Alexander Myasnikov, Russia's COVID-19 information chief, said in mid-April that it
would be “impossible” for Russians to get the virus, estimating the probability of
extensive spread in Russia at “0·0%”. This hubris has been sorely exposed. As of June
2, Russia has 423 186 cases, the third most in the world, while relatively few deaths
from COVID-19 (5031) have been recorded. The rapid spread of the epidemic in Russia
has highlighted the strengths and weaknesses of the health system, and presents the
traditionally strong Russian leadership with a new challenge.
There were some grounds for optimism. The 2615-mile Chinese–Russian border was shut
early, on Jan 30; population density in the country is low; and the public health
system in Russia has long experience in the control of infectious diseases such as
plague. Although many countries have cut back capacity over the past few decades,
Russia has retained an extensive, albeit outdated, public health system. Testing capacity
in Russia, for example, is vast, and was scaled up quickly. In Russia, more than 10
million tests have been done so far and more than 200 laboratories are providing same-day
test results.
This large testing programme at least partly explains the high number of cases. Although
many countries have very large numbers of cases, health officials publicly admit that
the official number is still a sizeable underestimation. As for deaths, many explanations
have been put forward for the relatively low mortality rate—from questions over how
cause of death is attributed, to the presence of widespread testing—but data on excess
deaths and all-cause mortality are needed to give the best insight into the true toll
of the epidemic in Russia.
Nevertheless, like in many other countries, there have been conspicuous shortages
of personal protective equipment (PPE) throughout the care system. According to one
report, Russian health workers are 16 times more likely to die from COVID-19 than
their counterparts in other countries, accounting for an estimated 7% of all COVID-19
deaths in Russia. Russian health workers report having been discouraged from highlighting
PPE shortages. There have also been problems with ventilators, a situation emblematic
of Russia's vast but creaking health system. Before the epidemic, Russia had 27 ventilators
per 100 000 citizens, far more than the 18·8 per 100 000 in the USA. However, many
of these ventilators were old and doctors have complained about their quality.
There are also regional variations to contend with. Quality of health care differs
greatly across Russia's many regions, which have varying levels of preparation and
equipment. A doctor speaking to the BBC called the kit available to doctors in Dagestan
“primitive”, and the region has capacity for fewer than 1000 tests a day among a population
of more than 3 million. According to a local health minister, 40 health workers have
died of COVID-19 in Dagestan, which is more than the official total of all COVID-19
fatalities for the region.
Regionalisation and delegation have led to a problem with overall public health messaging,
a consistent feature of countries struggling to manage their COVID-19 outbreaks. On
May 11, President Vladimir Putin called an end to Russia's “non-working period”, first
declared on March 30. As part of these measures, wages were paid by companies for
furloughed workers, rather than the state, but the removal of these measures meant
companies could refuse to pay workers who did not return to work. The return to work
for Russians clashed with the message from deputy prime minister, Tatiana Golikova,
who subsequently explained that only 11 of Russia's 85 regions were in the position
to loosen restrictions at all. Although regions have been in charge of their own lockdown
measures, the message from the central powers has been the need to return to work
and restart the economy.
Among all of this, public trust in Putin appears to be eroding, with his approval
rating tumbling in recent weeks. There is a sense that by leaving the difficult decisions
about public health to the regions he will absent himself from blame for the toll
of the pandemic in Russia. The USA, Brazil, and to an extent the UK, have seen how
local government and the public often have to use their own best judgment when they
do not receive direct, consistent messaging from the top. There are many unique factors
at play in the Russian epidemic, but a lack of clear political leadership has become
a common hallmark of countries that have suffered the most.
© 2020 Alexei Druzhinin/TASS/Getty Images
2020
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