Russia's low virus death toll still raises questions in West

MOSCOW (AP) - When Leonid Shlykov's father Sergei died after eleven days on a ventilator in a Moscow hospital last month, the death certificate listed the coronavirus as the underlying disease, but not as the actual cause of death.
"Yes, he suffered from kidney dysfunction and diabetes, but he would have been alive without COVID-19," the son wrote on Facebook. "If we had known the actual number of infections and deaths ... it would have helped us make the decision to go to the hospital earlier (father)."
The way Russia counts the deaths during the coronavirus pandemic could be a reason the official death toll, at 6,948, is far below many other countries, although nearly 529,000 infections have been reported only behind the U.S. and Brazil.
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The paradox has also led to accusations from critics and western media that the Russian authorities may have falsified the numbers for political purposes to downplay the scale of the outbreak. Even a senior World Health Organization official said the small number of deaths in Russia was "certainly unusual."
The Russian authorities have balked at the proposals.
"We never manipulated the official statistics," said Deputy Prime Minister Tatyana Golikova.
It is difficult to find the true numbers during the pandemic because countries count cases and deaths differently and the tests for the virus are inconsistent.
However, several factors could contribute to Russia's low virus mortality rate, including the way deaths are counted, the tendency of some officials to beautify statistics, the large geographic location, and the shorter life expectancy of the population.
An autopsy is mandatory in Russia in every confirmed or suspected case of COVID-19, with the cause of death being determined by a commission, said Dr. Natalia Belitchenko, a pathologist in the doctor's office in the St. Petersburg region.
She deals with coronavirus deaths almost every day, but said only about 20% of them were attributed to COVID-19. In other cases, the virus has been found to be an underlying disease.
"In the vast majority of cases, pneumonia itself would not have resulted in death if the underlying conditions had not flared to death," she told The Associated Press.
Unlike Russia, the official death toll of some countries includes those who had COVID-19 but died for other reasons, said Dr. Michael Ryan, Executive Director of the WHO Health Emergency Program.
"It will be important that the Russian authorities review the manner in which the death certificate is carried out to ensure that they are adequately attesting to deaths," he said.
The number of deaths varies worldwide as the number of COVID-19 deaths in countries was underestimated early on, said Ali Mokdad, professor at the Institute of Health Metrics and Assessment at the University of Washington. They attributed virus deaths to other causes due to inadequate testing, or initially counted only deaths in hospitals, he added.
Some countries also count too much by including "suspected deaths" - those who are likely to have died from COVID-19 but have never been tested, Mokdad said.
But what distinguishes Russia is the habit of disguising embarrassing truths, said Judy Twigg, a professor at Virginia Commonwealth University and a senior associate at the Center for Strategic and International Studies.
The way in which mortality data is collected in Russia is influenced by the tradition of the Soviet era to set future goals for improving public health by trying to reduce mortality for certain reasons, such as alcoholism or tuberculosis.
Health officials "are changing the way they code causes of death to try to achieve those goals," said Twigg.
Pathologists told AP that hospital administrators are exerting pressure to produce better looking reports.
Requests and instructions to cover up certain causes of death in postmortems are "an inevitable part of our job," said a pathologist in Siberia, who spoke on condition of anonymity because he was not authorized to speak to reporters.
Data analysts say that inconsistencies in Russian virus statistics indicate tampering, e.g. For example, regions reporting a similar number of new cases for several days in a row, or the number of deaths in regional reports that differ from those in federal reports.
"I do not trust official statistics and I believe I have reasons not to do so," Boris Ovchinnikov, director of the Moscow-based research agency Data Insight, told AP. "However, we do not have good alternative indicators to assess the real situation."
Among the anomalies:
- The governor of the Lipetsk region in southwestern Russia told his subordinates last month that "the numbers have to be changed, otherwise our region will be judged badly".
- In the Altai region in southern Siberia, a task force published a daily infection update with the words "for approval" to the provincial governor. It quickly deleted the words after it was reported on social media.
- Unusual peaks in pneumonia deaths indicate that more virus deaths than may have been officially reported in mid-May: St. Petersburg reported 694 pneumonia deaths, including 63 from coronavirus; The North Caucasus Republic of Dagestan reported 657 pneumonia and 29 coronavirus deaths.
"There was no doubt that statistics were manipulated at regional level," said Gleb Pavlovsky, an independent analyst and former Kremlin political advisor, adding that they appeared to have done so "on their own initiative".
At the same time, he noted that a drop in the number of cases was a key factor in the implementation of two major events on the Kremlin agenda that were postponed by the virus: a massive parade in Red Square to mark the 75th anniversary of World War II victory and one Vote on constitutional changes that could extend President Vladimir Putin's rule to 2036.
Calling for a slowdown in infections, Putin ordered the parade for June 24 and the vote for July 1. Most regions, including Moscow, recently lifted the strict restrictions imposed in March, although the daily number of new infections remained high at around 9,000.
To dispel allegations of under-mortality reporting, the government released updated statistics for April, listing patients who died of other causes while tested positive for the virus, as well as patients who tested negative, but probably died of it.
If these were counted as coronavirus deaths, mortality would have been 60% higher than advertised. The authorities insist that they should not be included in the official toll, but even if all additional deaths recently reported by federal and Moscow officials were added, it would still be around 11,000.
Russian officials attribute early quarantine measures and rapid expansion of hospital capacity that prevented health system overload. They also cite more than 14 million tests that have helped identify asymptomatic cases that account for more than 40% of all recent 146.7 million infections in the country.
Officials found that infections in Russia peaked later than in Europe and deaths are now increasing faster.
Experts say Russia's statistical gaps could result from its outdated mortality data collection system: in many regions, a death certificate must be issued by a relative of a local registry office. Many of these offices were closed or had limited opening hours due to corona virus locks.
"What we are seeing now is insufficient data in many regions," said Alexei Raksha, an independent demographer.
He said data from civil registries he examined showed that some regions reported fewer deaths in April than in previous years. In the southern Republic of Ingushetia, deaths were five times lower, while in Krasnodar they fell by around 1,500 compared to the monthly average, a record low.
"Some people just bury their relatives without going to the registry office," said Raksha.
Researchers expect most of these gaps to be closed next year when the Russian State Statistics Service publishes its annual report.
Raksha said Russia's few deaths from viruses could also be due to less frequent trips across the country, its low population density and lower social mobility. He also said that because the country has a much lower life expectancy than the West, it has fewer older targets for the virus.
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Follow AP pandemic reporting at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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