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Why Is Russia’s Coronavirus Case Count So Low?

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In the past two weeks, I’ve observed from afar as various places around the world to which I have a personal attachment registered a grim uptick in coronavirus cases, and then, in response, effectively shut down. In Southern California, my mother was the first person I knew to self-quarantine; next were friends in Paris, who, in the span of forty-eight hours, went from eating lunch in cafés and planning a trip to Germany to hunkering down with their young children; then it was the turn of friends and colleagues in New York, where I lived for nearly a decade. During this time, Moscow, the city where I have lived for eight years, has felt like an unlikely outlier. Life here has definitely become stranger, but it is far from completely upended. As of Tuesday, Russia has four hundred and ninety-five official cases of COVID-19, a small fraction of the number of cases in major European countries or in the United States.

Vladimir Putin has offered general assurances that the situation in Russia is “under control,” and, although Moscow’s mayor, a Putin loyalist, has closed schools and cancelled public events, the daily ebb and flow of the city hasn’t changed all that dramatically. I’ve mostly stayed at home, but the metro is still running, and shops and restaurants are open. The luxury department store Tsum is having one of its best years for sales in recent memory. Half my friends are observing some form of self-quarantine; the other half doesn’t get what the fuss is about—or, rather, their employers don’t.

It is unclear whether the Russian state has been lucky, smart with preëmptive measures, or dangerously incompetent—or some combination of all three. In the case of incompetence, Russia’s seemingly small figures will soon be replaced by colossal ones. In recent days, I’ve spoken to doctors, epidemiologists, and patients, to try and get a handle on whether Russia will be the next Italy, with an overwhelmed public-health system, or Japan, with its relatively flat and steady growth curve.

It is possible that, without having planned for it, Russian society, which is not nearly as defined by shoulder-to-shoulder public mixing as many European ones, had some advantages in weathering the early phase of the pandemic. Russia shares a twenty-six-hundred-mile border with China, but its most populous cities have fewer and less extensive ties with China than do many places in Europe. (Russian–Chinese trade topped a hundred billion dollars last year, but much of that came in oil and gas deliveries, a very different type of contact than one finds in, say, the many factories of northern Italy with a large Chinese labor force.) Russia is vast, with a relatively less developed transit infrastructure than European countries of similar populations. As a result, Michael Favorov, a doctor and public-health expert who previously oversaw C.D.C. programs in Eastern Europe and Central Asia, told me, “I wouldn’t expect a single outbreak in Russia but, rather, several, each with its own geography and developmental stages.”

It is also not impossible that Russia handled the early days of the pandemic with an admirable degree of foresight and care. In January, Russia shut down its land border with China. Beginning in February, passengers arriving to Moscow by plane from virus hot spots, such as China, Iran, and South Korea, were met by a phalanx of medical workers in protective gear administering tests. People who came from Europe—before those flights were cancelled—had their temperatures taken and were sent home for a mandatory fourteen-day quarantine. I talked to three people who developed symptoms while they were waiting at home for their test results, and who were put into isolation wards in a hospital in a Moscow suburb—a measure in line with recommendations from the World Health Organization to test and isolate. (I heard mixed reviews of this hospital, in the suburb of Kommunarka, which has become the city’s main coronavirus hub. One patient told me that he was “very impressed”; another complained that the swab she gave at the airport was lost and that she had to wait days to give another.) In theory, heavily policed authoritarian systems like Russia’s have a head start in tracking citizens—one man in Moscow, who had returned from Italy on the same plane as someone who later tested positive, was fined after cameras equipped with face-recognition technology caught him violating his mandatory quarantine by taking out the garbage. As I heard a political scientist acknowledge last week on Echo of Moscow, an independent, liberal radio station, “The fact that a certain regime is headed for a dead end in the long run doesn’t mean it may not have some advantages on the tactical level.” Melita Vujnovic, the W.H.O. representative in Moscow, recently told CNN, “Testing and identification of cases, tracing contacts, isolation—these are all measures that W.H.O. proposes and recommends, and they were in place all the time.”

As of this moment, Russia, a country of a hundred and forty-four million people, claims to have carried out a hundred and sixty-five thousand coronavirus tests in total, about half the number that were performed in the United States. Russia has fewer acknowledged cases than Luxembourg—and yet there is some evidence of a much larger outbreak of the coronavirus than the official statistics appear to suggest. According to Russia’s own statistics agency, the number of pneumonia cases in Moscow grew by thirty-seven per cent this January, compared with the same time last year. Anastasia Vasilyeva, the head of the independent Doctors Alliance trade union, said, “It’s impossible to know the real situation, but one thing we know for sure: the state is ready to manipulate medical statistics for political purposes.” In 2015, Putin announced a drive to lower the death rate from cardiovascular disease, after which hospitals reported a year-to-year drop in death from heart-related illness—and a nearly equivalent rise in deaths from rare or unclassifiable diseases. Similar manipulations may be at work now. On March 10th, a seventy-five-year-old man died at the hospital in Kommunarka. He had been undergoing chemotherapy treatment and recently returned from Italy. His cause of death was recorded as “adrenal hemorrhage”—meaning that his death was not formally attributed to the coronavirus. “We’ll never know the truth,” Vasilyeva said. “We can only assume.” On March 19th, a seventy-nine-year-old professor in Moscow died of pneumonia; initially, Russian officials linked her cause of death to the coronavirus, but later changed it to “blood clot.”

In recent days, stories about wards overflowing with pneumonia patients have circulated on Russian social media. As Vasiliy Vlassov, an epidemiologist and professor at the Higher School of Economics, in Moscow, pointed out, even if there is nothing to suggest that Russia is covering up a much wider outbreak, the country’s infection curve is just beginning. “For now, we’re way over on the left,” he said. “The question is, as it builds out to the right, will the curve be linear or exponential?” Vlassov also noted that, although official case numbers remain relatively low, they are growing at an alarming rate, doubling every two days, compared with every three or more days in Europe. Vlassov also explained that Russia has recently begun to use a more sensitive test and is allowing testing to be carried out by a larger number of laboratories around the country; the upward curve may therefore reflect not only new cases but the true scale of already existing ones. Increasingly, public figures are suggesting that Russia’s official count is likely too low. Moscow’s mayor, who is leading Russia’s response to the coronavirus, told Putin on Tuesday, “Nobody knows the real picture. In reality, there are far more people who are infected.”

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