From home immediately taken to the cemetery In Russia, covid is massively ill not only in million-plus cities, but also in villages. There are no doctors and quality medicine – and it’s harder to survive

In Russia – the second wave of coronavirus: on October 20, for the first time during the pandemic , more than 16 thousand new cases were registered in the country per day. Most of the cases are in Moscow, St. Petersburg and other cities with a population of over one million, but covid in Russia is massively ill even in villages and villages. Meduza talks about how local residents are trying to defeat the infection with little or no help from doctors – and why the authorities sometimes choose very exotic ways to contain the infection.

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At first, residents of the Khabarovsk village doubted the existence of the covid. Then an epidemic covered the village – and they panicked

Rumors of the coronavirus spread across the village of Bogorodskoye in late March, shortly after news of the first confirmed cases in the Khabarovsk Territory. At the same time, Russian President Vladimir Putin announced the “non-working days” regime. Due to the increased attention of the authorities to some unknown disease, some locals decided that the coronavirus was a government invention. However, they were unable to explain to Meduza why the government needed this.

Bogorodskoe is a large settlement on the right bank of the Amur, about 700 kilometers from Khabarovsk and 1200 kilometers from the Chinese city of Jiamusi. Its residents tell Meduza that the village is actually divided into two parts: the “old” one of wooden houses near the brick-making plant – and the “center”, where there are several stone buildings, as well as a school and a hotel. There is a small airfield nearby, from where you can get to Khabarovsk.

More than three thousand people live in Bogorodskoye, this is the center of the Ulchsky district. However, locals complain that there are almost no roads here, electricity is regularly cut off in houses, and young people try to leave the village right after school. Those who remain are mainly engaged in agriculture or fishing, or work in local budgetary institutions.

A local teacher, who asked not to be named, tells Meduza what happened in the spring in Bogorodskoye: “Our people were divided: some really started wearing masks, others said that the covid was not dangerous, that it was invented up there. It lasted a couple of weeks. Then almost everyone believed when people began to die. ” These words are confirmed by other villagers interviewed by Meduza: according to them, many elderly people had to explain that the coronavirus can indeed be dangerous.

Already at the beginning of April, several patients with suspected covid were urgently hospitalized from Ulchsky district to Khabarovsk . Three days later , the first four cases of infection in the village became known . Patient zero in Bogorodskoye was never found, but  quarantine was organized : entry and exit were closed, a curfew was imposed from 20:30 to seven in the morning, and residents were allowed to go only to the nearest store. An exception was made for doctors and sellers. “Only yesterday the village lived an ordinary life, but today it’s scary to go outside once again,” another local resident recalls in a conversation with Meduza. 

The streets of Bogorodskoye were empty. Many villagers stopped leaving their yards, tending to the garden and looking after the livestock. Some villagers complained that they missed the two-week smelt season because of quarantine, but in the end no one broke the quarantine, residents assure Meduza.

On April 13, the regional government said that the coronavirus had already been confirmed in 18 people from Bogorodsky. The authorities noted that one of the evacuees from the village died in the Khabarovsk hospital – a nurse in the procedure room of the district hospital. The name of the deceased nurse was not named in the government, citing medical secrecy. Meduza’s interlocutors also do not remember the name of the deceased, but note that this is an elderly woman who sang in the local choir and worked in the physiotherapy department. Some personally underwent procedures with her, many encountered her in the village.

Some local residents admit: after the death of the nurse, panic began in the village. People began to complain to doctors about any symptoms of SARS. A doctor from a local hospital said that he had to raise his voice to both patients and medical staff in order to calm them down.

All this did not help to stop the covid. By the end of April, 116 people had already confirmed the coronavirus in the Ulchi district – they were mostly treated either on an outpatient basis or in a hospital in Khabarovsk, where they were hospitalized by helicopter. In Khabarovsk, two more people with coronavirus from the Ulch district died, the regional hospital reported . They were not included in the statistics for the region, since the coronavirus was considered a side disease that did not affect death.

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Блокпост на въезде в Богородское. 20 апреля 2020 года
Checkpoint at the entrance to Bogorodskoe. April 20, 2020Administration of the Ulch Municipal District

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Дезинфекция села Богородское
Disinfection of the village of BogorodskoeRussian Emergency Situations Ministry

In the hospital in Bogorodskoye itself, according to the hospital, by that time there were only 16 people; as local residents and a hospital employee explain to Meduza on condition of anonymity, these were mostly infected doctors, who continued to work as there was a lack of personnel.

“We have no other choice, there are no more employees. We have a patient with a gunshot wound. If we hadn’t helped him, he could have died. How to be? From Rospotrebnadzor, then no one will ask, they will ask me, “- explained the situation the head of the surgical department Mikhail Dergilev (he is also a deputy of the Legislative Duma of the Khabarovsk Territory from the  Liberal Democratic Party ).

Doctors became infected, including due to a lack of personal protective equipment (PPE) – later Rospotrebnadzor officially discovered violations in a rural hospital. An employee of the clinic, in a conversation with Meduza, recalls that soon after the outbreak, many elderly nurses quit the institution, precisely because they were afraid of getting infected.

The incidence in the village began to decline only in May, after about a month of quarantine. On May 15, the restrictions were lifted . But in June, Bogorodskoye again got into the news: some doctors complained that they had  not been paid presidential allowances for work with coronavirus. Later, the prosecutor’s office issued an order to the head physician of the Ulch regional hospital and obliged him to make the due payments to employees. 

There are now three people with coronavirus in Bogorodskoye, an employee of the district hospital tells Meduza anonymously ( more than 160 people have been ill in the Ulchi district in total ). The interviewed villagers mostly do not know that some of the villagers continue to suffer from covid. However, they complain about problems with medical care. Two villagers immediately told Meduza that the cost of a full medical examination at a local hospital had recently jumped by about five to six thousand rubles (up to 16 thousand). Now they prefer to take a taxi for about 13 hours to Khabarovsk in order to undergo an examination and take tests – this is cheaper, despite the fare, which is about three and a half thousand rubles.

Local residents associate what is happening with a shortage of personnel. Local newspaper DVhab wrote that there was a conflict in the hospital between employees and the new chief physician, who in the summer lowered the salaries of those who combined several rates. According to the newspaper, because of this, the gynecologist, anesthesiologist, surgeon and head of the therapeutic department left the hospital. According  to data from the website of the Ulchskaya regional hospital, now there are not enough 11 doctors in Bogorodsky – including two vacancies for a surgeon and an anesthesiologist-resuscitator.

Local residents worry that because of this the “second wave” may turn out to be a more serious problem for the village: “Now most people follow all the rules. But people are still likely to get sick. What can we do without doctors is not clear. “

In theory, covid spreads more slowly in villages than in cities. But outbreaks of the disease were recorded in many villages.

Bogorodskoe is no exception: outbreaks of covid have occurred in dozens of Russian villages. Many villages were quarantined. This often led to local discontent. For example, residents of Zaoksky in the Ryazan region, where at the time of the introduction of quarantine there were 13 infected (there are about a thousand villagers in total), were unhappy with the decision of the administration to prohibit leaving the village. At a spontaneous rally, they demanded either to cancel the quarantine, or to give the names of the sick – “to know who to fear.” Three days after that, the planned two-week quarantine was canceled by the authorities .

Moreover, at the beginning of the pandemic, the regional authorities in Russia advised urban residents to isolate themselves in their dachas, villages and villages, citing the low population density. Most of the residents of Russian villages with whom Meduza spoke are also confident that they are better protected from covid than townspeople.

The incidence of covid in the village has been little studied in terms of epidemiology, mainly due to low testing in the province, experts interviewed by Meduza say. But even judging by the general data for regions with a large number of rural population, the identified incidence there is already relatively high. For example, in the Altai Republic, where rural residents make up about 70% of the total population, more than five thousand cases of COVID-19 have been recorded. Now there is an increase there: in the month from September 18 to October 18, the total number of cases has almost doubled. New cases are recorded there at once in many districts, and the index of the number of infections per 100 thousand population in the republic is one of the highest in the country: just over 2390 (in Moscow, for comparison, 2896).

Epidemiologist, researcher at the European University at St. Petersburg Anton Barchuk says that the coronavirus should theoretically come to villages and villages later than to cities. He attributes this to the fact that the infection spreads more slowly due to low passenger traffic and a small number of residents, which reduces the number of contacts. However, it is still possible to get sick: the main route of infection, according to the epidemiologist, is when someone comes to the settlement from the city.

Nadezhda Satosova, an epidemiologist from a private multidisciplinary medical center “XXI Century” agrees: judging by the observations of infectious diseases, they spread (regardless of transmission routes) in urban and rural areas in different ways, and the main difference is in the speed of spread. It is slowed down by the lack of metro, hypermarkets, densely populated areas – and, in principle, by the fact that there are few places for leisure in the village.

Barchuk notes that people in villages may “logically” face serious problems due to rare testing and lack of quick access to medicine. In theory, this can lead to more mortality.

According to Satosova, the situation is complicated by the fact that the infectious diseases service is one of the most economically costly items of health care. Because of this, the problem for rural doctors – when faced with any infectious disease – is the lack of access to expensive equipment and problems with the provision of consumables, as well as laborious laboratory diagnostic techniques, on which the success of treatment depends.

As a result, in many settlements in large regions, there are simply no doctors who can provide quality care for coronavirus.

In the Ural village, the “legendary man” was not treated for a week. The journalists called the farewell to him a “rally”, the police came to the village to check

In the village of Pervomaisky, 180 kilometers from Yekaterinburg, there are only six streets, and the main attraction is the House of Culture, opened back in 1978. 

There are no hospitals in Pervomaiskiy. One feldsher-obstetric center is open for 600 residents, but it works once every one or two weeks, when a doctor comes there from the hospitals of the Pyshminsky district (which includes the village). The station’s permanent operation stopped about 10 years ago, when a local paramedic retired, two people living in Pervomayskoye explained to Meduza.

After that, the villagers went for urgent medical care to neighboring larger settlements, about 50 kilometers from Pervomayskoye. Locals complain about the quality of the services they provide there, but, as one of the residents says, “nothing can be done anyway”.

“Medicine is our common big problem,” a journalist from Pyshma who asked for anonymity tells Meduza. – There is a shortage of personnel and poor quality of work. Doctors have to combine several rates, which is why they are torn apart in several positions. Attitude towards patients is also a problem: somewhere there is indifference, somewhere very superficial immersion in the situation. “

Whether there are now officially confirmed cases of COVID-19 in the village, Meduza’s interlocutors do not know. However, they note that in the spring and summer in Pervomaiskoe, some residents showed symptoms of pneumonia. They were treated mostly at home and only “as a last resort” went to hospitals for examination. Locals explain that not everyone has cars here, so some have to spend two or three thousand rubles on the road – taxis and public transport. Another local journalist, speaking on condition of anonymity, told Meduza that when local residents with covid-like symptoms come to hospitals in neighboring towns, no one isolates them there and they sit in a common queue.

Presumably, Gennady Podoksenov, a “legendary man,” as Znak.com described him, became the first officially infected with coronavirus in Pervomayskoye . Podoksenov is one of the  eight honorary citizens of the Pyshminsky urban district and the former head of the state farm, around which the village grew in the 1960s – 1970s. 

“The most important thing, for which everyone is grateful to Podoksenov, is that he managed to keep the state farm in the 1990s. You yourself understand what time it was. Then the Ministry of Defense wanted to give the farm, but he somehow agreed. The jobs remained. Plus, he always knew how to listen, support, – says a local journalist. – True, then the state farm still went into private hands. A gradual, albeit small, outflow of people [from the village] began. “

As Podoksenov’s daughter Svetlana Kazantseva told Znak.com, her 83-year-old father developed symptoms of coronavirus at the end of August. Prior to that, the man traveled 150 kilometers for two weeks to the Asbestos hospital (a city in the Sverdlovsk region) for hemodialysis due to the removal of a kidney, where he probably became infected.

When Podoksenov’s temperature rose to 38, his daughter called an ambulance; doctors, she said, took swabs from him for a covid test and left. Soon the temperature rose to 39, it could not be brought down. In this state, Podoksenov lay for almost a week, there was no news from the doctors. Then she called a relative who works at the Pyshminsky district hospital, and she said that Podoksenov had a coronavirus. 

According to her daughter, on September 2, her father was taken to the city clinical hospital No. 40 in Yekaterinburg. On September 4, the man stopped answering calls. On September 9, Kazantseva was told by phone that her father had been put into a coma and connected to a ventilator. On September 11, Kazantseva was called again and told that he had died.

Farewell to Podoksenov in the village was scheduled for September 14, three days after his death. On this day, about 30-40 people gathered near the House of Culture in the center of Pervomaisky. The daughter and granddaughter of the deceased also came there, and they immediately announced that the body would not be brought to the meeting place: it would be buried only with the participation of relatives.

Собрание после смерти Подоксенова в поселке Первомайский
Meeting after the death of Podoksenov in the village of PervomaiskyJaromir Romanov / Znak.com

According to the interlocutor of Meduza, who attended the farewell, the audience first spoke emotionally about Podoksenov’s death, and then moved on to discussing medicine in the village. A Znak.com journalist who attended the meeting cites the following excerpts from this discussion:

– They all have one word – “optimization”. With this optimization, we have already reached the handle. Medicine, in short, must be cured itself.

– What was the hospital in [the neighboring village] Chetkarino, eh? Now everything has closed in a circle! It seems that from home we are immediately taken to the cemetery. Putin is talking about millions [rubles invested in medicine], but where are they?

– The village in Russia lives like in a garbage dump, and on TV they show the beauty of the capitals, how everyone supposedly lives well, and Putin, who boasts endlessly of all this. In fact, everything is not so with us!

After about an hour and a half, the residents went home; The media called this meeting a “rally”. At the same time, the interlocutor of “Meduza”, who attended the farewell, tries to be careful in the wording and says that people just “wanted to speak out, discussed deep problems and listened to each other’s opinions.”

Four days later, police arrived in the village, walked around the houses and questioned people about the “unauthorized event.” At the same time, according to  the assurance of the head of the regional Interior Ministry’s press service Valery burned, the police did not want anyone to prosecute. “The representatives of the Ministry of Internal Affairs, as it should be in these cases, clarified the situation and the circumstances under which the event took place. No more. Nobody intends to start any business, ”he said.

Almost a month after these events, cases against the residents of Pervomaysky did not really appear. It is not known for certain about the cases of coronavirus infection at the meeting, but Podoksenova’s daughter was hospitalized shortly afterwards with a confirmed covid. She did not answer Meduza’s questions; her condition is unknown.

Interviewees say that some of those who attended the meeting in memory of Podoksenov isolated themselves, but no one has yet been tested for coronavirus. According to Meduza’s interlocutors, the medical situation in the village remains the same.

In Russia, no separate statistics are kept on sick people in villages. At the same time, the share of the rural population is 25%

According to the  calculations of the Center for Economic and Political Reforms, carried out in 2017 based on Rosstat data, from 2000 to 2015 the number of hospitals in Russia decreased by half – from 10.7 thousand to 5.4 thousand. Polyclinics decreased by 12%. 

The authors found that the optimization of the health care system led to this – the redistribution of costs by closing ineffective hospitals and the increased use of high-tech medical facilities. Officially, this optimization began with the health care reform in 2010, although, in fact, similar measures were taken already in 2003-2005.

In 2019, Deputy Prime Minister Tatyana Golikova officially recognized the optimization of healthcare in many regions as a failure. A year earlier, Vladimir Putin had been particularly critical of rural optimization. “In a number of cases, I just have to say this today, they were obviously carried away by administrative reforms: they began to close medical institutions in small settlements and in the countryside. <…> They left people practically without medical assistance, offering nothing in return. There is only one advice: “Go to the city – there you will be treated!” This is absolutely unacceptable, I want to say. Forgot about the main thing – about people. About their interests and needs. Finally, about equal opportunities and justice, ”said the president.

Shortly after Putin’s announcement, the All-Russian Popular Front (ONF) conducted a survey of villagers. Most of them – almost 85% – had complaints about the quality of medical care. 7% of respondents said that there is no medical organization at all in their settlement. According to the still unfinished map of the availability of medical care from the ONF, only in the Sverdlovsk region there are about 90 villages located more than six kilometers from the nearest medical center. In Dagestan and Altai Territory there are almost 70 such villages, and in Ryazan, Novgorod and Omsk regions, as well as Krasnoyarsk Territory – 50 each.In the Leningrad Region, Krasnodar Territory, the Republic of Mari El and the Chuvash Republic there are about 100 such villages, in Bashkortostan and Primorsky edge – almost 120.

After the outbreak of the pandemic, Leonid Roshal, President of the National Medical Chamber, told Kommersant that the issue of the readiness of the healthcare system in the event of mass admission of victims in emergency situations was discussed back in June 2019 at a closed meeting on the basis of the ONF. Then its participants came to the conclusion that “we are not ready to provide massive assistance to the population of the country”, including because of the optimization of health care and staff cuts.

Despite the  message the media of outbreaks kovidah in dozens of villages, to analyze the incidence of such settlements is very difficult, says “Medusa” independent demographer, former adviser to the Federal State Statistics Service Alexei Raksha. This is due to the fact that the official website of the Ministry of Health “Stopcoronavirus” contains only information on the incidence of diseases throughout the constituent entity of Russia, where there may be dozens of villages and villages. The telegram channels of the operational headquarters sometimes indicate the number of cases in individual settlements, but generalizations are made there too. There is often no other data available.

For example, Pervomaisky refers to the Chetkarinskaya village council, which is part of the Pyshminsky urban district in the Sverdlovsk region. In the messages about new cases, which are published in the  telegram channel of the headquarters of the Sverdlovsk region, there is a division by city districts, but without specifying the exact number of infections. So, the Pyshminsky district, which includes 44 settlements, is mentioned 46 times in the reports from April to October, but it is impossible to know the number of infected there according to open data.

The head of the Chetkarinskaya village council (which includes Pervomaisky and three other villages) Tatyana Krivonogova told Znak.com that by mid-September 67 coronavirus cases were registered on their territory, as well as “many people with community-acquired pneumonia who have not confirmed COVID”. There is no data on registered coronavirus diseases specifically in Pervomaiskiy. Meduza was unable to contact Krivonogova because she is on sick leave – it is not known whether this is related to the coronavirus.

Alexey Raksha urges, in any case, not to trust the official data and notes that the figures at the regional and federal headquarters often do not coincide: Moscow records fewer cases. Associate professor of Moscow State University, Ph.D. in physics and mathematics Mikhail Tamm, who studies statistics on coronavirus, adds that due to the small amount of information, it is almost impossible to find out about the real incidence in a particular village using open data.

“The best way to find out the real morbidity in a particular village is to ask its residents. Because all methods related to data analysis always, one way or another, rely on the fact that there should be a lot of data. That is, in the case of large numbers, we can say that this happens, it does not happen, here we have a tendency, but here we do not. And when we are dealing with small numbers, anything can be, ”Tamm tells Meduza.

Because of this, no one knows how many residents of villages and villages have already been ill or are suffering from coronavirus now – while, according to preliminary data from Rosstat, as of January 1, 2020, there are more than 37 million rural population in Russia, this is just over 25% of the total population country.

The authorities in Buryatia dug a triple ditch around the village to stop the covid. But voting on amendments to the Constitution was not canceled

Shuluta is located on the border of Buryatia and the Irkutsk region, 30 kilometers from Lake Baikal. This ulus  is a village with a predominantly indigenous Buryat population. Most of the locals live off agriculture: they raise livestock and sell cow and sheep milk, as well as cottage cheese and meat in neighboring villages and Irkutsk. There is no hospital or first-aid post in the ulus, there is only one store.

Residents of the ulus faced the coronavirus in early June, shortly after the first confirmed infections in the Tunkinsky district, to which the village belongs. During the month, the infection was detected in 66 people in Shulut – out of a total population of 390 people. Russian journalists called the place “the most infected in the world”: the incidence was 17% of the population.

(C)MEDUZA 2020

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