COVID-19 – A Tale of Two Countries
A report by Nathan Dampier, BEARR volunteer
12 June 2020
Information available on the extent and impact of the COVID-19 pandemic in Eastern Europe, the South Caucasus and Central Asia has been patchy at times, and as with other parts of the world, not always comparable, especially in terms of statistics for cases, tests and deaths. This note looks in particular at the course of the crisis in Russia and Georgia, countries of very different population size, and with, so far, very different experiences and outcomes.
The table below includes statistics up to 12 June 2020 using statistics from Worldometers (worldometers.info) drawn from World Health Organisation (WHO), government, academic and media sources. (in parentheses – comparison to 08 April 2020)
|EASTERN EUROPE||Confirmed Cases||Confirmed Recoveries||Confirmed Deaths||Cases per 1M pop||Deaths per 1M pop||Tests per 1M pop|
|TAJIKISTAN||4,834( – )||3,062( – )||49( – )||508||5||—|
How is Russia Recording COVID-19 Deaths?
On June 11th recorded cases of COVID-19 in Russia exceeded half a million, while recorded deaths from the virus stand at 6,532. Considering that at the start of the outbreak, concerns were raised about the Russian population’s susceptibility to coronavirus – a result of their high rates of conditions which weaken the immune system such as HIV and TB – the fact that the mortality rate for those diagnosed with coronavirus has remained so low has met with some scepticism, with the World Health Organisation describing the numbers as “difficult to understand.”The Russian authorities attributed the low figures for deaths to “mass testing, which has identified many cases with mild or no coronavirus symptoms.” However, given that Russia’s testing capacity is comparable to that of the UK (RF: 95,080 tests per million population; UK: 91,967 tests per million population), there remains a sizeable difference in mortality rates between the two countries – the UK has recorded almost 35,000 more deaths resulting from the virus than Russia. Data from Johns Hopkins University showed that Russia had reported a 1.2% mortality rate from COVID-19, while in Germany the rate was 4.7%, and in the UK – 14.2%.
Questions have been asked about how Russia is reporting its deaths tied to COVID-19. An article in The Guardian on June 4th highlighted the case of St. Petersburg, where the official COVID-19 death toll for May was 171. During May 2020 in St. Petersburg, 6,427 death certificates were issued, a 32% increase when compared to May 2019, when 4,875 death certificates were issued (the average number of death certificates in May for the past decade has hovered around 5,000). An investigation by the Riga-based Russian-language online news service Meduza identified that preliminary data published by the Moscow city authorities showed a 20% increase in recorded deaths in April 2020, compared to the April average.
A large part of this discrepancy can be attributed to how different countries are reporting COVID-19 deaths. The Guardian reported that ‘Russia’s conservative reporting standards require an autopsy to show that patients died of coronavirus, rather than simply that they died while infected with the disease, unlike countries in western Europe.’ In the UK, US, and much of western Europe all deaths where coronavirus has been diagnosed are recorded as “coronavirus deaths”, whereas in Russia there appears to be a distinction between people who die as a result of the coronavirus and people who die with the coronavirus, but while suffering from another condition. The Meduza investigation flagged the example of an elderly patient from Sverdlovsk oblast, who also had cancer. She died on April 20th and was recorded as the 2nd COVID-19 death in the region; the autopsy showed the cause of death was pneumonia, and the pathologist had diagnosed coronavirus pneumonia. Two days later Pavel Krekov, the Deputy Governor for the region, announced that the patient had in fact died as a result of their cancer, not the coronavirus. This approach is not necessarily new, an anonymous doctor from Volgograd oblast reported that a similar method was used when dealing with a flu outbreak in 2018, while a pathologist from Stavropol told Meduza that regional authorities would communicate similar instructions when attributing deaths to heart attacks.
It would appear that this approach to recording COVID -19 deaths is also being applied in Kazakhstan, and potentially other countries in Central Asia as well. Sergei Timonin, deputy head of the International Laboratory for Population and Health Research at Moscow’s Higher School of Economics, says that the number of deaths recorded as a result of coronavirus on the official Russian site stopcoronavirus.rf, amounts to up to a third of patients who died with coronavirus.
This is not the only way in which coronavirus-linked deaths appear to be left off the official COVID-19 death toll. Irina Ignatieva, the Chief Sanitary Doctor for Sarov – one of Russia’s “closed cities” – said that cases of coronavirus were not always included in the overall statistics for Nizhny Novgorod oblast. While medical staff at Podolsk City Clinical Hospital outside Moscow, speaking to Novaya Gazeta under conditions of anonymity, indicated that officials at the hospital had been hiding data on infections amongst hospital staff and attempted to conceal coronavirus deaths.
One of the most flagrant examples of discrepancies in recording coronavirus deaths is in Dagestan in the North Caucasus, where the death toll by May 27th was officially recorded as 36; however there had also been 659 deaths from “community-acquired pneumonia”. Officials have pointed to the fact that underreporting could be due to the region having more isolated villages which had not yet been canvassed, and to less testing in the region. In addition there is opposition there to autopsies, and an autopsy is required to confirm COVID-19 as a cause of death. Medical staff have said they lacked sufficient medical equipment and PPE, though the situation is improving. At least six doctors died at a single hospital in Khasavyurt’ and Dagestan’s health minister, Djamaludin Gadzhiibragimov said that 40 health workers had died in the republic since the beginning of the crisis (though officials claim that they did not all die from coronavirus).’
Georgia’s Plans to Reopen Tourism Industry
Georgia’s decision to enact lockdown restrictions early on in the pandemic, closing schools in early March after just three confirmed cases, suspending direct flights with “hot spot” countries, and installing health screening at border crossings, contributed to its remarkable relative success in controlling the spread of the pandemic in the country.  To date, only 831 cases have been recorded, with 13 deaths. Given the statistics, it is unsurprising that questions have been raised as to the manner in which Georgia has been recording coronavirus cases and deaths. They have administered fewer tests than their Caucasus neighbours Armenia and Azerbaijan. It is also unclear whether they are recording deaths using the approach seen in western Europe, where all deaths where a patient has been diagnosed with COVID-19 are counted, or the approach in Russia, where only the deaths deemed to have directly resulted from COVID-19 are counted.
Nevertheless, the apparent success in controlling the virus has enabled the country to start returning to some normality. Cafés and restaurants with open-air capacity reopened on June 1st, while from June 8th restaurants have been able to serve customers indoors, as long as they comply with certain requirements: limited capacity so as to permit social distancing, employees wearing PPE, and guests have their temperature taken before entering and required to wear masks whenever they are not eating.
Significantly, from June 15th hotels and other tourist amenities in Georgia will open to domestic tourists, and foreign tourists will be able to enter the country, it is hoped, from July 1st. This is motivated by the good epidemiological situation, but also by necessity. Georgia’s economy, of which tourism makes up around 20%, is expected to decline by 4.8-5.5% this year.
Georgia plans to establish a list of “green corridor” countries where the epidemiological situation is similarly stable, including the Czech Republic, the Baltic states, Austria, and Germany. Israel had been on the list, however the situation there has worsened and the governments have decided to delay.
The emphasis will be on promoting outdoor activities, such as visiting the wine region or the national parks.Discussions on procedures to avoid reintroducing coronavirus from abroad are ongoing, with 72-hour quarantine, demanding proof of negative diagnosis, and border testing all being considered. Hotels, restaurants, cafés, and other enclosed spaces for tourists will abide by strict regulations (surfaces must be cleaned several times a day, door and window handles, railings, and elevator buttons must be disinfected every two hours” etc.’ The costs of meeting these regulations, along with the reduced capacity of venues and transport will mean the cost of travel for domestic and foreign tourists will certainly rise. While the number of tourists will be small in comparison to pre-coronavirus expectations, it will go some way to mitigating the impact of the virus on Georgia’s economy. Prime Minister Giorgi Gakharia has stated that Georgia has the opportunity “to rebrand itself as a country free from coronavirus.”
Russia’s different approach to recording causes of death goes some way to explaining its remarkably low mortality rate. However, regardless of how both Russia and Georgia are recording the number of cases and deaths from COVID-19, it will be difficult to truly assess the comparative impact of this pandemic until there is a complete picture of the number of excess deaths. The example of Georgia goes to show that even for the countries that have had relative success in controlling the spread of the virus, the economic impact of lockdowns and the reduction in international travel will be long lasting.