Russia did not miss the beginning of the epidemic’s spread, and it has a very good chance that the spread of the coronavirus will be less extensive than in some other countries, believes Melita Vujnovic, the representative of the World Health Organization in Russia.
In an interview with BBC correspondent Oleg Boldyrev, Dr. Vujnovich answered the most frequently asked questions about the coronavirus: how Russia is coping, whether masks help, and when we can expect the end of the pandemic.
BBC: When it comes to the epidemic in Russia, what role does the WHO play, how much do you determine measures to combat the coronavirus, and can you insist that the Russian authorities do something?
Melita Vuinovich: The general role of WHO in each country where it is present is clearly defined. In Russia, we provide advice on policy development or technical recommendations. It is not our role to insist. Similarly, in the United Kingdom, we do not insist that the authorities do or do not do something. We make recommendations and assess the situation together when the national health system wants to review or discuss something.
BBC: A few days ago you expressed hope that the epidemic in Russia would be relatively small compared to some European countries. Has anything changed in the last few days?
M.V.: We are looking at the numbers and currently see a roughly equal increase. In order to draw conclusions about percentages and cumulative growth, we need a weekly series of observations. So far, the numbers correspond to a good scenario in the sense that we do not see a sharp, exponential growth. In any case, by understanding the situation of those who have been in contact, there are good chances for a strategy that will allow us to flatten the infection curve. The main thing is to make sure that the graph reaches a plateau without further increase.
BBC: Do you trust Russian disease statistics? Many people in Russia do not believe the official figures. Do you have other sources?
M.V.: It is not a question of trust or distrust. We have access to the mortality data. And if you look at the data for January and February in 2019 and 2020, you will see that this year, in these months, fewer people died compared to 2020. Then, according to the ICD-10 classification, we look not only at pneumonia, but also at other diseases that could indicate a death related to the epidemic – and here we also see a decrease. So not only is there no increase, there’s actually a decrease, and that tells us that we haven’t missed an unaccounted for, hidden epidemic, because it would have been visible anyway. We explain quickly, simply, and clearly what happened, why it matters, and what will happen next. The number of offers should remain: episodes. The end of the story: Advertising Podcasts.
BBC: Russia is following other countries with an epidemic with some delay, but many people think that a lot of time was lost in February and March because there was little and slow testing, and therefore the establishment of a network of contacts was also insufficient and slow. Could that be influencing the statistics we are seeing now?
M.V.: Actually, if you look at the WHO recommendations on testing, you will see that it is not only the quantity of testing that is important, but also who is tested and how they are isolated. In February and March, Russia had a very intensive policy of identifying potentially infected people, testing and isolating those who had contact with them, and testing those who had contact only if they had symptoms. In a situation where you do not have a huge reserve of tests, this is exactly what WHO recommends. That is why it seems to us that the Russian system was able to detect the majority of cases, but as everywhere, there are probably cases that were not detected, and now the increase in testing is revealing precisely those cases. We believe that targeted testing has been done quite well and has given the country time to prepare the health system for the epidemic.
BBC: The correlation between the total number of tests performed and the number of confirmed cases is often discussed on social media. Russian statistics show one confirmed case per 120 tests, while Italian statistics show one confirmed case per 5 tests, and British statistics show one confirmed case per 4 tests. Many believe this indicates inaccuracies in the Russian tests. Is this true?
M.V.: No, I wouldn’t say that. First of all, Russia provided the parameters of its test systems to the WHO at the very beginning, and we had no special claims regarding the tests in comparison with tests in other countries. The difference in detection definitely depends on the stage of transmission of the infection in a particular country. Russia was in scenario 2 for a long time – a situation of imported cases. There were many such cases, but overall they were still sporadic imported cases of the disease. Then came the outbreaks of the disease, which is Scenario 3 – widespread transmission in social groups over a large territory. This is evident in the number of new cases, but also in the statistics of new tests. And this also answers the question of whether there is a hidden epidemic that you are missing.
BBC: What about very young patients in intensive care? We have always been told that the virus hits the elderly hard, and suddenly in Moscow there are reports that 40% of people on artificial lung ventilation are under 40. Can we trust this data?
M.V.: I don’t think this is about mechanical ventilation. Intensive therapy and oxygenation are not mechanical ventilators, there is a difference. Although, if we look at the mortality rate, it is mainly the older age group. Also, I have seen from the very beginning that Russia has taken a course of hospitalizing and treating all severe cases, including with oxygen, which again is in line with WHO methods. We believe in what the authorities are reporting, but there is still much unknown about the coronavirus, it behaves differently in different age groups. Only when the epidemic is over and all the studies are available will we be able to talk about what happened in each age group.
BBC: Moscow has the most laboratories and more facilities for isolating patients. Could it be that we are not seeing the real picture because testing and contact tracing outside Moscow is weaker and slower?
M.V.: As far as I understand, Rospotrebnadzor is a vertical structure with a large number of personnel on the ground. The classic method of “worn-out boots” (wide outreach to residents – BBC) works here. It also worked in Singapore. We believe that contact tracing will be done quickly after the emergence of new cases. However, it should be understood that the country cannot have a single scenario of transmission of infection. Russia is a huge country and, of course, it is necessary to ask about the situation of the authorities in the regions.
BBC: On March 26, you said that quarantine was not necessary in Russia. Did you speak too soon?
M.V.: I didn’t say that Russia doesn’t need quarantine. I said that quarantine is an epidemiological term and it means that people suspected of infection should be isolated. It is a term. If you mean a complete lockdown, at that moment it didn’t seem necessary. But such decisions are made by the government, both central and regional governments, because they have their own risk assessments. The main thing is to follow the regime. Compliance is the most important measure in the fight against the epidemic.
BBC: Don’t you think that President Putin should have been tougher from the beginning, and then people wouldn’t have been relaxing with kebabs in the parks? What should have been said more clearly and firmly from the beginning?
M.V.: WHO believes that it is the responsibility of the authorities to assess the situation and take measures that are appropriate to the national context. Be it socio-economic or cultural. The subsequent measures have been quite effective. It’s not WHO’s job to tell the authorities of a country to do this or not to do that.
BBC: The question of masks. There is complete confusion around the world about what masks can and cannot do. Do you have a clear answer about what masks protect us from?
M.V.: The WHO has just published its latest technical recommendations, and I do not want to repeat them for fear of making a mistake. WHO definitely believes that masks are most important for health care workers, because these people are at a much higher risk of infection and need to be protected. Masks should be worn by the sick to protect the atmosphere around them. As for the use of masks by the rest of the population WHO urges countries where it has been decided that healthy people should use masks universally to monitor the situation carefully and look at the data, the potential risks and the local context, because justification and data showing that it works are needed. Yes, a special group is working on evaluating such indicators, evaluating all the data and options. With the current shortage of masks in the market, leaving healthcare workers without them means creating real problems. (Editor’s note: In its published recommendations, WHO leaves the question of widespread use of masks to the discretion of national authorities, but emphasizes that health care workers should be the first to be provided with masks and points out that the mask itself does not provide adequate protection against the coronavirus; it is necessary to maintain hand hygiene).
BBC: You’ve said before that you’re not Nostradamus. And yet, based on the numbers and trends that are visible now, can it be said that there will be a peak of infections in Russia at a certain date?
M.V.: Definitely, many models are being constructed now. But I am not Nostradamus and I am not a mathematician. Russia is building models, and the WHO is also modeling something. There will be a peak and there will be a flattening of the curve. What we need is for the curve to reach a plateau, because that means that the health system will be able to cope with the number of cases. At the moment it is difficult to be more specific and to play with numbers.
BBC: What is the relationship between the shape of this curve and the isolation measures? If the increase in the number of cases is small but not decreasing, does that mean that the isolation measures need to be tightened?
M.V.: It depends on the risk assessment and, as I said, it should be looked at in terms of percentage growth and cumulative cases. In other epidemics, the focus is on cumulative growth. Right now, off the top of my head, I would say the increase is around 15%, which is quite good compared to other scenarios or exponential growth. But this depends on many factors and needs to be monitored.
BBC: Is it correct that if the use of coronavirus antibody testing is widely established (which allows one to understand if a person has had an infection – BBC), this will somehow allow people to return to their jobs?
M.V.: Antibody tests are definitely used for scientific purposes. The WHO does not recommend them for diagnostic purposes, only to determine the general immunity of the population. This will also depend on government policy, but we can already see how some European countries are easing restrictions and gradually reopening their economies, such as Austria or Estonia. As we understand more about the epidemic and its evolution, different countries will be able to make decisions and get people back to work.
BBC: What about the risk of re-infection? Has this been studied?
M.V: Research is ongoing. So far, these are isolated cases. The WHO is monitoring this closely, but it is too early to say anything definite. We are not seeing a large number of cases yet.
BBC: Is it possible that the damage to health caused by non-viral diseases and phenomena – associated with stress disorders, depression, domestic violence – could at some point exceed the damage caused by the virus?
M.V ..: WHO is in close contact with the Russian and Moscow authorities to ensure their support for the general health services that still need to be provided. Efforts to control the coronavirus should not overshadow the normal work of health care. Of course, there has to be a balance. We need to address not only Covid-19, but also other pathologies – elderly issues, mental health, cognitive disorders due to depression, and rehabilitation work. Maintaining physical activity at home. I hope that in the next 10 days we will see several television appearances where such measures will be announced.
BBC: Russian health care has a mediocre reputation. Its citizens always curse it, and the authorities don’t seem to help when they “optimize”, reduce services and close hospitals. But health systems in other countries are not prepared either. Do you think that Russian healthcare has any advantages at the moment?
M.V.: I don’t know how citizens perceive this, I was talking about how important it is to give them information so that they understand what is happening. I think this is being done in Russia. If we look at the closure of hospitals, the same thing happened in other post-socialist systems, they closed small rural hospitals that could not provide proper services. Another thing is that instead of this, more outpatient or remote services should have been provided, but this needs to be evaluated after some time has passed. In Russia there is a system, there is a centralized strategy that is implemented at different levels throughout the country. The system has been prepared. To compare it with others and to say what was done better than others or what could have been done better will have to be done after the epidemic is over.
BBC: Some questions about treatment or medication. Russian authorities are also testing Plaquenil, an anti-malarial drug, in the fight against coronavirus. What do you think about that? How does WHO view the use of antimalarial drugs in this case?
M.V.: The World Health Organization (WHO) has established the Solidarity Trial System, which 74 countries have joined.
The system evaluates different methods of treatment and control of the coronavirus. After a full evaluation of safety and efficacy, it will be possible to say something. For now, this is just one of the trials in this system and it is too early to talk about the results.
BBC: What do you think about the so-called “BCG hypothesis” (according to some calculations, the number of coronavirus-related deaths is lower in countries where this vaccination is mandatory)? In other words, the idea that BCG vaccination somehow increases not only immunity against tuberculosis, but also general immunity?
M.V.: That also needs to be studied – how the immune system responds and what strengthens it. If we look at China, the BCG vaccination coverage there is 99%, but they still had a huge epidemic in China. At this stage, it is too early to say that this vaccine or any other vaccine actually boosts immunity, because this vaccine is against completely different antigens. The WHO will answer such questions during its regular scientific research briefings.
BBC: But back in 2014, the WHO decided that the BCG vaccine does not increase overall immunity. Is there any chance that this decision will be reconsidered?
M.V.: This is a question for our headquarters, not for me.
BBC: Back to statistics and numbers. In the United States, China is currently being criticized and accused of concealing the true extent of the epidemic and the mortality rate from the coronavirus. Some American politicians claim that the WHO was aware of this concealment. Has real data been withheld and did the WHO know about it?
M.V.: As I said, this is definitely beyond my authority and competence. You should ask the Director-General of WHO about this.
BBC: Will this pandemic lead to any fundamental changes in the way healthcare systems are set up in different countries, or will everything still depend on specific political and economic circumstances?
M.V.: This is a huge problem of our century and a global problem for the whole world. Globalization has allowed the virus to spread so quickly, creating so many different scenarios in different countries and testing everything we believe in as a human race. As a result, we will have to look at how the health systems of different countries work together. No one country will be able to deal with this alone. Some people will need protective equipment or medicines from abroad. Others will face an influx of visitors. WHO member states are already collecting and analysing data. Understanding how to prepare for everything is happening in parallel with the fight against the epidemic. And now it is critical for the world to recognize the importance of health workers – not just doctors, but everyone involved in these systems.
BBC: You communicate a lot with official figures in Russia. Until recently we have seen them either not wearing masks or sitting close to each other… Do you think they care about that? Do they understand the danger?
M.V.: Yes, absolutely. When I was last at the Ministry of Health, we had a strict two-meter distance. Now I work mostly online, communicating with the regional administration in Copenhagen or the headquarters in Geneva, and communicating with other organizations. And everything is already done through remote communication. There is a deep understanding of what is happening and concern for people’s fate.
Elderly people have found themselves in isolation due to COVID-19 not only in Russia, but also in many countries of the world. They told the Russian service of the BBC what they do in self-isolation and what they fear the most.