‘Straight from our homes to the cemetery’

Russia’s COVID-19 outbreak isn’t limited to big cities — it’s spread to rural areas, where a lack of doctors and quality healthcare makes it harder to survive

A second wave of coronavirus infections is currently hammering Russia. On October 20, more than 16,000 new cases were registered in a single day for the first time. Most of the cases are in Moscow, St. Petersburg, and other large cities, but the disease is spreading throughout rural Russia, as well. Meduza reports how local residents are trying to fight the disease with practically no help from doctors, and why officials sometimes use unusual methods to curb the spread.

At first, Khabarovsk residents doubted COVID-19’s very existence. Then it hit their village and they panicked.

Rumors of a coronavirus outbreak first started circulating in the village of Bogorodskoye in late March, soon after the first cases in the Khabarovsk region were confirmed. That’s when Russian president Vladimir Putin announced the first “non-working days” in an attempt to stop the spread of the virus. Some Bogorodskoye residents decided that the virus must have been made up by the government.

A local teacher, who asked to remain anonymous, described spring in Bogorodskoye:

“People here were divided. Some really started to wear masks, and others said that COVID-19 wasn’t dangerous, that it was made up by people in power. This lasted for a couple of weeks. Then almost everyone started to believe, when people started dying.”

After the first four confirmed cases in early April, a quarantine was organized: travel to and from the village was banned, a curfew was instituted, and residents were allowed outside only to go to the nearest grocery store. Exceptions were made for medical workers and cashiers. “Yesterday, we were going about our normal lives in the village, and today it’s scary just going outside,” one resident recalled.

None of this helped stop the spread. By the end of April, coronavirus was confirmed in more than 116 people in the Ulchsky district. Two more coronavirus patients from the area died in a hospital in nearby Khabarovsk, but they were excluded from official regional statistics because the coronavirus was considered a secondary condition that did not affect their deaths.

According to hospital data, only sixteen people had been hospitalized in Bogorodskoye itself by that point. Local residents and a hospital employee explained to Meduza on condition of anonymity that most of these patients were infected medical workers who continued to work because the hospital was understaffed.

“There was no other option; we didn’t have any other workers. There was one patient who came in with gunshot wounds. If we didn’t treat him, he could have died. Then what? No one would ask Rospotrebnadzor about it — they would ask me,” explained Mikhail Dergilev, head of the surgery department.

Medical workers became infected due to lack of PPE. Federal regulators later found evidence of health violations at the hospital, where employees told Meduza that many elderly nurses quit soon after the outbreak because they feared getting sick.

The infection rate didn’t start going down until May, after about a month of quarantine. Restrictions were lifted on May 15th. But Bogorodskoye appeared in the news again in June, when some medical workers complained of never having received their COVID-19 pay bonuses.

Residents continue to complain of problems with medical care. Two of them were quick to tell Meduza that the cost of a medical examination at the local hospital recently increased by about 5,000 or 6,000 rubles (to 16,000 rubles — about $210). They now prefer going about 13 hours by taxi to Khabarovsk to get a check up and get tested.

Villagers are worried that the disease’s “second wave” will bring more serious problems: “Right now, most people are following the rules,” one person said. “But folks will likely still get infected. I don’t know what we’re supposed to do without doctors.”

In theory, COVID-19 spreads more slowly in rural areas, but outbreaks have been recorded in villages throughout Russia

Bogorodskoye is no exception: outbreaks have occurred in dozens of Russian towns and villages. Many of them have undergone lockdowns, leading to discontent among citizens. Residents of Zaokskoye, for example, demanded that the administration either rescind the quarantine order or reveal the names of the infected people, “so people would know whom to avoid.” Three days later, the quarantine order was rescinded.

At the beginning of the pandemic, regional authorities in Russia advised residents of bigger cities to self-isolate in dachas and rural areas, citing the lower population density. Most of the rural residents who talked to Meduza were also confident that they are better protected from the virus than city dwellers.

Epidemiologist Anton Barchuk told Meduza that coronavirus should theoretically reach villages later than cities, due to the lower population density in rural areas, but it’s still possible to contract the disease even in more remote places. Barchuk says the most common route of infection in rural areas is people bringing the disease from cities.

Doctor and epidemiologist Nadezhda Satosova agreed: regardless of the mode of transmission, infectious diseases spread differently in rural and urban areas, and the main difference is the speed of the spread. It’s slowed down by the absence of metros, large stores, and densely populated areas, as well as by the general lack of leisure space in rural areas.

But Barchuk noted that people in rural areas face serious problems due to the infrequency of testing and the lack of quick access to medical care. In theory, this can lead to a higher mortality rate.

According to Satosova, the fact that infectious disease care is one of the most expensive items on Russia’s healthcare budget makes the situation more difficult. Rural doctors face a lack of access to expensive medical equipment, unreliable supplies of consumable materials, and labor-intensive diagnostic methods that are vital to successful treatment.

The result is that many localities simply don’t have any doctors who are able to provide quality care for coronavirus patients.

In a village in the Ural region, one local legend wasn’t treated for an entire week. Journalists referred to his memorial as a “rally,” and police came to the village to investigate.

The village of Pervomayskiy has only six streets and the main attraction is the local cultural center, which opened in 1978.

There are no hospitals in Pervomayskiy. There’s one medical center for the city’s 600 residents, but it’s only open once every week or two, when a doctor comes from the Pyshminsky district. Residents told Meduza that the center stopped it’s regular schedule 10 years ago.

After that, villagers started going to neighboring towns for urgent medical needs. They complain about the quality of care there, too, but, in the words of one resident, “there’s nothing you can do.”

“The doctors have to fill multiple roles, so they’re torn between different positions,” a journalist from Pyshma told Meduza, on condition anonymity. “Their attitude toward patients is a problem, too: somewhere there’s indifference, somewhere there’s very shallow engagement with the situation.”

The residents didn’t know whether there are any confirmed cases of COVID-19 in the village now, but they noted that several people were exhibiting symptoms of pneumonia in the spring and summer. They were mostly treated at home, only going to the hospital “in extreme cases.” Locals explained that not everybody here has a car, so people sometimes have to pay 2,000 or 3,000 rubles (about $35) to make the trip. One other journalist in the area, on condition of anonymity, told Meduza that when people go to the hospitals in neighboring towns with COVID-19 symptoms, they aren’t isolated and they wait in line with all of the other patients.

Presumably, the first confirmed person to get sick with coronavirus in Pervomayskiy was Gennady Podoksenov — a “legend,” according to Znak.com. Podoksenov was the former head of the state farm that the village grew up around.

“The most important reason everyone is thankful to Podoksenov is that he was able to keep the local state farm running into the 1990s. You yourself understand what kind of time it was. They wanted to give the farm to the Defense Ministry, and he somehow made an agreement. Jobs were saved. Plus, he always knew how to listen to people, support people,” the journalist told Meduza. “But then the farm ended up in private hands anyways. The gradual, though small, outflow of people [from the village] began.”

Podoksenov’s daughter, Svetlana Kazantseva, told Znak.com that her 83-year-old father began showing symptoms of coronavirus at the end of August. He was taken to the hospital in Ekaterinburg on September 2. Two days later, he stopped answering her calls. On September 9, Kazantseva was told by telephone that her father had fallen into a coma and been put on a ventilator, and on September 11, the hospital called to say that he had died.

Three days after his death, Pervomayskiy residents planned a memorial for Podoksenov. Thirty to forty people gathered outside the cultural center. According to residents who attended, people made emotional speeches about Podoksenov’s death, and then started discussing healthcare. A journalist from Znak.com, who was also present, recorded the following quotes from the conversation:

“They have one word for everything — ‘optimization.’ Well, we’ve had it with optimization. Basically, it’s medicine itself that needs to be treated.”

“Just look at the hospital they had in [neighboring village] Chetkarino — now it’s all closed up. You get the feeling we’re being taken straight from our homes to the cemetery. Putin talks about millions [of rubles to be invested in health care]. Well, where are they?”

“Living in a Russian village is like living in a dump, and on television they just show the beauty of the capital, how nice it is to live there, and that endlessly bragging Putin. Well, that’s actually not the case with us.”

After about an hour and a half, the residents went back to their homes. The news media later described this gathering as a “rally.” But one attendee, trying to be more accurate with her wording, told Meduza that people simply “wanted to speak their mind, discussed deep problems, and listened to each other’s opinions.”

Four days later, police officers visited several locals and questioned them about the “unlawful assembly.” According to police spokesperson Valeriy Gorelikh, the authorities weren’t trying to punish anybody. “The law enforcement officers investigated the situation and the circumstances of the meeting, as they should have. Nothing more. Nobody intends to prosecute anyone,” he said.

Roughly a month later, the police still haven’t charged anyone in Pervomayskiy with breaking the law. Residents say some of the people who attended the meeting self-isolated afterwards, but nobody has taken a COVID-19 test. They noted that healthcare in the village hasn’t improved.

In Russia, there are no separate statistics about rural infections, despite the fact that 25 percent of the population lives in rural areas

According to calculations from the Center for Economic and Political Reform, the number of hospitals in Russia was cut in half (from 10,700 to 5,400) between 2000 and 2015. The number of clinics decreased by 12 percent.

The authors concluded that this was due either to cutbacks in healthcare spending or the reallocation of funds through closure of inefficient hospitals and expanded use of high-tech medical institutions. Officially, “optimization” began with the healthcare reforms of 2010, but similar measures were already being implemented in the early 2000s.

In 2019, Deputy Prime Minister Tatyana Golikova officially acknowledged that health care optimization had failed in many regions. A year earlier, Vladimir Putin singled out cutbacks in Russia’s villages. “I’m obliged to mention that, in many cases, the administrative changes clearly went too far. Healthcare institutions in smaller villages have started closing. People are left with practically no medical care, and nothing is offered instead. They’re given only one piece of advice: ‘Go to the city—get treated there!’ I want to say that this is unacceptable. They’ve forgotten about the most important thing — they’ve forgotten about people. About their interests and their needs. And finally, about equal opportunities and justice,” the president said.

Soon after Putin’s statement, the Russia People's Front (ONF) conducted a survey of village residents. Most of them — almost 85 percent — had complaints about the quality of medical care. Seven percent of respondents said that there are no healthcare establishments in their village.

The president of the National Medical Chamber, Leonid Roshal, told Kommersant that the readiness of Russia’s healthcare system for an emergency situation was already being discussed in June of 2019 at a private ONF meeting. Participants concluded that Russia was “not prepared to provide mass assistance to the country’s population,” in part because of healthcare optimization and personnel cuts.

Despite media reports of coronavirus outbreaks in dozens of villages, determining the infection rate in rural places is difficult, according to independent demographer Aleksei aksha. This is because the Ministry of Health’s official coronavirus information site only includes information about disease incidence for each federal subject as a whole, each of which might contain dozens of villages. The Telegram channels operated by local coronavirus task forces sometimes include case numbers in individual villages, but they also make generalizations. Otherwise, there’s often simply no other data to guide more rigorous analysis.

“The best way to find real information about case numbers in a specific village is to ask the locals. Because all methods of data analysis rely on having a lot of data. In other words, when we’re dealing with large numbers we can say this is happening, this isn’t happening, here we have a pattern, and here we don’t. But when we’re working with smaller numbers, anything is possible,” Tamm told Meduza.

For this reason, nobody knows how many rural residents already had coronavirus or have it right now — and according to preliminary Federal Statistics Service data from January 1, 2020, Russia has more than 37 million rural residents — a little more than 25 percent of the country’s entire population.

Leaders in Buryatia dug a trench around one village to stop COVID-19, but they still didn’t cancel the referendum on Constitutional amendments

Shuluta is a small village on the border of the Buryatia and Irkutsk regions, almost 20 miles from Baikal. The population of the village, or ulus, is made up primarily of indigenous people, most of whom make their living in agriculture. There’s no hospital or clinic in the ulus, and only one store.

The coronavirus appeared in Shuluta in early June. In one month, 66 cases were detected in Shuluta, which has a population of 390 people. Seventeen percent of the village’s residents were infected, leading Russian journalists to call the settlement “the most infected place in the world.”

According to research conducted by Rospotrebnadzor, the outbreak can be traced to a religious ceremony. Moscow Komsomolets reported that the event was an obo-tahilga — a yearly event in which participants ask the spirits of nature for abundant rain, a plentiful harvest, and more livestock. Villagers usually conduct ceremonies at the foot of the Bukha-Noyon mountain, but they decided to hold one in the village this year because of the pandemic.

By the end of June, there were 30 confirmed cases in Shuluta. On June 27, Dora Khamaganova, press secretary of the Tunka district administration, reported that Shuluta would be quarantined. The following day, tractors from the village council dug a two-layer trench around the village. “I was in the garden when I heard some kind of roar. I thought, ‘What happened?’ Nobody warned us that they were going to dig a trench, because they didn’t want us to leave. Everybody was in shock,” cashier Tatyana Budozhapova told the Internet magazine People of Baikal.

Residents were banned from leaving the ulus, and everyone else was banned from entering, with the exception of doctors. Next to the only paved road into Shuluta, a medical outpost with a sign with the word “quarantine” appeared. Medical workers came daily to examine residents and administer tests. Trucks delivered food for the stores to the outpost, where the government stationed police and National Guard officers.

Ivan Alkheyev, the head of the Tunkinsky district, told Meduza that such measures were necessary to ensure that people didn’t break the quarantine. According to the authorities, the trench was supposed to stop everyone who tried to enter or exit the village through unpaved roads. Putting an outpost on every country road would just be too expensive for the district authorities, said Alkheyev.

The head of the district assured Meduza that Shuluta residents were “understanding” about the moat, while the villagers themselves said that they were in shock, having no idea how to earn a living without leaving the ulus. But they obeyed the quarantine order so that it would be lifted sooner. A lot of residents stopped leaving their houses, and groceries were brought to them by the village’s only social worker, Natalia Dugarova.

Because of the trenches, Shuluta has appeared in The Washington Post, Reuters, and The Associated Press. Now residents are refusing to talk to reporters. Meduza contacted 24 villagers through social media, and those who answered said they were tired of talking to journalists. “I’m not interested in telling a stranger about our village! We went through the quarantine and that’s it!” said Bayarma Balbanova, a librarian in the village.

The construction of the trench coincided with the referendum on amendments to the Russian Constitution — which, among other things, allow Putin to stay in power until 2036. The coronavirus outbreak did not prevent the village from voting. According to regional authorities, a team of medical workers in PPE were sent to Shuluta, where they disinfected the polling place and gathered the votes. Ivan Alkheyev confirmed that the ballot boxes were taken by doctors in protective suits. When asked why all this was necessary, Alkheyev answered tersely: “We can’t deprive residents of their constitutional rights.”

By July, all of Shuluta’s residents had been tested. More than 60 people tested positive and one person died.

The quarantine was officially lifted on July 25 — 15 days after the last positive test in the village. There were no reported incidents of religious persecution against the participants of the ceremony that started the outbreak.

Ivan and Alkheyev confirmed to Meduza that “everything’s fine,” and that the village has returned to a “safe epidemiological situation.”

Story by Bumaga journalist Evgeny Antonov, edited by Pavel Merzlikin

Abridged translation by Sam Breazeale