The cases for optimism and pessimism

Can Russia’s healthcare system handle the coronavirus outbreak?

As the Russian authorities continue to report relatively low numbers of confirmed coronavirus cases, state officials have already started enacting emergency measures, such as closing schools nationwide and asking senior citizens to stay at home. COVID-19 has already killed thousands of people in Europe — mostly in Italy, where the disease has infected more than 30,000 people and claimed more than 2,500 lives. To find out if Russia’s healthcare system can be expected to handle the pandemic any better, Meduza turned to Russian healthcare scholar Larisa Popivich and Russian healthcare union leader Andrey Konoval.

An optimistic scenario

Larisa Popovich

Director of the Institute for Health Economics at Moscow’s Higher School of Economics

First, we need to distinguish the situations [with the case numbers] in Italy and South Korea. They missed the first patient in Korea, but they realized it quickly and started large-scale testing. They tested nearly the entire population, which is why there’s a high incidence of the disease there, but its lethality is minimal — about 0.5 percent. It’s a different situation in Italy, where there was clearly a large influx [of the virus]. They completely missed it, and now the situation is dire.

Things are completely different for us [in Russia]. We reacted quite quickly: Border regions were closed off quickly, and we began isolating people. I’m also very happy that we still have a centralized service for epidemiological control, which has worked extremely well. Plus, we’ve developed our own tests, which generate results within four hours, and mass production has already begun. In the near future, we’ll transition from testing people with symptoms to testing everyone with minor illnesses, and then testing will be available to anyone who wants it. This will help identify those who are asymptomatic carriers.

Russia is better prepared for the coronavirus than many other countries. Historically, we have experience fighting complicated forms of pneumonia and drug-resistant forms of pulmonary disease. We have a high prevalence of tuberculosis, and our doctors know how to treat respiratory distress syndrome. Our doctors know how to manage this.

But Russia faces another problem: our population doesn’t believe in the healthcare system. This is reasonable in some cases, but it’s absolutely wrong when it comes specifically to this. We have extensive experience with dangerous infections: one way or another, Russia has also been home to various infectious diseases. It’s wrong to distrust Russia’s disease-control system.

And there’s another problem: part of the population believes that their personal freedom eclipses their social responsibility. It’s precisely because of this attitude that the epidemic’s outbreak is now greater overall in Europe than in China. For example, this is the thinking shared by the people who flew in from other countries and then fled the hospital. This is the most dangerous category of potential carriers. The thing to understand about “corona” is that most people who catch it will have mild symptoms and only 20 percent will need to be hospitalized. This fifth of everyone infected will be the elderly and immunocompromised, and such individuals can always come into contact with younger carriers. Young people must behave responsibly. The lives of everyone around them depend on it.

It’s important right now not to fall prey to conspiracy theories. For example, we shouldn’t be shocked that we’ve detected so few cases within a large number of tests. The figures reflect a normal distribution in light of Russia’s quick response. Yes, the virus could have been brought into the country earlier, but it would have appeared [more widely] by now. Today, the only real way it can spread is through those returning from affected countries and through contact with these people. With the closure and control of the borders, the number of cases should not spike.

I’m certain that there’s been no suppression of positive test results. Yes, our situation with pneumonia isn’t great right now, but no one is silencing these cases and these people are being tested for coronavirus, which is nothing like SARS, by the way. Once distress syndrome begins, it’s impossible to hide and conceal it as some other disease.

Many people, even my students, are talking now about an exponential distribution curve. It’s true that the average carrier infects 2.3 other people, compared to 2.1 with influenza. But we have to understand that each country has its own distribution curve, which depends on population density, the number of contacts, and mobility. Yes, Moscow and St. Petersburg are like Europe in these parameters, and we could have seen the same curve here that we’re seeing there, but we promptly took the necessary measures, and that didn’t happen.

What we’re lacking now is the proper management of our disinfectant and medical-mask supplies. For example, in Taiwan, which in my view has been exemplary in this situation, they involved the military in the production of medical masks, controlled the prices, and handed them out for free on the street. It’s unclear what’s happening with masks here in Russia.

To summarize, we shouldn’t expect an Italian scenario and we have enough equipment and everything else for a standard epidemic. Generally speaking, we’re looking pretty good in terms of our ventilator supply, too. Several years ago, we panicked about a lack of mobile ventilators for people receiving palliative care, and then we ordered a bunch more. Now there are plenty, and the main hospitals are outfitted especially well. In any case, what we need to understand is that the main blow from “corona” will be in Moscow and Petersburg. The residents of these cities simply travel abroad far more often than people elsewhere. And the hospitals here are better equipped.

The bottleneck in our healthcare system is that nobody knows how or even tries to engage the public. The Health Ministry should understand that the situation is now developing according to the laws of social psychology. If people don’t understand something or don’t believe something, they’ll begin to feed on rumors. All the Health Ministry has done, however, is post a single picture about coronavirus on its website, thinking that’s sufficient. Rospotrebnadzor posted five pictures and they, too, think it’s enough. But it isn’t. People need everything explained in an accessible way.

There’s no need to panic or spread fake news. When people get nervous, the total incidence of the disease grows. An uncontrollable panic would be worst of all. We just need to observe the basic rules of hygiene and be sure not to play the hero by going into the office when feeling sick. Even if you have no symptoms, it’s also better to stay at home to avoid catching anything from the person who flees the hospital.

At the same time, there’s no need for excessive measures. For example, we don't have to shut down subway systems. Factoring in the ventilation and disinfection measures, riding the subway isn’t the same thing as sitting in an indoor theater for two hours. Yes, closing the borders and limiting public assemblies was the right thing to do, but it would be excessive to do this for more than two weeks. If the entry points are well secured, everything should start falling after two or three weeks. We don’t expect the infections to spread exponentially.

A not very optimistic scenario

Andrey Konoval

Russian healthcare union leader and co-chairman of the “Action” union

If the scale of the epidemic ramps up, then our system will run into some serious obstacles. The main reason for this is that medical institutions are underfinanced, which makes them understaffed, underequipped, and so on. Second, there’s severe “optimization,” meaning cuts to networks of brick-and-mortar institutions, including infectious disease departments and infectious disease beds. In some regions, a few years ago, the number of infectious wards was cut in half. It was done “to facilitate a more rational distribution of resources” — in other words, they were just economizing. Ultimately, the wards are packed in the fall and winter and then we don’t have enough beds as it is. Now imagine what’ll happen if you add in the extraseasonal factor of the coronavirus. Adding more beds will be much, much harder than it was 5 – 8 years ago.

Now, [our union members] are also talking about another serious problem: There’s not enough personal protection equipment for workers. These are the same first respondents who see it as a normal situation when they’re not given new uniforms for years. Now, they don’t have enough additional protective equipment for the coronavirus either. In some places, there’s not enough for every brigade, and in other places, they’re handing out homemade gauze masks and telling the workers to wash used ones themselves. There’s no clear-cut formula for when you’re supposed to use protective gear, either. What you often end up with is a situation where the doctors can become carriers [of the virus] themselves: They come into contact with potential cases without protective equipment. In theory, they should be quarantined after those encounters. But then who’s going to work while institutions are understaffed? Brigades are taking 20 – 25 calls per shift as it is, and the standard caseload is 7 – 13 calls.

Even without the coronavirus, we had problems with medical help. Everyone’s been talking about this in the last few years, including the government. And now something as serious as the coronavirus is being added onto all that. It’ll aggravate the situation. Out systemic problems will start manifesting in much more severe ways.

Transcribed by Pavel Merzlikin

Translation by Hilah Kohen and Kevin Rothrock