After the peak

How Dagestani communities hit hard by a COVID-19 cover-up are mourning, recovering, and bracing for the rest of the fight

In mid-May, eyes across Russia turned to Dagestan as it became clear that the Caucasian republic’s COVID-19 statistics were being massively undercut. Many Russian regions had seen a spike in “community-acquired pneumonia” diagnoses, but in Dagestan, testing was so scarce that these misclassified coronavirus cases far outnumbered those that were correctly confirmed. Now, after media attention that forced regional officials to recognize the problem, the republic has received an influx of direct medical deliveries, military troops are building emergency hospitals, and charitable foundations are rushing to meet hospitals’ orders for personal protective equipment (PPE). Official COVID-19 statistics in Dagestan also began rising sharply soon after officials admitted that they had previously been deflated. On May 18, when President Vladimir Putin held a videoconference with the republic’s leaders, there were 3,460 confirmed COVID-19 cases and only 29 deaths in Dagestan. Less than two weeks later, on May 30, those figures were 4,830 and 226, respectively. Now, as of June 11, Dagestan has officially tested 109,801 of its residents, revealing 6,272 coronavirus cases and 309 deaths. Even as the numbers continue to rise, however, it is likely that the first peak of Dagestan’s COVID-19 epidemic has passed. In the process, the disease changed every part of Dagestani society, from cities to mountain villages. Vladimir Sevrinovsky traveled through the region to ask what happens to tightly bound communities left to fight COVID-19 with support that comes too late.

On May 23, 2020, the Dagestani newspaper Novoye Delo openly accused the republic’s government of killing hundreds of people. Attorney Rasul Kadiyev, a regular contributor to the paper, argued that when the government hid data on a sharp spike in “community-acquired pneumonia” cases, it was violating Article 237 of Russia’s criminal code, which penalizes “the concealment of information about circumstances that pose danger to the lives or the health of individuals.” To back up that argument, Rasul cited Irina Tragira, who directed a group of leading doctors sent to Dagestan. She attributed the republic’s medical shortages during the epidemic’s peak to the fact that medications are “distributed across Russia using official illness and death statistics. In Dagestan, 36 fatalities have been officially registered with COVID-19 the cause of death [as of May 20], but 820 people have died of pneumonia that wasn’t officially registered as coronavirus-caused.” Tragira’s statements came during a visit to Derbent, the only city in Dagestan whose local leaders have collected their own statistics. Those numbers differ sharply from what’s available on the regional level.

Derbent

“Brother, I’ll let you through, but I can’t promise that they’ll let you back in. Even a deputy minister got fined the other day!” a policeman told my driver at an exit checkpoint on the border of Makhachkala. It’s only been two days since new COVID-19 regulations were put in place in Dagestan, but motorists in the seaside capital have already developed a whole bag of tricks to get around them. Some cars maneuver along narrow alleyways to get in and out of the city, while others take kilometer-long detours along one-way roads. The federal Kavkaz Highway is strangely empty on the route to Derbent.

In 2018, Khizri Abakarov became Derbent’s mayor. Abakarov is a project manager for the wealthy senator and entrepreneur Suleiman Kerimov and the former shareholders’ board chair for Makhachkala International Airport. During the peak of Dagestan’s pandemic, his team was responsible for delivering 1.5 billion rubles ($21.8 million) in medical equipment and PPE that Senator Kerimov had purchased for the republic out of pocket. Despite that level of support, local doctors continued to complain that they didn’t have enough respirators for critically ill patients and that their workplaces weren’t properly divided into red (infected) and green (uncontaminated) zones.

In mid-May, Khizri Abakarov wrote a report on COVID-19 in Derbent and addressed it to the regional governor, Vladimir Vasilyev. The document contained information, including information from government sources, that contradicted official statistics on COVID-19 infections and deaths.

“We requested data on the number of cases in local [medical] institutions. We have more than 3,000 [medical] workers, and if you include their family members, it’s almost 15,000 people. At the same time, we contacted religious institutions: mosques, churches, the synagogue,” Deputy Mayor Zaur Eminov explained. “Confessional leaders told us how many people in their congregations and how many of those people’s family members had gotten sick. When we put those reports together, we figured out there had been at least nine or ten thousand people in the city with pneumonia symptoms. Relative to Derbent’s total population, which is officially 124,000 and unofficially more than 150,000, that’s no small number. In April 2020 and the first half of May, the official statistics showed that 50 Derbent residents died of pneumonia, and two died of COVID-19. According to our data, it’s actually 134 people. From May 1 to May 15, 2019, there were 1,368 ambulance calls in Derbent. In the same period this year, that number went up to 2,245. The number of pneumonia diagnoses rose from seven to 331, and acute respiratory viral cases went from 140 to 538,” the deputy mayor continued.

“What I’m saying hasn’t come out of thin air. I am speaking the language of data, of figures from an official source,” Eminov said when asked why the difference between his figures and the regional government’s is so large. “These numbers sort of horrified me.”

“On May 20, we held a team meeting,” added another of Derbent’s deputy mayors, Shamil Aliyev. “We identified hospitals where relatives are allowed to visit patients in the red zone—where they bring food and take back plates and spoons and dirty laundry to wash. They bring it all out into the city. We recommended declaring a state of emergency in those hospitals. Five days passed. It’s still a revolving door out there.”

The narrow, winding streets of Derbent’s mahals, its ancient neighborhoods, are as eerily empty as the highways. There aren’t any men playing backgammon in the tea houses or women discussing the day’s news outside their gates. At the end of May, the Jewish holiday of Shavuot came and went, but Derbent’s Kele Numaz synagogue remained empty. Instead of spending the night praying and studying together to mark the giving of the Torah, the city’s Jewish community did its best to stay awake at home. Robert Ilishayev, a Jewish community leader, told Meduza that because of the laws of Shabbat, worshippers couldn’t even keep each other company via Zoom as they spent the night in solitary prayer.

Makhachkala

“We are searching for your ride… We are searching for your ride…” for ten full minutes, the taxi service’s answering machine repeated its message over and over. In anticipation of Uraz-Bairam (or Eid al-Fitr), the Muslim holiday that marks the end of Ramadan, both the Dagestani government and the mayor of Makhachkala introduced strict limits on public transport. Police guard posts appeared on the regional capital’s streets and at its entrances and exits. Taxi drivers in Kaspiisk, a satellite city of Makhachkala, turned down long-distance rides to avoid the police in turn. Only on rare occasions did an old yellow marshrutka appear, and passengers would pack themselves in. Many of them weren’t wearing masks, and some of them were coughing, but I had no other way to travel.

The peak of the coronavirus pandemic coincided with the end of the Ramadan fast in Dagestan. Anna Popova, who leads Russia’s public health agency, said those days were “the region’s most difficult” on a call with Vladimir Putin and regional leaders. Since then, the number of “COVID skeptics” in Dagestan has significantly decreased. According to sociologist Rasul Abdulkhalikov, the proportion of the republic’s residents who don’t believe in the disease is now lower than the national average. In a May 28 nationwide survey from Moscow’s Higher School of Economics, more than a third of respondents said either that the coronavirus pandemic is a hoax or that its dangers have been exaggerated. In the Northern Caucasian Federal District, which includes Dagestan, the number of people who think “there is no epidemic, nor will there be; somebody made it up to serve their own interests” is exactly 10 percentage points lower than in the neighboring Southern Federal District, where almost a third of respondents said the pandemic was a hoax.

In the final weeks of May, sold-out medicines started to reappear on Makhachkala’s pharmacy shelves. Customers, however, almost disappeared.

“It used to be that hospitals didn’t have enough of these medicines, so [patients’] relatives had to buy them. Now, the supply is doing better,” one pharmacist told Meduza.

The capital’s streets are still full of pedestrians, and some of them still make a habit of ducking under the red caution tape intended to keep them off the city’s beaches and out of its parks. Nonetheless, funerals and weddings with hundreds and even thousands of guests have come to a stop, and many villages have introduced their own self-isolation rules.

A muezzin still calls Makhachkala’s Muslims to prayer as before, his back facing the enormous hall of the city’s Juma Mosque. The mosque, which is among Russia’s largest, can house up to 17,000 people, but nowadays, the muezzin is the only one inside. For Uraza-Bairam, Muslims here typically pay visits to one another and trade gifts. Now, only the city’s most careless residents would let their children go knock on the neighbors’ doors. Instead, Dagestanis celebrated Uraza-Bairam this year by sending each other WhatsApp stickers of candy, socks, and other gifts associated with the holiday by local tradition.

The Ramadan tent outside the Juma Mosque, where Makhachkala’s Muslim faithful would typically gather after their fasts, is nowhere to be seen this year. Instead, hundreds of volunteers from a foundation called Insan have handed out out plov and groceries door-to-door. Insan has been supporting several thousand low-income families during the pandemic. Charities have also raised three million rubles ($43,822) to equip the city’s Municipal Clinical Hospital Number 3. On May 12, the hospital was able to accept its first COVID-19 patients as a result.

“About 80 percent of our funds are donations from ordinary people,” said Magomedrasul Akhmedov, Insan’s director. “The rest comes from businesses, philanthropists, and large sponsors. A lot of charities are low on funds themselves nowadays — some Russian foundations are on the brink of shutting down — but our donations have only increased. Dagestanis are coming together in a difficult time and helping one another.”

Reports coming out of various districts in the republic — Khunzakh, Gergebil, Karabudakhkent — say the peak of the pandemic is behind Dagestan, and the number of new patients has been decreasing. Makhachkala is no exception. The sociologist Rasul Abdulkhalikov believes that the main influx of the new virus into Dagestan came as Dagestanis working in other Russian regions lost their jobs and returned home. The lack of any quarantine measures for travelers enhanced the problem. Now, that wave has begun to decline, bringing new coronavirus cases down along with it.

“We’ve seen a significant drop in requests for care,” confirmed Magomed Imanaliyev, the head physician of Dagestan’s Republican Clinical Hospital for Emergency Care. “But hospitalizations of severely ill patients in our hospital have only gone up. When patients are discharged, we fill their spots with critical patients from other districts in the republic. Our fatality rate is about five percent,” he said.

One area where ambulances regularly pick up new patients for Imanaliyev’s team is the Gergebil District, located 100 kilometers (62 miles) southwest of Makhachkala. Official statistics put the district’s COVID-19 case count at only 20, but the consensus among Gergebil’s residents is that more than half of them have already contracted the disease.

Gergebil

Usually, the drive from Makhachkala to Gergebil takes about an hour and a half. Now, even if you have the right papers, it takes twice as long. There are boom gates at the entrance into each town and police posts on the borders of every district. “You can go on through, but your taxi driver can’t,” one officer told me. Eight concrete blocks form a maze across the road that marks the border between the Akushinsky and Levashinsky Districts: even for a pedestrian carrying a suitcase, getting to the other side is no easy task.

It is similarly difficult to enter Gubden, where the road makes its westward turn toward Gergebil. Village administrators in Gubden say that more than 40 of its residents have died during the pandemic. Still, the boom gate at the village entrance is accompanied by a small truck bus stocked with a pile of medications any passerby can take for free.

Gergebil is a spacious town that spreads from the intersection of the Kazikumukhskoye Koysu and Karakoisu Rivers. In Avar, the town’s name means “bounteously sown”: Gergebil’s fruit orchards are renowned across the republic. This April, though, the district capital also became known as a major hotspot of the coronavirus pandemic.

Bagavudin, a local first grader, is the youngest son of X-ray technician Aminat Medzhidova. When I visited his family, Bagavudin climbed up the hill outside his parents’ home and laughed as he flew back down on a navy-blue Desna bicycle. He whizzed past his sisters, who had recently recovered from difficult battles with COVID-19, as well as his grandmother, who was sitting on a bench underneath an apricot tree. His path took him up to his father, who wore a black facemask and had stopped coughing only two days before. Only Bagavudin’s mother was missing — still in the hospital, he was told. His three older sisters already knew that, in fact, she had already died.

“Aminat wanted to heal people since she was a child,” said her husband, Magomed Omarov, “but she wasn’t able to study to become a doctor. She grew up without her father, so she had to help her mother. She liked working. I’m an entrepreneur myself. I told her, ‘Aminat, I need your help.’ But she stayed in the hospital. And in her last days, I told her that there was a major wave coming. I told her to take sick leave, stay home. She wasn’t having it. She said people would say she was scared. And she didn’t leave her work behind.”

On his phone, Magomed showed me a picture of his late wife. She was wearing a homemade gauze mask that reached up to her eyes, dark blue gloves, and an old robe covered with an extra layer of oilcloth. She and her colleagues had no other form of PPE.

“It all started on April 11,” said Magomed Abakarov, the head physician for Gergebil’s Central Clinical Hospital. “Our colleague, the clinic director, was checked into the infectious disease wing. On the 16th, we transferred her to the republic-wide infectious disease hospital. On the 23rd, she passed away there. But by that time, patients had started coming to us en masse, 15 or 17 per day. Nobody was prepared for a burst of infections that explosive. There was an order from the regional health minister that made it mandatory for us to build a 40-bed observatory department to quarantine people for two weeks who didn’t have the ability to self-isolate at home. We offered patients the option of transferring to the hospital in Buynaksk. Three of them made it there in time, but apparently, other districts started sending patients there, too, and the hospital was closed off [to new transfers]. Then, I set up an infectious disease hospital in our internal medicine department. Anyone who was pregnant and might have had COVID was put in the neurology department, surgery turned into the ICU, and we started plugging peripheral hospitals from our district’s villages into the system as well. We ended up making 170 new beds available. We didn’t have enough medications, and all of us have only ever seen those full protective suits in pictures on the Internet. There were plague robes with aprons, like in the olden days. Instead of respirators, we had weakly built single-use facemasks. Then, we started making multi-layer ones — I asked my team to do that.”

A new employee was sitting at what used to be Aminat’s desk when I visited the hospital. She was wearing a facemask with a respirator and a protective suit with a black hijab under the hood. The X-ray machine she now runs is new: it was installed only last November. On the desk, there was a sign-in notebook and a bottle of antiseptic. A corridor with off-white walls led away from her office, with benches lining its sides for patients to sit on while they wait. The hallway was empty, but in late April, there were crowds of frightened people standing in it.

“We and the Untsukulsky District, which is right next to us, were the first to take the hit in Dagestan,” Abakarov said. “At first, people came in to pay their condolences. They’d give each other hugs. I told them they shouldn’t, and they’d say, ‘If you’re scared of shaking our hands, we aren’t asking you to.’ They laughed about the ‘mask show.’ We had no CAT scan capability. When it all started, everybody rushed here. Healthy people, sick people—everybody wanted a chest X-ray. It was psychotic. Nothing we said could convince people. We had 30 or 40 at a time crowding into a narrow hallway. Threats, uproars. Somebody saying their mom is sick, so she should go first. Somebody else saying it should be their brother, their sister.”

The largest influx of patients thought to have COVID-19 began reaching the Gergebil hospital on April 20 and 21. Then, on April 22, the facility was left without its head physician: Magomed Abakarov was flown to Moscow to be treated himself. He told Meduza that the Health Ministry didn’t appoint a temporary replacement for him until April 30. In that time, Gergebil residents had managed to organize their own delivery system to supply the local hospital with medication and PPE. A WhatsApp group was created for that purpose around April 25, making it easier for Gergebil community members living outside Dagestan to participate. Local activists brought order to the hospital’s X-ray lines.

In her last two weeks of work, Aminat Medzhidova examined about 1,400 people — more than 100 every day. Of those individuals, 127 were diagnosed with pneumonia, but the tools the hospital had on hand were insufficient to give a more precise diagnosis such as COVID-19. Specifically, without the ability to conduct CAT scans, the hospital’s staff couldn’t see whether patients’ lung damage was characteristic of COVID-19 or not.

Outside the door to the intensive care wing, dozens of oxygen tanks stood waiting. Volunteers rested their legs nearby.

“More than 130 patients were undergoing treatment here at once, and more than 20 of them were in critical condition, in the ICU,” said senior volunteer Dzhavatkhan Guseinov. “And at first, we had four tanks. The doctors asked for more oxygen and medicine to be delivered. Only 30 percent of the medical staff was coming to work. Some people were quarantining because of their age, some people were sick, and some people were scared to get sick. There was no PPE. It was only later on that volunteers, sponsors, people’s friends from Russia or abroad started helping. Representatives from the [Dagestani] muftiate brought in medications and something like 500,000 protective suits. They paid off people’s grocery debts. Our [volunteers] worked like nurses — they were carrying tanks that weighed 70 kilos [154 pounds]. In the course of 20 or 30 days here, more than 30 patients died. That’s the number of people who usually die here in a year.”

In the ICU, machines were beeping. An unmoving body, bare feet spread apart, was connected to a ventilator. Doctors wearing protective suits and respirator masks were working around the patient. As far as essential PPE, they only lacked goggles to protect their eyes. Amid the snowman-like figures of the doctors, a young man was scurrying around wearing a T-shirt, striped sweatpants, and a baseball cap with its bill bent sharply upward. His beard was covered by a flimsy mask. He was a volunteer — one of those who had already recovered from the virus. A lot of people now fit that description in Gergebil. At the end of May, when Russia’s public health agency claimed that there were eight confirmed COVID-19 cases among Gergebil’s population of 22,000, Abakarov himself said that 407 people had gotten sick, including 18 doctors. He said 22 cases had been thoroughly confirmed, and 23 people had died. Despite the scale of those numbers, Gergebil’s residents told me the reality of the situation is even worse: they believe most of the city’s population has had the virus. Anyone who didn’t seek medical help or let inspectors near their homes wasn’t counted even in local statistics.

“No less than 80 percent [of the people here] have been infected,” said a volunteer named Mazhid with certainty.

“In our town, people know about each other in a way that people don’t in Russia. The disease has reached almost every family. They treated it in their own way, with traditional methods.”

“Only severe cases came to the hospital,” Abakarov admitted. “It is possible that many people suffered a mild form of the disease. We didn’t have a precise count.”

Patients who were still able to speak with me had no complaints about their care. One nurse showed me a pantry piled with medications, including the now-scarce arthritis drug Actemra, which has been used to control inflammation in COVID-19.

Hospital staffers said the shortages and other problems they had experienced had been solved since Dagestan’s health minister admitted on May 16 that the region’s coronavirus statistics were artificially deflated, sparking a national scandal. In an interview, the minister said more than 40 doctors alone had died in Dagestan — that number was greater than the region’s total confirmed case count at the time. Now, Abakarov said, his staff is able to diagnose COVID-19 more often than it did before. Even without access to sufficient lab tests, doctors and nurses can use CAT scans to confirm the disease. The head doctor said he couldn’t explain why Russia’s federal public health officials are still broadcasting such low case counts for his town.

Basic equipment is still lacking in Gergebil. Instead of sealable gateways that separate contaminated areas from safe ones, the hospital has a short corridor with its doors propped open. Many of the makeshift beds installed at the peak of the pandemic now lie empty, but Abakarov told me at the end of May that there were still 50 patients undergoing treatment, and 39 of them had pneumonia. People tend not to talk about the catastrophe that unfolded before their eyes in late April, when the relatively few doctors who were still willing to work stayed on the job 24/7. Aminat Medzhidova kept accepting patients for as long as she could. When she started coughing and registering a high fever, she spent only two days resting at home before she was transferred to the hospital and intubated. On May 2, she died at the age of 44. Three medical workers have died in total in Gergebil.

A new plot was added to the edge of the town cemetery after a local man donated the necessary land. When I visited the graveyard, 12 new tombstones were standing in that plot. The graves hadn’t been fully constructed yet, so cobblestones and wooden boards had been carefully placed to prop them up from the sides. Those graves represented only a fraction of the epidemic’s dead.

Magomed Omarov decorated the top of his wife’s gravestone with a green sculpted ornament. The words carved into the stone hadn’t yet been painted, so it took effort even to make out the date “May 2, 2020.”

“Our middle daughter, Raisat, is planning to go into medicine like her mother,” Omarov said. “After all this, she wants to do it even more.”

Text by Vladimir Sevrinovsky

Translation by Hilah Kohen