The implementation of Government measures to combat the novel coronavirus infection.
Excerpts from the transcript:
Question: Russia has lived with the coronavirus for three months now. What could you say about this difficult period? How effective were the measures taken to counter the spread of the novel coronavirus infection?
Tatyana Golikova: 29 May is a special date because the first case of COVID-19 was recorded in Russia three months ago. It was brought by a 30 year-old Russian citizen who returned home from Italy. This is a coincidence, of course, but nonetheless people in Russia have lived in conditions of the new coronavirus infection, in the difficult new reality, for three months now. Of course, we must have a responsible attitude towards our families and ourselves. Our behaviour must be responsible.
On the one hand, these three months were very busy, and on the other, they were highly complicated. There were some special moments during these three months, which I would like to recall because in a sense they predetermined our life during this period and beyond it.
Two months prior to 29 February, that is, at the end of 2019, Russia launched the entire package of anti-epidemiological measures as soon as we received the first information from the Chinese city of Wuhan about the spread of the novel coronavirus infection there. The main result of the first month of work, that is, January, was that we identified the infecting agent based on the publications by Chinese researchers. This was done on 19 January, 2020. Russian scientists from the Vector State Research Centre of Virology and Biotechnology created a PCR test system that was designed to diagnose COVID-19. In fact, that was when we started preparing for an outbreak.
Today, 17 PCR test systems and five ELISA systems have been registered in the Russian Federation. All of them are Russian-made, so we have everything we need for diagnostics and these test systems allow us to be independent and safe in this respect.
We have already explained more than once that the PCR test systems are required for timely diagnostics of the disease, whereas the ELISA systems allow us to reveal how many people in a population had the disease and how many have developed antibodies to the new coronavirus regardless of whether they were in a medical facility or stayed at home without medical attention because they had no symptoms or had a mild case of the disease.
The number of test systems I have mentioned allows us to make about 10 million tests per month. This is a very high figure. As of today, we have conducted over 10 million tests. The number of people who have taken them amounts to 9,354,000. These serious figures give us the grounds to hope that we are able to confirm the maximum possible number of cases today.
In the second half of March 2020, Russia entered an active phase of countering the novel coronavirus infection. We were all getting ready for the negative scenario and, using the accumulated reserve of two and a half months, were preparing our healthcare system for this challenge. When the infection reached Russia, we had around 40,000 beds ready to accept patients. Now, owing to the efforts of all regions we have more than 177,000 beds, including over 25,000 intensive care beds.
Over 80,000 doctors, more than 130,000 paramedical personnel and over 53,000 junior medical workers are involved in countering the new coronavirus infection. Many of them were ready for this work and many had to undergo retraining in the process but obviously, this big medical army has done and is doing everything it can to save as many people as possible.
Regrettably, the first, albeit isolated deaths happened in Russia in March. We recorded them and stared conducting post-mortem examinations to identify the main reasons for these fatalities.
Needless to say, our medical personnel were accumulating very useful practical experience. We adjusted recommendations on treating patients and made our practices more effective. However, regrettably the number of cases continued growing both in absolute and relative terms. To stop the infection (we were not an exception in this case) and proceeding from the main principle of saving human lives, on 25 March the President made a difficult decision to introduce non-working days in the Russian Federation. As you know, they lasted from 30 March to 11 May. This was probably the most difficult period for all of us but it resulted in slowing down the daily growth rate of the infection curve in early April. Since early April and up to this day, the daily growth rate of the disease was reduced by 11.8 times. For several days now, we have observed a 2.3 percent daily increase. Of course, this is still a high number in absolute terms. Nevertheless, the Moscow Region is demonstrating an obvious trend towards a reduction in confirmed new cases although the number of tests is growing substantially and continues to increase.
I should mention some other results I consider important for assessing the lockdown period we went through when we had the non-working days. First, we saw a 2.6-fold increase in cases with asymptomatic COVID-19 as compared to the disease's first and last weeks. Second, there was a 1.4-fold reduction in the percentage of moderate and severe cases. And finally, we had a 1.5-fold decrease in the number of patients who require intensive care. I mention these figures to say that this is allowing us to ease the burden on healthcare – not entirely, but to a considerable extent as compared to April. Yet, our hospitals still have many coronavirus patients with moderately severe and severe cases, and doctors have been working to save them for the past several weeks. And, of course, we are eager to see these patients recover – because, I will say it once again, everything we have done and will continue to do is all about saving the maximum number of lives.
Although we were concerned that the virus will spread further during the May holidays, we have seen the situation starting to stabilise, which created an opportunity to ease the restrictions to a certain extent, and this is what we did. On 11 May, the President abolished the executive order on non-working days, with heads of regions to make decisions regarding restrictive measures in their respective territories in coordination with chief sanitary doctors in the regions. In addition, Russian Chief Sanitary Doctor issued guideline recommendations on the gradual lifting of restrictive measures.
Today, on 29 May, we see that the infection spreading coefficient in Russia is less than one. We monitor the number of new cases every day and very much hope that the growth rate will decrease. But I have to say this will depend on us and our responsible attitude to our families and ourselves. We are going to face a very tough and important period.
Question: Mr Golikova, what is the current situation with the mortality rate?
Tatyana Golikova: We started to register initial COVID-19 deaths in March. They were isolated cases, and they had no effect on the overall mortality rate for the first three months of the year. At the same time, April and May have been difficult months in Russia as regards the death rate. There are several factors that I would like to mention.
On 29 May, we were supposed to post official data on the natural population changes, which includes births and deaths, as well as marriages, divorces and a number of other indicators.
But due to the fact that the period between 30 March and 11 May was announced as non-working days, with only vital infrastructure facilities operating, in certain regions civil registration offices did not work either and thus did not have an opportunity to send data to the Unified State Civil Acts Register maintained by the Russian Taxation Service.
Russia is fundamentally different from other countries in this regard as we keep statistical records for every person, which allows us to track natural population changes statistics in real time.
Regrettably, the situation in April did not allow us to finalise this work; we gathered all the available information for April but it is incomplete. We will definitely finalise these efforts soon and will post the official statistics on natural population changes.
Now I would like to mention how the cause of death is determined in Russia, particularly from infectious diseases. COVID-19 is no exception here as it is an infectious disease as well.
In Russia, autopsies are performed on almost 100% of patients, which allows us to receive accurate data on disease progression and causes of death that cannot be determined if the body is examined superficially.
Post-mortem data is actually a direct response to those claiming we are underreporting deaths from COVID-19. I should note that since day one, when we just started registering coronavirus deaths, our pathologists comprehensively looked into the disease progression and thoroughly examined autopsy samples. They made proposals in the course of this work as regards treatment methods as they could see how the disease progressed and what the actual causes of death were. Also, our pathologists provided information as to which deaths resulted directly from COVID-19 and which were caused by a patient's chronic disease, with COVID-19 only aggravating its unfavourable course.
While preparing for a thorough examination of the death rate structure in the Russian Federation, we used the data provided by our pathologists to classify the COVID-19 deaths.
We also observed related developments at international platforms and took note of the World Health Organisation's proposals as to how COVID-19 deaths should be classified given the experience of the countries that were affected by the novel coronavirus infection first.
On 20 April, the World Health Organisation posted its recommendations; Russia, in accordance with these recommendations as well as those from our pathologists that we believe to be the most insightful, issued guideline recommendations that have been approved by the Ministry of Health and received by all regions for practical implementation.
Now let us look in more detail at the developments over the past four months and in April concerning mortality in the Russian Federation according to the data as of today and, as I have already said, that data is not final.
In January through April, mortality in the Russian Federation decreased by 19,500, and in April by 6,700. But let me reiterate that this data is not final. We realise that the numbers will be changing as more data is obtained, and probably for the worse. Let me try to explain why. As I said, based on the WHO data and the experience of our pathologists we divided all the mortality factors related to COVID-19 in one way or another into five groups and classified them in the following manner. The first group is mortality clearly connected with COVID-19, where the virus was identified in full and where the deceased tested positive for the novel coronavirus infection either during their lifetime or post-mortem. The second group comprises cases where the virus was not identified but the disease progression made it highly likely that the death was caused by COVID-19. We have incorporated these two groups into one, actually, as mortality with COVID-19 as the major cause or as most likely connected with COVID-19. According to today’s data, the number of such deaths in the Russian Federation totals 1,675, of which COVID-19 was confirmed 100 percent by all the information in 1,136.
The second group, as I have already mentioned, may be a little more fluid because autopsy data will be coming and it may be slightly smaller or bigger during this final stage of work. Deadlines for autopsies vary in different Russian regions. The final deadline for the Russian Federation is up to 45 days, although in such regions as Moscow, St Petersburg and the Moscow Region the time autopsies take is considerably less because their laboratory facilities make it possible to conduct autopsies faster.
The third group we identified is death from other causes. In essence, they are diseases a person was suffering from throughout their lifetime. But these people tested positive for the coronavirus. And it is this group where we were strictly following WHO recommendations and post mortem reports to classify the main cause of death.
The third group for today has 1,038 cases, but let me repeat, so far this is not COVID-19, it is a different cause of death (say, a heart attack); however, autopsies on these cases are ongoing. And we took the liberty to divide this group into two more according to crucial conditions that could have accelerated death from the main disease. We are working on this large group. I repeat, autopsies will determine the main cause of death. Then we will certainly publish official reports and will be able to answer how many COVID-19 deaths we have and how many of them were totally unrelated to COVID-19.
These are the major mortality indicators that we have today. We will keep working closely on it while improving both our analytical base, which is being expanded daily, and treatment methods so as to save as many lives as possible.
Question: Some countries did not go along the lockdown route. Was the decision to introduce this regime in our country justified?
Tatyana Golikova: I believe this decision was absolutely correct. Moreover, there are regions that still maintain the lockdown regime, either for some categories of residents or for certain municipalities in their territory, which allows us to prevent the spread of the disease. I have already mentioned such a crucial factor as the basic reproduction number. It shows how many people an infected person can infect before being isolated. It is important for us that this number should be below 1 and closer to .5. Why? Because in this case we will feel more confident that the spread of the disease is slowing and restrictions can be lifted.
Obviously, such decisions were very hard to make. We realise that they have caused an economic slowdown, the need to support the population and businesses. But, as I have already said, the biggest priority for us is saving people’s lives, and I think our doctors are managing to do that, for which we are very grateful.
Now regions are moving towards lifting restrictions, some of them are bolder, others are more cautious. It is important for us that they should take such decisions proceeding from whether the situation is really stable and there will be no bouncing back to lockdown. This is important, and we must bear it in mind.