department store Tsum is having one of its best years for sales in recent memory. Half my friends are observing some form of self-quarantine; the other half doesn’t get what the fuss is about – or, rather, their employers don’t.
It is unclear whether the Russian state has been lucky, smart with preëmptive measures, or dangerously incompetent – or some combination of all three. In the case of incompetence, Russia’s seemingly small figures will soon be replaced by colossal ones. In recent days, I’ve spoken to doctors, epidemiologists, and patients, to try to get a handle on whether Russia will be the next Italy, with an overwhelmed public-health system, or Japan, with its relatively flat and steady growth curve.
It is possible that, without having planned for it, Russian society, which is not nearly as defined by shoulder-to-shoulder public mixing as many European ones, had some advantages in weathering the early phase of the pandemic. Russia shares a twenty-six-hundred-mile border with China, but its most populous cities have fewer and less extensive ties with China than do many places in Europe. (Russian–Chinese trade topped a $100bn last year, but much of that came in oil and gas deliveries, a very different type of contact than one finds in, say, the many factories of northern Italy with a large Chinese labour force.)
Russia is vast, with a relatively less developed transit infrastructure than European countries of similar populations. As a result, Michael Favorov, a doctor and public-health expert who previously oversaw CDC programmes in Eastern Europe and Central Asia, told me, “I wouldn’t expect a single outbreak in Russia but, rather, several, each with its own geography and developmental stages.”
It is also not impossible that Russia handled the early days of the pandemic with an admirable degree of foresight and care. In January, Russia shut down its land border with China. Beginning in February, passengers arriving to Moscow by plane from virus hot spots such as China, Iran, and South Korea were met by a phalanx of medical workers in protective gear administering tests.
People who came from Europe – before those flights were cancelled – had their temperatures taken and were sent home for a mandatory fourteen-day quarantine. I talked to three people who developed symptoms while they were waiting at home for their test results, and who were put into isolation wards in a hospital in a Moscow suburb – a measure in line with recommendations from the World Health Organisation to test and isolate. In theory, heavily policed authoritarian systems like Russia’s have a head start in tracking citizens – one man in Moscow, who had returned from Italy on the same plane as someone who later tested positive, was fined after cameras equipped with face-recognition technology caught him violating his mandatory quarantine by taking out the garbage. As I heard a political scientist acknowledge last week on Echo of Moscow, an independent, liberal radio station, “The fact that a certain regime is headed for a dead end in the long run doesn’t mean it may not have some advantages on the tactical level.”
Melita Vujnovic, the Word Health Organisation (WHO) representative in Moscow, recently told CNN, “Testing and identification of cases, tracing contacts, isolation – these are all measures that WHO proposes and recommends, and they were in place all the time.” As of this moment, Russia, a country of 144m people, claims to have carried out a 165,000 coronavirus tests in total, about half the number that were performed in the US.
Russia has fewer acknowledged cases than Luxembourg – and yet there is some evidence of a much larger outbreak of the coronavirus than the official statistics appear to suggest. According to Russia’s own statistics agency, the number of pneumonia cases in Moscow grew by 37% in January, compared with the same time last year.
Anastasia Vasilyeva, the head of the independent Doctors Alliance trade union, said, “It’s impossible to know the real situation, but one thing we know for sure: the state is ready to manipulate medical statistics for political purposes.” In 2015, Putin announced a drive to lower the death rate from cardiovascular disease, after which hospitals reported a year-to-year drop in death from heart-related illness – and a nearly equivalent rise in deaths from rare or unclassifiable diseases. Similar manipulations may be at work now.
On 10th March, a seventy-five-year-old man died at the hospital in Kommunarka. He had been undergoing chemotherapy treatment and recently returned from Italy. His cause of death was recorded as “adrenal haemorrhage” – meaning that his death was not formally attributed to the coronavirus. “We’ll never know the truth,” Vasilyeva said. “We can only assume.” On 19th March, a 79-year-old professor in Moscow died of pneumonia; initially, Russian officials linked her cause of death to the coronavirus, but later changed it to “blood clot.”
In recent days, stories about wards overflowing with pneumonia patients have circulated on Russian social media. As Vasiliy Vlassov, an epidemiologist and professor at the Moscow Higher School of Economics, pointed out, even if there is nothing to suggest that Russia is covering up a much wider outbreak, the country’s infection curve is just beginning. “For now, we’re way over on the left,” he said. “The question is, as it builds out to the right, will the curve be linear or exponential?” Vlassov also noted that, although official case numbers remain relatively low, they are growing at an alarming rate, doubling every two days, compared with every three or more days in Europe.
Vlassov also explained that Russia has recently begun to use a more sensitive test and is allowing testing to be carried out by a larger number of laboratories across the country; the upward curve may therefore reflect not only new cases but the true scale of already existing ones. Increasingly, public figures are suggesting that Russia’s official count is likely too low. Moscow’s mayor, who is leading Russia’s response to the coronavirus, told Putin: “Nobody knows the real picture. In reality, there are far more people who are infected.”
As the epidemic continues to spread, Russia may have a harder time tracking people who have caught the coronavirus at work, on the metro, or from relatives. Sergey Netesov, the head of the bio-nanotechnology, microbiology, and virology laboratory at Novosibirsk State University, who was previously a researcher at Vector – the state laboratory that developed the first coronavirus test in Russia – told me, “These are the most dangerous carriers, and I’m worried this contingent is not being caught at all, at least not yet.”
Russia has a higher number of ventilators per capita than many Western countries, which suggests that the country may not be in the worst position as the outbreak spreads. At the same time, according to numerous reports in the Russian press, doctors across the country are worried about a lack of training in how to deal with suspected coronavirus patients, and about a deficit of basic supplies, including masks and gloves. Higher up the chain, Russia’s bureaucracy tends to favour obedience and loyalty over competence.
[link url="https://www.newyorker.com/news/dispatch/why-is-russias-coronavirus-case-count-so-low?mbid=&utm_source=nl&utm_brand=tny&utm_mailing=TNY_CoronaVirus_032820&utm_campaign=aud-dev&utm_medium=email&bxid=5dde3931576f2c58a6660725&cndid=59266439&hasha=3bd6edead33064f2e9c640f64f1111b6&hashb=489dbf4041c4bdc3e72e43f2aa9e7a1522ff116d&hashc=5b8d14a3ad34208fadf943a87cd3afb698c150fc7bfa43aed97435fe63c5a8fb&esrc=&utm_term=TNY_CoronaVirus"]Report in The New Yorker[/link]