But an important difference separates Russia from the other two nations. On Monday, in the United States, at the heart of the pandemic for almost two months, the mortality rate from Covid-19 was 6%, according to Johns Hopkins; in Brazil, hard hit for a month, mortality was almost 7%. And in parts of Western Europe, including Italy, France, Spain, Belgium and the United Kingdom, the death rate was over 10%.
Dr. Elena Malinnikova, head of infectious diseases at the Russian Ministry of Health, has a simple explanation: the low mortality is due to the rapid detection of the infection as well as the fact that Russians tend to consult their doctor shortly. time after symptoms appear.
Russian journalists have reported that more than 60% of all cases diagnosed in the country have occurred in Moscow, which has a younger and healthier population than rural areas.
Whatever the reason, the extremely low death rate is completely unexpected. So I compared different factors to try to understand what is going on.
The test difference between Russia and Brazil is huge. Dr. Malinnikova and the Russian leadership should be very proud. At the time of this writing, they had tested 40,995 people per million people. In contrast, Brazil has a very low rate, at 3,459 tests per million citizens. (for comparison, the United States has a rate of 30,937 per million).
As we have seen in Switzerland, Germany and other countries undergoing extensive testing, death rates start low as many cases are identified and never progress to serious disease, but as the German epidemic has reached maturity, the mortality rate has gone from less than 0.5% to around 4.5%.
The deep difference between the tests may be the main reason, but other factors may contribute to the risk of death from Covid-19 infection, including being a man, old age, heart disease, chronic lung disease, diabetes and obesity, for which nationally comparative information is available.
It should be noted that Russia has high rates of these comorbid conditions, especially among men.
Unfortunately, neither Russia nor Brazil has published much information regarding the age and sex distribution of cases or deaths in their country, although at the end of April, Brazil reported that 59% of deaths by coronavirus involved men. However, according to the World Bank, 15% of the Russian population is 65 or older, compared to 9% in Brazil (the United States stands at 16%). This difference predicts that Brazil would have a lower death rate than Russia.
Heart disease is also much more common in Russia than in Brazil. Recent study suggests that, whatever the measure, Russia has at least twice the complication rate of cardiovascular disease like Brazil - another reason why Covid-19 death rates would be lower, not higher in Brazil than in Russia.
No statistics on chronic lung disease rates by country are available. However, smoking, a major cause of lung disease, is more common in Russia (57% of men and 23% of women) than in Brazil (17% of men and 10% of women). In contrast, deaths from lung disease are lower in Russia (14.5 per 100,000) than in Brazil (26.6 per 100,000).
Diabetes is about half as common in Russia (6%) compared to Brazil (10%) while obesity rates are about the same: in 2016, Russia was 70th in the world with a prevalence of 23 % while Brazil sat at 22% for 82nd in the world. (In comparison, the United States had the 12th highest rate with 36%).
Therefore, known and measurable risk factors for serious illness indicate that Russia has at least a comparable, if not higher, mortality rate than Brazil.
So, is Dr. Malinnikova right? Is the difference really due to the tests and the apparently efficient Russian health system?
Maybe, but there may be other ways to explain the differences. We do not know, for example, how Russia attributes death to Covid-19. If a person with heart disease dies from the infection, what condition is the "cause"? How quickly does information get to Moscow from rural areas which may have higher death rates given the higher rate of co-morbidities?
And what about deaths in nursing homes - are they included as linked to Covid-19, even though no test has been done?
As in the United States and elsewhere, the precise classification of a death related to Covid-19 remains very important for our understanding of the disease and the effectiveness of our attempts to control it. However, it is very difficult to determine with certainty how a person died.
Diseases are not independent of each other: a person with heart disease will predictably behave with pneumonia worse than a person without heart disease - but if the person dies, what is the real cause of death? Probably a collision of illnesses that collectively burden a person rather than a single nameable cause.
This means that the cause of death can be tilted in one way or another while remaining precise. And with a disease like Covid-19, where political tensions are evident in many countries, this latitude (and the temptation to exploit it) recalls the frightening statement popularly attributed to Josef Stalin, although it is far from being Clearly he said: "It is not who votes but who counts the votes that counts."
In other words, the mortality rate of Covid-19 in Russia and worldwide is not defined by an internationally agreed definition, but by the reporting authorities. Once again, we may find our understanding of Covid-19 hampered by a whole new uncertainty - this not at all medical, but entirely the product of political calculations.
