Running out of coffins

After welcoming tourists all summer, officials in Russia’s Kaliningrad region deny rising numbers of coronavirus cases

In early December, Russian Health Minister Mikhail Murashko said the country’s coronavirus situation was most dire in two regions: St. Petersburg and the Kaliningrad region. Shortly beforehand, Meduza and Mediazona uncovered that officials in Kaliningrad had published figures on deaths from COVID-19 that were nearly five times lower than those contained in the classified database used by government officials. Meanwhile, Kaliningrad’s regional authorities maintain that they aren’t hiding anything — and they actively continued to encourage tourists to visit the region throughout the fall, despite of the pandemic’s second wave. In a dispatch for Meduza, correspondents Ekaterina Medvedeva and Vadim Khlebnikov from the local newspaper Novy Kaliningrad report on how Russia’s westernmost region is coping with COVID-19.

Welcoming tourists from ‘big Russia’

“There’s no second wave, there’s no third wave. Everything that you hear about this is simply rumors and speculation,” said Kaliningrad Regional Governor Anton Alikhanov in an Instagram stream, as he biked on an evening in August.

At this point, the city had survived the coronavirus pandemic’s first wave with relative calm. Tens of thousands of tourists from “big Russia” (as many locals call the rest of the country) strolled through Kaliningrad’s streets. The beaches were overflowing with people and nearly every hotel room was booked until the end of the summer — Kaliningrad hadn’t seen such an influx of tourists since Russia hosted the 2018 FIFA World Cup.

In total, around 270,000 Russian citizens visited the city in July and August — that’s twice the number of people who came to the region during the World Cup in 2018. Last year, the region hosted 1.74 million visitors. And despite the pandemic and quarantine restrictions, the authorities are anticipating that 1.3 million tourists will have visited by the end of 2020. Officials have shown no hesitation when it comes to promoting Kaliningrad during the pandemic: they’ve shot new promo videos, invited IT specialists to work remotely from the city, and promised vacationers cashback on the price of tours and the possibility of spending a third night in a hotel for free.

That said, back in May the region had no tourists at all — workers from Kaliningrad’s food services industry posted naked pictures to draw attention to their plight amid restrictions that shut down cafes. In the summer, according to official statistics, the pandemic was on the decline and the restaurant business was reopened. At this time, the region was only recording 10–15 new cases per day and the death rate was less than one person daily. Due to the obvious drop in cases, Kaliningrad residents didn’t raise any questions about the official statistics — in general, they became less and less interested.

‘The statistics make the regional leadership look better’

On August 30, the Imam at a local Muslim prayer house, Khalil Mukhlisov, died of pneumonia caused by COVID-19. The regional government published a press release with condolences, directly stating that Mukhlisov’s death was linked to the coronavirus. A month later, however, his death still hadn’t been included in the official reports from Kaliningrad’s operational headquarters for combating the coronavirus; it published data on the age and sex of the deceased daily, but the Imam was never among them.

For two and half months, journalists from the local newspaper Novy Kaliningrad tried to find out why Mukhlisov’s death wasn’t included in the official statistics. The Regional Health Minister, Alexander Kravchenko, assured that the numbers weren’t being manipulated; the regional authorities blamed the local branch of Russia’s public health watchdog, Rospotrebnadzor, which in turn blamed the regional authorities. The discussion came to a dead end and the coronavirus headquarters, citing medical confidentiality, simply stopped publishing information on the age and sex of the deceased.

By September, the number of cases in Kaliningrad was on the rise, despite the governor’s assurances. According to the official statistics, there were at least 30 new cases daily. By October this figure had doubled and it tripled by the second half of the month. The number of reports about well-known local figures dying and social media posts about the deaths of relatives and loved ones grew. But at the same time, the official death toll was only slightly worse than in June — the region often had days where it recorded zero deaths from COVID-19.

At the end of November, Meduza and Mediazona published classified data from the Health Ministry’s Information Center for Monitoring the Coronavirus Situation (ITsK) on the number deaths among COVID-19 patients at hospitals in Russia’s regions. In 31 regions, this data hardly differed from the official death tolls published by local coronavirus headquarters. But in the other regions the differences were huge. In the Kaliningrad region in particular there was almost a five-fold difference in the data: the coronavirus headquarters had reported 106 deaths since the start of the pandemic, while the Health Ministry’s Information Center recorded 496.

At first the regional authorities tried to refute the report. Then government officials acknowledged the numbers, but tried to deny that data on hundreds of deaths had been hidden deliberately. They attributed the discrepancy to the fact that for many patients the coronavirus was allegedly not their main cause of death.

Local journalists insisted that the authorities disclose the mortality statistics in full. The regional coronavirus headquarters expressed doubts that the journalists “would be able to convey it,” but nevertheless began sharing complete data from time to time (the authorities refused to release statistics on a daily basis). It then turned out that from December 2–3 alone, for example, 37 hospitalized coronavirus patients had died. The official information the authorities published only mentioned four deaths.

Demographer and former Rosstat advisor Alexey Raksha, who studies coronavirus statistics, is convinced that the mortality data from the coronavirus headquarters should be disregarded. In conversation with Meduza, he confidently maintained that in the regions “a governor or local Health Ministry head can draw absolutely any number.” As a result, according to Raksha, in reality there may be ten times more cases and deaths than are indicated in these official reports.

Kaliningrad Regional Duma Deputy Mikhail Chesalin told Meduza that in his opinion, the official statistics for the region are at the very least incomplete. “I know a huge number of people who were not included in these statistics, because a doctor didn’t come to see them, [or] an ambulance didn’t come, and they had to be treated at home. Today, the statistics are used to make the regional leadership look better,” he said.

In this situation, Raksha suggests relying on the data on total mortality, which is available through regional registry offices. According to the Kaliningrad branch, there was a record increase in deaths in November 2020 — 43 percent more than in November 2019. The region recorded its previous record in September, when deaths increased by 21 percent. During the first wave, excess mortality in the region was several times lower; not exceeding 4 percent.

‘There’s a line in intensive care’

“We know more about the virus, we know how to treat it — and there are medicines for treating it, unlike [during] the first stage. The medical system is more prepared: we bought ventilators, various oxygen supports, and so on and so forth,” said Kaliningrad Regional Governor Anton Alikhanov in early November.

Meanwhile, people were lining up to get into local hospitals, pharmacies were facing shortages of antiviral medications and antibiotics, and the regional health minister was forced to admit that wait times to speak with an operator at the special coronavirus call center were up to 40 minutes long (during peak hours, the hotline receives approximately 2,000 class per hour).

Kaliningrad residents began reporting that in spite of fevers and other coronavirus symptoms, they were being neither tested for the virus, nor hospitalized; nor were they sent for X-rays or CT scans. In response, medical workers said that the hospitals simply didn’t have any space for more patients. But the authorities denied this and continued to maintain that local hospitals had enough beds. At the same time, Regional Health Minister Alexander Kravchuk tried to blame the high burden on hospitals on the shortages of medicines at pharmacies: locals could have been treated at home, but there was nothing to treat them with.

A Meduza source familiar with hospitalization procedure in the Kaliningrad region explained that the main problem is a severe lack of ICU beds: “There’s enough regular hospital beds, but there’s a line in intensive care. People wait for hours and this is the most important period, when a person is in very bad condition.”

On December 1, Russia’s Health Minister, Mikhail Murashko, addressed the shortage of hospital beds. He underscored that the Kaliningrad region’s hospitals had less than 5 percent of their beds available, adding that this region, along with St. Petersburg, is causing him “the greatest concern.”

Governor Anton Alikhanov replied immediately, saying that the federal health minister had the wrong data. During a subsequent working visit on December 5, Murashko didn’t witness any problems at local hospitals. Indeed, he noted that the situation in the Kaliningrad region was tense, but “manageable.” According to the regional government, at the time of the Health Ministry’s visit there were 365 hospital beds available at local coronavirus hospitals out of the 1,746 in total (20. 9 percent); 40 patients were on ventilators and 417 were receiving oxygen support.

However, according to Alexander Pyatikop, a State Duma lawmaker from Kaliningrad, “emergency works” were conducted at regional hospitals ahead of the federal health minister’s visit.

“First of all, 361 patients allegedly cured of the coronavirus were discharged. Apparently, they would be treated, as Murashko put it, ‘using remote support technologies for outpatients.’ Medicines and personal protective equipment were urgently delivered to all of the medical institutions set to be shown to the country’s chief physician. Where they got them is a well-kept secret. Head doctors and medical personnel were briefed accordingly,” Pyatikop said. According to official data from the local coronavirus headquarters, the number of patients in the region decreased by more than 10 percent (318 people) in the three days leading up to the health minister’s visit.

The Kaliningrad region now has 27 hospitals dedicated to treating coronavirus and pneumonia patients, as well as a temporary hospital with 230 beds set up in the media center at the Kaliningrad Stadium. A nurse working at the temporary hospital told Meduza that the building isn’t equipped for this: some of the toilets are out of order already, the roof is leaking in places, and the wiring can’t accommodate the large number of heaters.

According to her, the influx of patients increased significantly in the fall: “We had a situation where there were 258 people in these 230 beds. Some — whose housing conditions allowed it — were simply given [medical] records and sent home. That is, they were treated at home but listed here. Nobody examined people who had come in contact with our patients. Many of my friends fell ill and stayed at home for treatment — no one checked their contacts either. What is this, if not an underreporting of statistics?”

The region’s hospitals are also facing another problem — personnel shortages. In terms of shortages of healthcare workers, Kaliningrad has long been one of Russia’s most disadvantaged regions. And there have been even more vacancies since the start of the pandemic: many medical workers refused to work for fear of contracting the coronavirus, while others fell ill themselves. Immunizing doctors from the “red” zones began at the end of October.

In December, Governor Alikhanov said the Kaliningrad region’s healthcare system was in a “state of war,” but also insisted that it’s still coping. “In my opinion, it is very important to strike a balance between concentrating efforts on treating the new coronavirus infection and providing routine care. And now we can say that even in such difficult conditions the medical system in the region is doing well and looks better than Russia’s average indicator,” he said, adding that other regions saw even greater increases in mortality.

‘We’ve never seen such death rate’

Government officials in Kaliningrad are using the fact that the healthcare system is allegedly managing to justify a lack of stricter lockdown restrictions. The region has once again implemented mandatory self-isolation for people over the age of 65 and those with chronic illnesses, and employers are obliged to have at least a third of their employees working from home. Restaurants and bars, currently required to close by 9:00 p.m., will be allowed to remain open until 11:00 p.m. starting on December 7.

However, those dealing with COVID-19 deaths directly — doctors and people working in the funeral business, specifically — consider these restrictions insufficient. “We need to sound the alarm and close the entire region. The situation in the region is terrible: the registry office has no time to write out death certificates for us, we have a line at the morgue. The Kaliningrad region has run out of coffins! We’ve never seen such a death rate,” the owner of a funeral home, who has been working in the industry since 2008, told Meduza on condition of anonymity. Other funeral homes have yet to speak out about a shortage of coffins.

The anonymous funeral home owner also noted discrepancies in the official statistics, explaining that they often have to bury people who, having never been diagnosed with COVID-19 at a hospital, still require burials according to the same sanitary and epidemiological standards as deceased coronavirus patients. “There’s a special brigade working, we all dress in protective suits, we take two kilograms of lime. There’s no funeral service, it’s a closed coffin, and the deceased is in there in a [body] bag,” he said.

Currently, there are just over 13,000 registered cases of the coronavirus in the Kaliningrad region. Around 200 new infections and recoveries are registered daily. In conversation with Meduza, epidemiologist Anton Barchuk noted that this situation is comparable to other Russian regions with similar populations.

“It seems to me that we haven’t survived the second wave yet. But how events will develop in the future will ultimately depend on two factors: when vaccination begins, as well as the measures to contain and reduce the amount of interactions, including tourist flows. Tourism is always linked to the spread of infection, especially when there are still few cases inside a region,” Barchuk explained.

Nevertheless, trips to Kaliningrad are still in high demand among Russians: according to the authorities, 90 percent of local hotel rooms are already booked for the New Year holidays.

Story by Ekaterina Medvedeva and Vadim Khlebnikov

Edited by Pavel Merzlikin

Translated and abridged by Eilish Hart