Dagestan: Coronavirus hotspot raises questions about counting Russia’s Covid-19

Russian President Vladimir Putin holds a videoconference meeting with representatives from Dagestan.

More than two decades later, the remote mountainous region presents a new challenge to the Russian president, as his outbreak of Covid-19 raises new questions about how Russia contains coronavirus infections and deaths.

As of Tuesday, Dagestan confirmed 3,553 COVID-19 cases and 32 deaths, ranking fifth out of 85 regions in official Russian federal statistics. But in an Instagram Live interview with a local reporter on Sunday, the head of the republic’s ministry of health gave much higher figures than Moscow, stating that the total number of people infected with coronavirus and community-acquired pneumonia in Dagestan has exceeded 13,000, with 657 deaths.

When asked by journalist Ruslan Kurbanov to explain why the Covid-19 and pneumonia cases were counted separately, the health official, Dzhamaludin Gadzhiibragimov, replied that patients with pneumonia are treated as if they have the virus, but not all cases are attributed to coronavirus due to a lack of testing.

“Basically, the same [treatment] the methodology is used for both, “he said.” But since we don’t have a lab test confirmation, the statistics are compiled this way. “

As in other countries, frontline health workers in the region were most vulnerable to the fatal outbreak. Between 40 and 50, health workers died in Dagestan since the start of the pandemic, according to estimates by Gadzhiibragimov and the chief mufti of the region. Dagestan has a population of around 3 million people. According to Russia’s ministry of health, the region has 635 intensive care beds and ventilators.

Doctors from the region complained of weeks spent on social media about the lack of protective equipment and some hospitals have had no room to treat their staff. A video of nurses connected to intravenous drips in a warehouse in the city of Derbent went viral in early May.

Civil rights activist Ziyautdin Uvaisov, who heads the Patient Monitor, a nonprofit organization that raised funds to buy protective equipment for Dagestan doctors, told CNN that the health system in the region it is in very bad condition.

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“We’ve been talking about it since 2017, but unfortunately there is a habit of sweeping everything under the carpet,” said Uvaisov.

He added that most of the doctors with whom his organization interacts say that about half of their colleagues are sick and no one can replace them when hospital wards overflow.

The terrible situation in Dagestan has put the republic in the spotlight of high-ranking officials of Russia. On Monday Putin took the unusual step of presiding over a special government session with Dagestani leaders.

“The situation in Dagestan is difficult and requires urgent measures,” Putin said in a video conference, ordering the military to build a 200-bed hospital to help alleviate overcrowded emergency rooms.

Much of the Russian government’s response to the pandemic has been hampered by bureaucracy and mismanagement of regional funds. In poorer regions such as Dagestan, where the average monthly wage is two times lower than the national one, according to the Russian state statistics agency, this dragging has become one of the main reasons behind serious outbreaks.

Further payments promised by Putin to compensate for the difficulties of frontline work have become another complaint for health workers.

“We have been at work since the beginning of the pandemic and have faithfully carried out our duties – now many of our colleagues are [confined] inside medical institutions, fighting for life, “said a paramedic from the city of Buinaksk in Dagestan in a video released by a local store.

“Few of us remain on the front lines. We have 151 employees, but only 41 received payments. Others got nothing.”

Similar videos and open letters they surfaced in at least 20 of 85 Russian regions last week, according to a CNN count. In a public outcry, healthcare professionals complain that they did not receive any additional wages or a fraction of it, calculated on the basis of hours and even minutes spent working directly with Covid-19 patients.

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“If the government decree initially declared clear, understandable, transparent and easily controllable the principles and ways to bring these presidential payments [to health workers] to work in special conditions, then there would be fewer questions for general practitioners working from morning to night, and also for governors, “Putin said Tuesday

The federal government amended the relevant decree, removing a bureaucratic loophole that led some doctors to receive less than 50 cents of extra wages and promised to facilitate all payments due.

At Putin’s special meeting on Monday, officials acknowledged that the situation in Dagestan is more serious than reflected in official statistics. Russian health minister Mikhail Murashko said that 7,000 people were hospitalized. In Monday’s videoconference, the head of the republic Mufti Ahmad Abdulaev told Putin that many Covid-19 deaths are not recorded because people die in their homes without ever being hospitalized and buried according to local traditions – and without a ‘ autopsy that could confirm cause of death.

Vladimir Vasilyev, the head of the republic, attributed the infection rates in part to the traditions of Dagestan, involving mass gatherings to mark pivotal events such as weddings and funerals, as well as a some reluctance to suspend Friday prayers in the early stages of the epidemic. He also addressed discrepancies in the numbers between pneumonia and coronavirus.

“We don’t hide anything,” Vasilyev said, citing the high number of respiratory-related deaths in 2018 and 2019, before the coronavirus. “But here it is [is] it is not so easy to distinguish between the two “.

In mid-April, the streets of the regional capital Makhachkala were still occupied by people. Independent Meduza socket described in a report last week as a 500-person wedding in one of the small towns of Dagestan it became one of the first coronavirus hotspots in late March. However, some Dagestans dispute speculation that their traditions are one of the causes of the increase in infections; Uvaisov, the local activist, expressed distrust of local authorities and the health system for pushing some to disregard the warnings.

The Kremlin has promised to help Dagestan with additional resources to help it combat the pandemic, including more test kits as the republic is still testing twice daily than recommended, according to the Federal Agency for Health and Rospotrebnadzor wellness. The head of the agency, Anna Popova, told Putin that Dagestan is maintaining “a very fragile balance”, as authorities fear that the Muslim holiday of Eid al-Fitr and mass celebrations could cause a new outbreak.

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Russia’s overall coronavirus death toll remains low with 2,837 deaths recorded on Tuesday and its death rate is 7.4 below the global average, according to deputy prime minister Tatiana Golikova. The country’s counting method has been examined by observers who point out that deaths are often attributed to other causes.

Russian demographers and epidemiologists hope that nationwide statistics for all-cause mortality for April, which is expected to be published by authorities in late May, will help to get a clearer picture of the pandemic balance sheet on Russia, both for coronavirus deaths that may have been lost and for people who have been unable to obtain medical care for other conditions due to overwhelmed hospitals.

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