Health issues

Russia’s Corona Epidemic Response

In a global comparison, Russia’s corona epidemic response has been very strong. The best and most foolproof indicator is the fatality rate. Russia has experienced the lowest Covid-19 mortality among all countries in the Northern Hemisphere, significantly lower than nearly all Western countries. Presently the fatality rate in Russia is 10 per 1 million, compared to 684 in Belgium, 544 (Spain), 483 (UK), 481 (Italy), 386 (France), 274 (Sweden) and 211 (USA).

Russia’s initial decisive response helped reduce the spread. The Russian healthcare system proved superior to most other countries in terms of adequate facilities, medical devices and protective gear. Russia increased capacity nationwide by refurbishing existing hospitals and constructing 17 new ones in record time (4-6 weeks). The country also ramped up domestic production of medical necessities, including personal protective equipment. By May, Russia’s production capacity was enough to cover 100% of domestic needs. At the time of this writing, Russia has not yet exhausted its hospital capacity (even at the virus’ epicenter in Moscow).

Another commendable facet of its response has been the rapid roll out of testing. In absolute numbers, Russia (4.5 million tests) is second only to the US. In per capita terms, Russia has conducted one-third more tests than the United States and is now on par with Germany.

Most countries have almost exclusively tested only severely ill people who have been admitted to hospital. Russia, on the other hand, is currently the global leader in contact tracing. As a result, many outwardly healthy people have been tested. Two weeks ago, the Russian epidemiology authority reported that 60% of all those who tested positive in Moscow were asymptomatic. Later it was reported that 95% of all those who tested positive were either asymptomatic or only with mild symptoms, similar to a common cold. Lately, there have not been any new reports on the proportion of severely ill vs. those showing mild symptoms among people tested.. The author assumes this is due to the government’s efforts to motivate people to follow the stay-home orders strictly during the last ten days of the lockdown, coinciding with the traditional Russian May Day and Victory Day holidays. Due to the extraordinary warm and sunny weather, the government faces an increasing challenge to keep people at home. However, today the Swedish government reported that a staggering 98.5% of all infected people in their country were asymptomatic or mild. Presumably, this would also apply to Russia.

Preliminary, the government has promised to start gradually loosen the lockdown restrictions starting from May 12. Most seem to think it is about time. The comparison of Russia’s infection with the global count would just not seem to motivate that Russia keeps the restrictions in full force anymore.

MOSCOW, May 7. / TASS /. The number of people infected with coronavirus in Moscow is 2-2.5% of the population, which is about 300 thousand people. This was announced on Thursday by the mayor of the capital, Sergei Sobyanin, on the television channel Russia-24 .

“The fact that we have identified so many patients is not a minus, but a huge plus. Obviously, there are even more really sick people in the city. According to screening studies, they are in the region of 2-2.5% of the total population of Moscow, in terms of the figures are about 300 thousand, "said the mayor.

He added that the task of the authorities of the capital - the maximum possible identification of people infected with coronavirus. This is necessary to quarantine them and thus prevent infection of their contacts. "A huge work is being done for this, we doubled the tests in a week. Previously, we tested about 20 thousand, now - about 40 thousand," the mayor added.

According to the latest data, 92 676 cases of coronavirus infection were confirmed in the capital.

Case detection
Sergei Sobyanin also noted that the detection rate of coronavirus infections in Moscow is higher than in New York.

"If you look at the registration of newly diagnosed diseases in New York for the entire period and Moscow, we, perhaps, have already <...> surpassed New York by detectability," he said.

Moscow authorities do not hide statistics on the detection of coronavirus infection. "We are not trying to push people away with their diseases. <...> A system for the early detection of the disease has been created," Sobyanin noted.

Positive dynamics
According to him, over the past two weeks the number of hospitalizations with coronavirus in Moscow has not increased.

"Over the past two weeks, the number of hospitalizations [of people with coronavirus] has not increased. Moreover, today the number of hospitalized and those who are discharged shows a positive trend. More were discharged than were hospitalized. And this is the main result of our work," the mayor said .

As the mayor noted, Muscovites will not soon have to return to life without limits.

“Optimism can never be lost. How quickly we get out of this situation will largely depend on ourselves, on discipline. I don’t want to think about the future, but my opinion is all the same - we will not have to return to a full life without any restrictions soon ", - he said.

The mayor is confident that residents will survive all the trials and "defeat the virus."

Over the last day in Russia, 11,231 new cases of coronavirus were detected in 84 regions, of which 48.7% did not have clinical manifestations of the disease. 88 deaths were recorded. In a day, 2,476 people fully recovered in Russia.

Why is Russia's Covid-19 mortality rate so low?

(CNN)For almost two weeks, three countries have led the rest of the world in the daily number of new Covid-19 infections: The United States, Russia and Brazil.

This makes some sense -- each is in the top 10 of most populous countries with well over 125 million people and each has a few very crowded cities. Furthermore, each country was disorganized and disbelieving as the disease settled in their region.
But one important difference separates Russia from the other two nations. As of Monday, in the United States, which has been in the midst of the pandemic for almost two months, the mortality rate from Covid-19 was 6%, according to Johns Hopkins; in Brazil, hard-hit for a month, the mortality was nearly 7%. And in parts of Western Europe, including Italy, France, Spain, Belgium and the UK the mortality rate was over 10%.
But in Russia, where the pandemic arrived about the same time as Brazil, the mortality rate sat at less than 1%.
How can this be?
Dr. Elena Malinnikova, the chief of infectious diseases in the Russian Ministry of Health, has a simple explanation: The low mortality is due to timely detection of infection as well as the fact that that Russians tend to see their doctor soon after symptoms appear.
Russian journalists have reported that more than 60% of all cases diagnosed in the country have been in Moscow, which has a younger and healthier population than rural areas.

No matter the reason, the extremely low mortality rate is quite unexpected. So, I compared various factors to try to understand what's going on.
The testing difference between Russia and Brazil is enormous. Dr. Malinnikova and Russian leaders should be very proud. At the time of writing, they have tested 40,995 people per million population. In contrast, Brazil has a very low rate, at 3,459 tests per million citizens. (for comparison, the US has a rate of 30,937 per million).
As we have seen in Switzerland, Germany and other countries with extensive testing, mortality rates start low because so many cases are identified and never progress to serious illness though as the German epidemic has matured, the fatality rate has increased from less than 0.5% to about 4.5%.
The profound testing difference may indeed be the main reason, but other factors can contribute to risk of death from Covid-19 infection, including being a male, advanced age, heart disease, chronic lung disease, diabetes and obesity, for which comparative countrywide information is available.
Of note, Russia has high rates of these comorbid conditions, especially among men.
Unfortunately, neither Russia nor Brazil has released much information regarding the age and sex distribution of the cases or the deaths in their country, though in late April, Brazil reported that 59% of coronavirus deaths were in men. However, per the World Bank, 15% of Russia's population is 65 years old or older, compared to Brazil with 9% (the US sits at 16%). This difference would predict that Brazil would have a lower mortality rate than Russia.

Cardiac disease also is much more prevalent in Russia than Brazil. A recent study suggests that by any measurement, Russia has at least twice the rate of complications from cardiovascular disease as Brazil -- another reason Covid-19 death rates would be lower, not higher, in Brazil than Russia.
No statistics for rates of chronic lung disease by country are available. However, smoking, a major cause of lung disease, is more common in Russia (57% of men and 23% of women) than Brazil (17% of men and 10% of women). In contrast, death from lung disease is lower in Russia (14.5 per 100,000) than in Brazil (26.6 per 100,000).
Diabetes is about half as common in Russia (6%) compared to Brazil (10%) while rates of obesity are about the same: As of 2016, Russia was 70th in the world with a 23% prevalence while Brazil sat at 22% for 82nd in the world. (By comparison, the United States had the 12th highest rate at 36%).
Therefore, the known and measurable risk factors for severe disease point to Russia having at least a comparable, if not a higher, death rate than Brazil.
So, is Dr. Malinnikova correct? Is the difference really due to testing and the apparently efficient Russian health care system?
Perhaps, but there may be other ways to explain the differences. We do not know, for example, how Russia attributes death to Covid-19. If a person with heart disease dies with the infection, which condition is the "cause?" How quickly does information come to Moscow from the rural areas which may have higher death rates given the higher rate of comorbidities?
And what about nursing home deaths -- are these being included as Covid-19 related, even if a test was not performed?
As in the US and elsewhere, accurate classification of a Covid-19-related death remains very important to our understanding of the disease and the effectiveness of our attempts to control it. However, certainty about how, exactly, a person died remains a very difficult determination.
Diseases are not independent of each other: someone with heart disease will predictably fare worse with pneumonia than someone without heart disease -- but should the person die, what is the true cause of death? Probably a collision of illnesses that collectively overwhelm a person rather than a single nameable cause.

This means that the cause of death can be tilted one way or another while still remaining accurate. And with a disease such as Covid-19, where political tensions are evident in many countries, this latitude (and the temptation to exploit it) calls to mind the chilling statement popularly attributed to Josef Stalin, though it's far from clear that he said it: "It is not who votes but who counts the votes that matters."
In other words, the death rate from Covid-19 in Russia and worldwide is defined not by an internationally agreed upon definition, but by the authorities who are reporting. Once again, we may find our understanding of Covid-19 stymied by an altogether new uncertainty -- this one not medical at all, but entirely the product of political calculations.

Why Moscow didn't count 60% of suspected Covid-19 deaths

Moscow (CNN)Moscow's health department hit back at media reports that it was underreporting Covid-19 fatalities, saying its data was "absolutely open," but acknowledging that it only counts deaths that were found through postmortem autopsy to have been caused directly by coronavirus complications.

In a statement Wednesday, the Moscow health department said authorities conducted autopsies on 100% of suspected coronavirus victims and confirmed that 639 people died directly of coronavirus complications in April.
"In other cases, it's impossible to put Covid-19 as the cause of death," the health department said in a statement Wednesday, acknowledging the April spike in mortality rates.
"In more than 60% of [suspected] cases, deaths were caused by obvious alternative causes, such as heart failure, stage four malignant diseases, leukemia ... and other incurable deadly diseases," it said.
City health officials argue that a mandatory autopsy is performed on all patients with suspected coronavirus to establish diagnosis and cause of death "in contrast with the practice in most other countries," adding: "Post-mortem diagnoses and causes of death recorded in Moscow are therefore extremely accurate, and mortality data is completely open. It is impossible to name the cause of death as Covid-19 in other cases."

CNN and other news outlets reported this week that Moscow saw a surge in mortality in April, according to civil register's data. The city registered 11,846 death certificates that month, which is about 20% higher compared to a ten-year average of 9,866 deaths.
The statistics in the Russian capital have come under scrutiny as observers note the comparatively low overall number of deaths in Russia -- a total that currently stands at 2,305 according to Johns Hopkins University -- even as the country takes second place in the world for the number of confirmed cases, over a quarter of a million.
Russia has the second-highest number of cases behind the US, and Moscow is the country's worst hit-city. According to official statistics, Moscow has seen a total of 1,290 deaths out of an official total of over 130,000 cases recorded as of Thursday, although Moscow Mayor Sergey Sobyanin has said the total number of people infected is likely higher, based on screening studies.
The statement from the Moscow health authorities argued that even if all mortality figures for April in Moscow were adjusted to attribute more cases to coronavirus, the overall mortality rate from Covid-19 infections would be far lower than the official mortality rates in New York and London.

So, is Dr. Malinnikova correct? Is the difference really due to testing and the apparently efficient Russian health care system?

We do not know, for example, how Russia attributes death to Covid-19. If a person with heart disease dies with the infection, which condition is the "cause?" How quickly does information come to Moscow from the rural areas which may have higher death rates given the higher rate of comorbidities?

As in the US and elsewhere, accurate classification of a Covid-19-related death remains very important to our understanding of the disease and the effectiveness of our attempts to control it. However, certainty about how, exactly, a person died remains a very difficult determination.

In other words, the death rate from Covid-19 in Russia and worldwide is defined not by an internationally agreed upon definition, but by the authorities who are reporting. Once again, we may find our understanding of Covid-19 stymied by an altogether new uncertainty -- this one not medical at all, but entirely the product of political calculations.

The deaths per million of the population is low in eastern Europe due to BCG vaccination:

kvs wrote:
Even if it isn't, it is some sort of special achievement.   But you will not hear about it until some rotten
western outfit tries to take credit.

The western fake stream media creates a misinformation environment where all sorts of crooks are enabled to
engage in brazen intellectual property theft.   But the victim, Russia, gets accused of theft and hacking.