Just not to die from coronavirus in Russia are struggling with the epidemic COVID-19, by manipulating the statistics. The Investigation Of “Medusa”
Vladimir Putin may 11, overturned the rule “days off”. How and when to lift the quarantine in the regions should be decided by the governors, based on epidemiological statistics. At the meeting with the President on the same day, Deputy Prime Minister Tatiana Golikova said proudly that the fatality rate from COVID-19 in Russia — 7.4 times lower than the world. Demographers say that it is an occasion not for pride and for investigation. The theme of the abnormally low mortality of coronavirus in Russia are already discussing media world: they came to the conclusion that the problem is in the method of accounting of deaths. However, the correspondent of “Medusa” Lily approva found that this technique allows officials deliberately concealed the death from the coronavirus that causes to embellish the statistics in the regions. Doctors and demographers have told her what week of the epidemic began to overflow the morgues, who makes decisions for pathologists and Federal statistics of infections and deaths fell, a city of nuclear physicists.
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A BRIEF RETELLING OF THE TEXT
“If I die single, that throughout the country there must be hundreds”
The first inconsistencies in statistics of deaths was noticed by the doctors. Egor (the name changed at the request of the interviewee) decided to tell me about a situation when in the hospital — one of the largest Moscow COVID center- filled morgue. “The administration said that now the bodies of the dead patients urgently need to send [the autopsy] to [the hospital in] the Project, says the doctor, “Medusa”. — The clear evidence of false statistics, which we every day publish. And I’m unwittingly become complicit in this lie, even though we’re diagnoses don’t lie: even if the deceased negative analysis, we, on the basis of clinical data and CT [computed tomography], honestly write in the conclusions of the code U07.2 — “COVID-19 unidentified virus” pneumonia as a complication”.
That morning, when Josemaria was talking with the correspondent of “Medusa”, he lost a patient with confirmed coronavirus. Whether the death statistics in Moscow, the doctor does not know. “The discrepancy with official figures I saw in three weeks after we started receiving patients with COVID-19, — says the doctor. — The average per duty die half a patient of my office. If I die single, then the whole country must be hundreds.”
Drew attention to the fact that their patients do not fall in the official lists, and other doctors. “I thought we should give a picture of total mortality — that is, all who have COVID-19” — surprised in a conversation with “Medusa” surgeon Alexander Vanyukov, working in restructured under COVID-19 Moscow hospital No. 52. By the end of April Vanyukov, as he told the publication, “Project” and confirmed the “jellyfish”, also ceased to converge the numbers of deaths in his hospital died each day 10-20 people, but the statistics in these data, the impression of the doctor, did not fall.
Noticed the strangeness and relatives of the dead, received the death certificate. “Nowhere [in the death certificate] was not told that my mother was a coronavirus”, — told the “Medusa” Moskvich Sergey Kolomiets. The staff of the clinical hospital No. 15, told him that his mother is sick COVID-19, however, the cause of death, this diagnosis did not hit. “I called the coroner — said Kolomiets. I was told that an autopsy will not do — and in the death certificate as the cause of death was recorded as “other bacterial pneumonia other specified diseases of vessels of the brain””.
Finally, the discrepancy between the numbers of deaths from the coronavirus and other statistics drew attention demographers: they were embarrassed that the mortality rate of coronavirus (relative to the officially registered cases) are much lower than in other countries. “You understand that we may not be the mortality rate six times lower than all the rest? We do not believe that Russia has some special genetic splendor? said the Medusa demographer Daria Khalturina. — Judging by the massive loss of health workers, Moscow is now “the new Wuhan”, and the total mortality should be decent enough”.
In early may, the Moscow authorities have published preliminary data on the registration of deaths in the city in April. It turned out that the civil registry offices of Moscow has registered 11 846 deaths — almost 20% more than the average for that month indicator. Demographers once pointed out that this “excess mortality” — a consequence of the epidemic of the coronavirus. In comparison with April 2019 mortality increased by more than 1,800 people, and officially from the coronavirus in a month died only 658 people, that is almost three times less.
Officials say the accuracy of Russian pathologists, pathologists — bureaucratic requirements
A source in the Moscow mayor’s office explained the Agency “Interfax” that the case is in exceptional accuracy of the Russian register of deaths. Revealed that over 60% of deaths happened from the “obvious alternative cause” that is “infectious origin is like a catalyst for rapid progression of chronic diseases”. Similar situation with statistics is observed in other countries, pointed at city hall.
WHAT DATA LEADS TO CITY HALL?
The official death toll from the coronavirus do not fall all who were treated from infection, but only those whose autopsy will show: main (“initial”) the cause of their death was exactly COVID-19. “We have the lists of mortality there is evidence autopsy and everywhere pathological diagnosis of “coronavirus infection”,” — says an employee of Rospotrebnadzor Maria (name changed at the request of the companion). Not to conduct an autopsy it is impossible: according to the law “About bases of health protection of citizens in the Russian Federation”, the autopsy of the dead from infectious disease patients is necessary.
Then “the pathologist chooses between death “from COVID-19” and death “COVID c-19″,” explains the Deputy head of the International research laboratory for population health and the HSE, a demographer Sergey Timonin. If the death of the patient with COVID-19 due to complications of his chronic diseases in the postmortem diagnosis of main (“original”) cause of death can call them, explains demographer. “We have rules more strict: in the U.S., Italy and the UK to COVID death took all those deaths, when the coronavirus has been laboratory confirmed or clinically diagnosed,” says Timonin.
The medical examiner Viktor Golovanov from Moscow regional Bureau of forensic medical examination since the beginning of the epidemic failed to diagnose COVID-19 never — while “cause of death” all of coronavirus fatalities, which examined specialist. Thus in each case the picture in the lungs for Golovanov was obvious. “I’m 28 years old and working, but are so light, a picture of purulent-fibrinous pneumonia see for the first time. There is minor thrombosis in the blood vessels, the blood congeals, trombini formed — and when the lungs are under pressure, from the vessels out these here trembecki” — describes Golovanov.
However, for the diagnosis of the medical examiner has to wait for the result of the analysis of the tissues according to the recommendations of the Ministry of health, it makes even the dead, who during his lifetime received a positive test. “I have no right, from the bulldozer to put here when I get virological conclusion, I’ll put him coronavirus and pass the paper to the Department of statistics, agrees with the position of the medical authorities Golovanov. — [In vivo] tests are one thing, but when the corpse took from the deep division of the trachea, then there is a hundred percent [to be exact result] — positive or negative.”
Two coronavirus death, who studied Golovanov, in the statistics of Sergiev Posad was not yet reflected. “We still put “cause of death is not established,” — said Golovanov. — Upon receipt of histology and Virology we write is already the main cause of death and send”.
These data then fall into the statistics?
NOT THE FACT
In the end, on the main page of the official website of stopmanager.Russia is no more than a third of the total number of deaths “with the coronavirus” patients, says demographer Timonin (those who are pathologists diagnosed COVID-19 as the primary cause of death). More complete information, see health officials say interlocutors of “Medusa” familiar with the work of the state register, which receives all statistical information from hospitals.
WHAT KIND OF REGISTER?
Now complete mortality statistics collected, but is not studied seriously even at the level of the Ministry of health, tells a familiar with the work of this database is the source of “Medusa”. “The register was filled with interruptions, he says. — It still added additional fields. But now the Minister of health of Russia has set the task to become the single most comprehensive source of information on sick and dying. The Ministry of health solves this problem in dense regions”. “In Moscow are planning to retrospective recalculation of the death”, — tells the employee of one of institutions of Ministry of health (the Ministry did not answer the questions of “Medusa” on the possibility of such a revaluation).
However, all the strangeness of the statistics on mortality COVID-19 specificity of the Russian pathology and bureaucratic complexities can not be explained, I think pogovorili with “Medusa” demographers.
The main issue may not be methods of counting, told to “Medusa” the two sides in different regions, and the fact that the instructions contribute to the deliberate concealment of deaths from COVID-19 on the ground for the implementation of the orders of the centre. “Medusa” has traced the journey of the death certificate from the Desk of the pathologist up and learned how to drop and ignored the “extra” dead.
How is the epidemic of coronavirus in Russia
“Moscow seems to be saying how to do it”
The manipulation of statistics on deaths traditionally occurs at the stage of diagnosis by a pathologist, told the “Medusa” more than a dozen interlocutors who are familiar with this topic (including a pathologist, eight other physicians, two demographers, the expert laboratory diagnostics and a member of the CPS; three of them are already faced with the concealment of deaths from COVID-19).
“I said that at the beginning of the epidemic was the order that was given by the pathology service of [a hospital] to the day in the city was not more than five or so COVID-associated deaths — says, “the Medusa” a source in one redeveloped for coronavirus hospitals. — So, everybody who can write “cancer”, “infarction”, “chronic obstructive pulmonary disease””.
State regulations for pathologists written to create the ability to hide from the statistics the diagnosis of “coronavirus”; this was also the impression from speaking with “Medusa” pathologist from Stavropol (asked not to be named for fear of dismissal). “These statements came just when was the first death from COVID-19 — and [the chief pathologist of healthcare in the Central Federal district Oleg] of Zairatyants came out and announced that “the death was caused by complications of chronic diseases, and not from the coronavirus,” says the pathologist. — And we looked at each other: “Well, Moscow is saying, how to do it. Well, of course””.
What is wrong in the instructions?
A FEW POINTS
It is the official recommendation of the Ministry of health to work with COVID-19 dated March 28, explained, “the Medusa” pathologists and demographers, has created a space for fraud on the ground: the most difficult procedure for the production of posthumous diagnosis of “coronavirus” — and, conversely, increased the possibilities for “alternative” opinions.
“A man can be all sorts of ills, and history to stand for several chronic diseases and often have the opportunity to write any one cause of death, or the other, or even third. Coronavirus and the victims, if there’s any cron [chronic disease], often write this Chrono, not a coronavirus. More often than in other countries,” — says working with the state statistics of mortality demographer Alexei Raksha.
“The coronavirus does not kill anyone — kill him complications! Sometimes pneumonia is heart failure, myocarditis,” says the Medusa resuscitation of city clinical hospital № 29 Alex Ehrlich, convinced that the statistics of mortality subjected to manipulation.
“Medusa” has collected evidence of underreporting of deaths in several regions.
- “Was on duty when he died eight people, but COVID-19 almost no put — write “pneumonia”, — told the “Medusa” a source in Dagestan, whose relative is working in the Khasavyurt Central city hospital named Askerkhanov. — Every duty die five or six people, all of the data on the actual number of deaths send to Makhachkala. When I say that according to official statistics, a little less than 20 people died in the entire Republic, and I graciously replied that I “child, if you believe it.” At home [my family member] refuses to sit, although the medical staff they are ill. “I’m not a deserter! I read the antivirus prayer, Allah will protect me!“ — says”. In an informal list of deaths from the coronavirus physicians 28 health workers from Dagestan; according to official data in the Republic, the total number of deaths have not exceeded 20.
- Were not included in the official statistics, the second death from the coronavirus in the Bryansk region, wrote to local media
- In may, the Ministry of health of Bashkiria publicly refused to link the death of the nurse Experts of the Central regional hospital with COVID-19, although the main cause of death was officially listed infection.
- It is at the stage of opening was hidden death from the coronavirus in the CRB Bogdanovich in the Sverdlovsk region, told the “Medusa” the doctor-the phthisiatrician from Ekaterinburg Natalia eysmont (its data was confirmed by the staff of the CRB, who agreed to talk with the “Medusa” on the condition of anonymity). Dead April 20, an elderly woman had to fix as the second dead from COVID-19 in the region, but in the statistics of the case and did not get — either April 21 or later. “She fell ill with a temperature, cough and shortness of breath — says Eismont. — The primary version of the autopsy showed that she had bilateral pneumonia, the pathologist put it “coronavirus pneumonia”. Sick doctor who treated her, went to the hospital with pneumonia, her husband and son. Two days passed, and suddenly the Vice-Governor [Paul] Krekov speaks in the media: “Oh, we were wrong, she didn’t die from coronavirus, and cancer.” Substitution of concepts: Yes, she’s a cancer patient, but if not this pneumonia, she would have lived — and died-then she coronavirus pneumonia!” (In the Ministry of health of the region, the situation did not comment.)
- “The diagnosis of this is not put — says, “the Medusa” a person familiar with the work of the Filatov hospital in Moscow. — Previously, it was impossible for them to put in the main cause of death cardiovascular diseases and heart attacks, because “we must take the threshold of a developed, not a developing country.” Now, the coronavirus does not pose: put “crown” in the end, and upstairs is the “heart”, “chronicle”, something else”.
- “The leadership of our hospital at all other statistics shall submit to the [regional] Ministry of health and the head of the city, — said the employee of the CCCH in Reutov, who asked not to be named. — We have patients who initially admitted to the cardiology Department who’s in surgery for a planned, who is in Oncology — in the hospital they were infected with coronavirus and died from it, but the manual forces [in the pathology conclusion] to write the diagnosis, which they did, and the diagnosis of “coronavirus” to write as collateral. And then reports that the sick — yeah, she died, but who pneumonia who from the heart”. “Everything reported as it should, what you say, we have the unthinkable” — denied this information in conversation with “a Medusa”, the head physician of GKB Reutov Garik Khachatryan. The Ministry of health did not answer questions about the situation in the hospital.
The next version of the recommendations of the Ministry of health appeared only a month later, on April 28. “Now came the recommendation that COVID-19 [initial cause of death] to put, so there’s no way not to hide,” says pogovorili with “Medusa” pathologist of the Stavropol territory.
However, by may — this month Vladimir Putin has decided to lead the country out of quarantine regions allegedly received instructions from the Deputy Prime Minister Tatyana Golikova to register as coronavirus pneumonia, says close to the government, the source of “Medusa”.
Ambulances from the admissions Department of hospital # 24 in Ekaterinburg. 28 APR 2020
Donat Sorokin / TASS / Scanpix / LETA
Statistical manipulation and “may decrees” Putin
“Medusa” failed to find any precise evidence that the concealment of deaths from COVID-19 is a Federal policy. In the Russian Ministry of health and the Department of healthcare, the evidence manipulation did not comment.
However, for the regions of managing mortality has become a political process long before the epidemic. Data is deliberately distorted at least in 2012, says the demographer, who spoke to “Medusa” — from the moment of signing of the “may decrees”. In them, the President ordered to decrease the mortality rate on a number of specific positions. At the same time, explains demographer, the mechanism of transformation of units launched in the regions, in collusion with the recommendations of the doctors and specific actions pathologists.
THE TRADITION OF MANIPULATION
To hold the regional government responsible for statistics dangerous, demographers agree. “Of course, they are afraid and don’t always know what they right thing to do. And when it is possible to choose some other disease, which is also suffering people, that is the probability that he will choose”, — said Timonin. “If you have some Russian statistics on deaths from coronavirus, it must be multiplied by an average of three to four, advises working with data on deaths from COVID-19 demographer Alexei Raksha. — In Moscow — in 2.5–2.6 times, and in the regions — up to 5”.
During the current epidemic demographer Raksha began documenting her Facebook dismissal of medical officers: in April and early may after outbreaks COVID-19 or bursts of deaths, falling into the news, replaced by seven regional Ministers of health.
Raksha says he knows why these people leave their posts and that they are willing to do numbers to stay in the chair. “In the Kaluga region, when the numbers on four new deaths passed by the Governor and ranked the Federal headquarters, was dismissed by the Minister of health — in the region for eight days simply ceased to die from coronavirus,” says Raksha.
“In St. Petersburg are very fond of the number three: on 20 April from COVID three people died, and 21 — three, 22-th — three, the 23rd — three, 24th — three, 25 four. As if given 20 April, the order to die no more than three, although there is per day more than 20 people dying from community-acquired pneumonia, and on April 30 he died 40. I look at the numbers there day after day three — no, never! The probability of this is less than 1%”. (In St. Petersburg since the beginning of March from community-acquired pneumonia died 697.)
A similar sequence Raksha observed in the Krasnodar Krai and in Moscow. In the Arkhangelsk, Lipetsk, and Omsk regions of the dead “resurrected” in front of demographics who are watching daily reports of the operational headquarters. “The press then came reports erroneously reported by the deaths,” he recalls.
In Bashkortostan and the Chuvash Republic at the end of April, data on mortality just froze and ceased to be updated. “In some regions, probably, just not to die from coronavirus, says Raksha. As if the Governor says the meeting a conference call: “nobody dies as you want, and twist”. In Bashkiria the latest death was April 20 — “no longer die” when everything went on the rise. April 11 — the first deceased, 14th and 15th — two by two, the 16th — three, 19th—, four — and all on a cut. After that first death appeared in the statistics only on may 9. This is implausible.” (In the Republican Ministry of health in response to the request of the correspondent of “jellyfish” was proposed to connect to the “online on YouTube channel of the Ministry.”)
The doctor from Volgograd region (requested anonymity, fearing dismissal) was a witness to the machinations of pathoanatomical diagnosis long before the epidemic of the coronavirus. “When in 2017, the flu was raging, ill even vaccinated against it, — says the interlocutor of “Medusa”. And the leaders began to panic: a lot of money spent on the vaccination and to the vaccine itself, the idea is that we need the entire population to instill — and then you die. An unwritten rule was that “pneumonia is not dead.” I have seen the doctors in the intensive care unit: a chief medical officer [chief medical officer] said that “problems are”. And the attending [doctor] went to negotiate with the pathologist”.
Decisions of the Federal authorities, which then retransmit to the hospital the authorities of the regions that directly affect pathologists, says, “the Medusa” a pathologist from Stavropol. “Said to reduce mortality from heart attacks — are reduced, — said the expert. — There are national guidelines on how to put the diagnosis “myocardial infarction” — so they painted the five types of myocardial infarction that can be put to he did not go to the underlying disease. That is, in the diagnosis of heart attack is mentioned, but for the help it turns out that the person did not die from it.”
Unrecorded city
When counting coronavirus deaths occur and errors can not be explained even by bureaucratic logic. So, in the Nizhny Novgorod region from the statistics was gone the whole city.
11 may in the city of Sarov reported the first death from coronavirus. But in a summary by region this data is not entered, because since may 1, the closed city of science for nuclear physicists have withdrawn from the General calculation made by it, judging by the statements of local authorities, it is official. “Sarov is not included in the statistics of the Nizhny Novgorod region”, — was declared by 7 may, the chief sanitary doctor of the city Irina Ignatieva.
“On may 1 in connection with changes in the methods of verification cases in the city of Sarov not counted in the Nizhny Novgorod region”, — stated in small font below the tables with the reporting of COVID-19, which puts in instagram the Deputy Governor of the Nizhny Novgorod region, David Melik-Guseinov.
Signature small font on the charts with the reports appeared only in may, although reports of the Vice-Governor at COVID-19 began to disperse with the numbers in the Sarov in April: for example, on April 30, Melik-Guseinov continued to talk about the 43 injured sarovchane, although in fact there were already 55. “The place [of the Nizhny Novgorod region] in the regional ranking by incidence per 100 thousand population has decreased from 20 th to 24 th position in just three days,” rejoice in that day the Vice-Governor on social media.
Apparently, information about sick people of the city do not fall into the Federal reports. At least on stopmanager.of the Russian Federation of increase of cases is not reflected in may: the official site duplicates the data in the Nizhny Novgorod region, which are prepared without taking into account the situation in the closed administrative-territorial district (ZATO) is satisfied “Medusa” comparing Federal lists with reports of the Vice-Governor.
“They have this text under the asterisk that Sarov allegedly not taken into account in connection with any technique, only appeared after people started to ask questions! — told the “Medusa” resident BUT who asked for anonymity. They attribute this to the fact that our hospitals belong to the FMBA [running Veronika] Skvortsova and figures are taken into account there. But where are these numbers? Why not then a separate page on the site stopmanager.of the Russian Federation, which have been shown all the data from cities served by the FMBA? And why are we suddenly appeared “statistics of the Federal medical and biological Agency”, when we have the growth go?”
Data Sarov regularly posted on the website of the Federal medical-biological Agency. To explain why neither the Federal, nor in regional Ministry of health “Medusa” would not.
13 may in the town reported on 79 patients (the website field still shows the figure 43). “The administration of our city-forming enterprise [part of Rosatom] just trying to [at Federal level] of such large numbers did not know, as need to open and do not need to go into quarantine — says, “the Medusa” a resident of the city. — We all work, even now I’m in the “Children’s world” — a lot of people here, all children need to wear, because open kindergartens”.
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