3 Jul 2020

Russian Health Minister Mikhail Murashko: Russia could have had millions of coronavirus deaths, if no restrictive measures were introduced

Mikhail Murashko

Russian Health Minister Mikhail Murashko
Photo: Health Ministry press office

Russian Health Minister Mikhail Murashko has given an interview to Interfax in which he speaks about the fight against Covid-19 in Russia, work on a vaccine and prospects for returning to normal life.

Question: Let us begin the interview with the coronavirus, which has claimed more than half a million lives worldwide. How much have specialists learnt about Covid-19 over the last few months? Why is it deadly for some people while others seem unaffected? Does the "dose" of virus affect the seriousness of the disease?

Answer: There are several factors here. First, this is indeed the amount of the infectious agent. Second, this is immunity, including conditions that may aggravate the course of the illness. These are two key things. Hypertension, obesity, diabetes, and a number of cancer diseases are risk factors for coronavirus. The virus affects the coagulation of blood and vessel walls. Those who have a risk of blood clot formation are in the risk group. Age also plays its role.

Q.: Italian scientists have recorded that the virus has become less aggressive and noted that it has begun to adapt. What is your assessment of the situation?

A.: There are different viral clades. But gradually herd immunity is being developed, despite the different viral clades, and this helps to interrupt the spread of the disease. Although not all of those who fell ill developed similar immune response. The immune response of those who had a severe form of the disease is more intense.

Q.: Is it possible to fall ill once again?

A.: So far, no such cases have been recorded, but this requires observation, as those who recovered develop different immunity.

Q.: The World Health Organization warns that the infection rate has been growing in many countries and that new peaks are being registered. Is it possible to say for sure that Russia has passed the point of no return, the first wave?

A.: I would say that this depends on the social culture of our people and the way they follow recommendations. If we treat our health prudently, develop the right social behavior and practice good hygiene then the risk diminishes. If you behave like a "Covid-dissidents," the risks are high.

Q.: Is a second wave possible in Russia? If so, when will it come?

A.: The issue isn't about waves. The thing is that the virus is still circulating. But a second wave on the same scale as the first one is unlikely. We've acquired certain immunity and have created a system of treatment and prevention. Therefore, a repeat of this scenario in the full format is unlikely, but there could be an increase in morbidity rates if rules of conduct aren't observed.

Q.: Is it possible to say for sure that the virus is non-seasonal?

A.: Yes, the situation is that that in countries with hot climates the disease doesn't disappear if the rules aren't observed. We are facing such virus behavior and such scale for the first time.

Q.: Many people say that the coronavirus threat has been exaggerated and that the world's response to Covid-19 is a product of the information society.

A.: The plain facts are that there are 3,500 people currently on ventilators in our country. This is a serious figure.

Q.: What can the novel coronavirus be compared to? The Spanish flu?

A.: Such comparisons are being made, although Covid-19 is a different virus. We can't compare them, as there are other methods of protection and treatment today. If they didn't exist, coronavirus may have caused far greater damage.

Q.: Some studies stated that Russia would have had 4 million rather than 9,000 deaths if protective measures hadn't been taken.

A.: These would be commensurable figures. A large number of countries predicted such numbers.

Q.: Does it mean that there would have been millions of victims in our country?

A.: Possibly.

Q.: Are doctors more exposed to infection, if we speak about the "dose" of the virus that has an effect the course of the illness?

A.: Doctors who wear protective gear in line with all the rules minimize the risk. Work in "red zones" of course constitutes a higher risk, and additional payments and insurances policies are given for it. We thank doctors for working in this environment, they are taking risks. It is very good that society now understands social responsibility before a doctor, and that doctors, medical workers, and nurses have occupied a worthy place in society.

Q.: How many doctors have died because of the coronavirus?

A.: The most precise and verified information is the number of cases in which lump-sum indemnities have been paid. The Social Insurance Fund has paid 40 indemnities by now. A few other cases are being investigated.

Q.: Is it possible to say that the new "format" of the virus indirectly proves it is artificial and originated in a laboratory?

A.: We have no information that the virus is of artificial origin.

Q.: The European Union has not included Russia in the list of countries for which its borders have been open since July 1. Do you consider this decision justified seeing as the coronavirus infection rate has gone down drastically in Russia?

A.: In our country, different regions are now at different stages of the epidemic process, which is why [the EU's] "restraint" could be prompted by this. One region has low levels, some regions practically haven't encountered the disease, but there are also territories where the situation is not so good. I can presume that it is linked to the varying nature of the spread of the virus. There's more clarity when it comes to a small country, but all this doesn't happen simultaneously in large territories.

Q.: When might international travel resume?

A.: Such decisions are based on the situation in other countries, depending on the epidemiological situation in this or that country. There can be no universal all-clear signal here. These decisions must be adopted bilaterally. It is better to put off all nonessential travel abroad right now. If a trip inside the country is planned, the necessary hygiene rules should be observed.

Q.: Clinical research of a medicine whose active agent is Favipiravir will soon be completed. Can it really be called Russia's first fully-fledged, safe anti-coronavirus medicine?

A.: As for Favipiravir, indeed, the first clinical tests showed its effectiveness. And it has passed safety tests. In the future, the medicine will get to be used with special arrangements. What does this mean? The medicine is so far allowed for treatment in hospitals, but each pack must be put into a database and each undesirable reaction will be passed to the pharmaceutical oversight system. There are restrictions regarding who it is prescribed to. A doctor must assess the stage of the disease, its seriousness, and prescription risks.

Q.: How do you assess Dexamethasone, which the WHO has described as a breakthrough in treating the coronavirus? Is it a cure-all?

A.: The WHO has confirmed that as part of the research Dexamethasone is effective only in serious cases of the cytokine storm. Dexamethasone is a cheap hormonal medicine which can be used broadly. There are other medicines with other mechanisms of action that also block the cytokine storm, and they are widely used in Russia. The choice of a medicine should be based on the balance between price, quality and safety.

Q.: As for a Russian anti-coronavirus vaccine, when will the ministry sum up results of the clinical tests? And how has been the research been progressing?

A.: The tests are proceeding routinely. No conclusions can be made so far.

Q.: And routinely means successfully?

A.: There are situations when clinical tests have to be interrupted. There are no such situations here. We are expecting results in early August.

Q.: Are there reasons to believe that Russia will be one of the first countries to get the vaccine?

A.: There are not so many countries that develop and produce vaccines. This is the calling of the strong, from both industrial and scientific point of view. And Russia has such potential.

Q.: Is Russia collaborating with other countries, for example the United States and China, on the creation of a vaccine?

A.: In this area, countries tend to withhold information and protect it with patents. But there is interaction with a number of countries. In particular, there are negotiations on the use of the vaccine in foreign countries. Not just on one country but in several. It is always better to have several vaccines.

We will complete clinical tests, this will be followed by registration, then there will be the expansion of the pool of the vaccine use by risk groups, then we will make conclusions, and then we will plan its broader use. We hope that we will begin mass production of the vaccine in September. We are quite optimistic about that.

Q.: When will life be able to return to normal?

A.: I'm asked this question quite often. What is normal life? It's going to concerts, flights, proper work routines and proper vacations. But, in my opinion, this is unlikely to happen earlier than February. The virus transmission chain should be broken first.

Q.: Now many regions have been lifting restrictions, at the same time keeping it mandatory to wear masks. Is it a justified measure? Maybe, it is enough to keep social distance?

A.: That's the right measure. Of course, everything depends on the situation: if there aren’t many around you, then you can do without it, for example, at your country house. But if we speak about indoor premises, walking on city streets, wearing a mask is justified here. Furthermore, it's necessary to remember that this infection circulates by airborne transmission, and a mask is a barrier that deters the virus. There is a rule to change masks every couple of hours, and these rules should be observed. The infection isn't completely drug-manageable for now. If a medication appears of which we'll be 100% certain both in terms of prevention and treatment, and especially when we reach herd immunity, then it'll be possible to take off masks.

Q.: The Moscow Health Department has published death statistics for May. The number of deaths grew by 5,715, from 9,998 cases in May 2019 to 15,713 in May 2020 or by approximately 50%. And 92% of excess deaths are related to the coronavirus. Are there fresh statistics on the mortality rate throughout Russia? Could the same trends as in Moscow be seen there?

A.: There is no official Rosstat data for May at this point, but we can see from current information that the mortality rate will go up. On the whole, it is possible that the mortality rate will increase 1.5-2% since the beginning of 2020. This includes deaths caused by the coronavirus itself, as well as comorbidities impacted by Covid-19, say, in patients with coronary heart disease. The same happens during flu epidemics.

Q.: What is the difference between mortality growth rates in Moscow and in Russia in general?

A.: It is spreading faster in highly urbanized areas, so Moscow and Russia should not be directly compared. Whenever we calculate the amount of required assistance and the probability of deaths, we keep in mind population density. It is much higher in Moscow.

Q.: How has alcohol influenced mortality rates in Russia? There is data indicating that 10% of deaths are to some extent related to alcohol, and 70% among able-bodied people. Do you agree with these figures?

A.: Alcohol starts having a strong effect on the gap between male and female mortality rates from the age of 18. The number of deaths of able-bodied men from alcohol-related causes reaches its maximum at the age of 35-40, up to 80% of all able-bodied men who die at that age. Alcohol and alcohol-related deaths caused by injuries, liver and digestive system diseases make a significant contribution to the structure of mortality. The female and male mortality rates roughly level off at the age of 70, when they develop approximately the same careful attitude to their health. There were times when alcohol was sold round the clock. Restricting when it can be sold immediately reduced the number of patients admitted to intensive care units in serious condition.

Q.: What measures could be taken to reduce alcohol consumption?

A.: First of all, this includes separating sales of alcohol and food products, just as in many countries. You cannot sell strong alcoholic beverages next to bread. Alcohol should not be marketed all over a store and be bought on impulse. Furthermore, the legal drinking age is 21 in many countries.

A person starts to become independent and develop a sense of responsibility when he turns 18. There are two ways: either a person develops a drinking habit which leads to super-mortality rates or he lives a healthy lifestyle. Increasing the legal drinking age would promote the movement along the second path. Currently, a bill [increasing the drinking age] is moving through the approval process.

Further time limitations of alcohol sales could also influence excessive alcohol consumption. Measures that are worth taking have yet to be discussed. We must build a healthy society.

Q.: So, you are in favor of separate alcohol stores?

A.: I can see that this works in many countries.

Q.: What should be the time limits for alcohol sales?

A.: In the Soviet era, it [alcohol] was sold until 7 p.m. or 8 p.m., as long as stores were open. The selling started at approximately 11 a.m. In my opinion, this is reasonable.