The "Fiddled" Russian COVID19 Mortality Numbers

I have been following the saga of the "Fiddled Russian COVID19 Mortality" numbers for a while and it looks more and more like yet another F... Again. It is a basic F... Again in Primary care amplified by a whole raft of F... Agains in analysis with an F... Again in Disinformation trying to fix all of them so it looks good and fits our narrative.

Well, tough, it does not. If I can figure it using back-of-the-fag packet calculations, then it has been figured out by plenty of other people "in high places" out there and what we see is not investigative journalism, but basic propaganda mob.

To cut a long story short - the actual analysis.

Background

Effectiveness of Antivirals

It is a well known fact that for any virus which does not attack the immune system (basically, pretty much anything except HIV), the effectiveness of antivirals is inversely proportional to the date from which they start to be administered. They are most effective if taken immediately after infection and absolutely ineffective if started around day 14 when the the body primary immune response has kicked in.

Susceptibility of Covid19 to Antivirals

COVID19 has been demonstrated by a number of studies to be susceptible to various antivirals. They all have a common denominator - Chinese, Japanese, Korean, Taiwanese and Russian studies show significantly higher susceptibility than the rest of the world (more on that later). Neither one of these antivirals is new and most of them were prescribed early on even before we have narrowed down the list to the 2-3 most effective ones.

Life-cycle of a COVID19 infection.

A COVID19 infection proceeds in 3 stages:

  1. Day 0 - 14. Incubation/Asymptomatic stage. No symptoms, patient after day 3 becomes infectious and starts spreading the disease.
  2. Day 5-14. Viral infection stage. Fever, metal taste, loss of sense of smell and taste. Dry Cough. The patient is MOST INFECTIOUS during this stage. Not all patients proceed to stage 2. Some continue to be asymptomatic.
  3. Day 14 - the day of reckoning. The full immune system response kicks in as expected (that is the day when this usually happens). In ~5%-10% of the infected, instead of attacking the virus, the immune system attacks blood vessel walls, lungs, kidneys, etc and causes what is known as a cytokine storm. It is quite common for the virus not to be detected at this point in PCR tests and that is normal - it has done its damage and gone and it is the body literally eating itself at this point. According to recent research and analysis of bodies of people who died of cardiovascular and other complains, this can happen to people who are asymptomatic. You can go straight from 1 to 3 skipping 2. In either case, this can happen in a matter of 2-3 hours. A patient which felt reasonably fine may now need intensive care. This is also the point where the outcomes are very bleak - 20-30% survival rates for patients whose immune system has misfired and has started to eat them are considered an achievement.
  4. Day 21+ Some patients who have had a cytokine storm recover. Not many. Outcome of ~20-30 % is considered very good.

Differences in COVID19 Primary Care Approach

The countries which I already mentioned, namely Korea, China, Russia, Taiwan and Japan tried to hospitalize as many (some of them ALL) pre-clinical COVID19 patients (stage 2). If there were beds available, people were taken in.

This is absolute opposite to what we have been doing. We have kept people at home until the last moment (stage 3) when they get into breathing difficulties.

The approach is guaranteed to produce a statistically significant difference in outcomes for multiple reasons:

  1. Antivirals can now work. While day 5 is not a perfect day to start, it is still better than day 14 by which time the horse has bolted.
  2. The patient is closely and constantly observed and the risk of "losing them" because they are not admitted into intensive care on time is significantly minimized.

The end result is a significantly improved outcome. The ultimate champion here is Korea - 0.4% mortality. The numbers achieved by others - 1-2% are also quite good, especially when compared to our >5%. These numbers are to be expected. If you have the patient on a medication which improves the outcome by ~ 50% (pretty much any antiviral, even a non-specific one) which is administered on day 5, you get 5% decreased to what? 2.5%. Add half a percent to a percent from not losing patients which die at home because they were not admitted into intensive care in time and you get what? The Russian, Chinese, Japanese and Korean numbers.

You have to be terminally dumb or paid specifically not to see that. It is bleeding obvious.

The Silver Lining.

Every cloud has a silver lining and the Silver Lining in this case is that you have medical personnel in contact with the patients when they are most infectious - between days 5-14. All of these countries piled up their medics in front of COVID19.

We have to admit it is traditional too. China has some form in "No more enemy" as per the joke about China and the Vietnam war. Japan has a venerable tradition of ramming Betties into allied cruisers and the Russians are Russians. "Up Goes the Red Flare" alternated with "Farewell of the Slavic Woman". The sole difference is that it is not the kom-bat with an iconic TT leading the troops/

It is а slighty podgy head of infectious diseases department with a mask and and an oxygen bottle.

None the less, it is still that and it is unmistakably, quintessentially Russian.

Update (3/07/2020):

An even better, albeit very difficult to write about example to illustrate what I just wrote above will be this:

A medical student with Stage IV terminal cancer who despite being what should be the "ultimate" risk group volunteered to work during the COVID19 pandemic and helped until her last breath. Nothing more to say here really.

All in all, their approach to the pandemic unfortunately leads to a horrifying death toll in medical personnel. China and Russia have some of the worst numbers in medical personnel loss per "civilian death" (which only Britain managed to beat). For example Russia (by independent investigation) count has 200+ medics died of COVID19 by 1st of June and that number is constantly growing.

Doing it by the book

Last, but not least, there is also the factor of doing things by the book. You can literally see the the Russians and the Chinese following exact paragraphs from a Cold War civil defence handbook and using that to improve their outcomes even further.

Specifically:

  1. The Russians sent their teams to train under "live fire" in other countries with the perfect knowledge that they will have their own outbreak in 3-4 weeks. Their help missions finished right in time for them to return and to be available to plug holes in regions which fail to contain the disease. Something they actually did.
  2. The Russians are now moving teams from areas of the country which have the pandemic towards its end to areas where it is in full swing. They are experienced, they have seen it first hand and they can relieve the local medics when they are about to be overwhelmed. Once again, quintessentially Russian - "В бой идут одни старики" (Only veterans go into battle today).

Rather unsurpisingly, both of these improve the outcomes.

The Dunce Cap

The Dunce cap is definitely ours. We have failed to pick up the Chinese practice to isolate and hospitalize the pre-clinical despite adapting enough facilities (f.e. Nightingale Hospital). We have failed to send our medics to train in the outbreak zones. We watched how Russians TRAIN THEIR MEDICS in Italy and concocted obnoxious propaganda narratives instead of doing it ourselves.

Fail. Fail. Fail. And again Fail. To the tune of 30K+ extra deaths.

So frankly, it is not surprising that we have to invent disinformation narratives instead of admitting why other people have achieved better results.

Endnote.

By the way, I know that some regions in both Russia and China fiddle numbers. Sure, lunatics like Ramzan Kadyrov would try to make the Virus apologise on local TV. They, however, do not form the bulk of the numbers and the bulk of the numbers is from places which we can see and where we can analyse the approaches and outcomes.