Debriefing: how Naked Science and Novaya Gazeta counted mortality from coronavirus in Moscow

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Debriefing: how Naked Science and Novaya Gazeta counted mortality from coronavirus in Moscow
Debriefing: how Naked Science and Novaya Gazeta counted mortality from coronavirus in Moscow
Anonim

He who does not try is not mistaken. In the situation with April 2020, we trusted the official figures and tried to explain the excess mortality by other factors that are consistently taken into account in the scientific community. But on June 10, data on excess mortality in Moscow for May 2020 were published, showing that our hypothesis was largely wrong. However, not only her: the forecasts of our opponents also turned out to be inaccurate. We have made an analysis of the errors. We hope other publications will follow this example.

Moscow, May 2020

What happened

The Moscow Department of Health has published mortality data for May 2020. According to them, there were 15,713 deaths in the capital this month, which is 5,715 more than in May 2019. This difference is called excess mortality. In total, in May 2020, the death rate in the capital increased by 57%.

This figure can be called a record - even in August 2010, at the height of peat fires around the city, the peak monthly death rate in Moscow was only 15,016 people, about five thousand above the norm. True, the population of the capital was then 20% less, that is, the per capita mortality rate in 2010 was still higher.

The question arises: what exactly was the cause of excess mortality? The Moscow Department of Health claims that of the dead, only 2,757 died "from covid." Of these, 433 - with negative tests, they recorded the coronavirus because of the typical pattern of damage to internal organs for it, revealed during autopsy.

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Another 2503 Muscovites, according to the Department of Health, have died with Covid-19, but not from it. "The virus has become a kind of" catalyst "for the development of the underlying disease in 980 cases (mainly BSC - 843, respiratory diseases - 73, other diseases - 63)," the department said. It turns out that 1,523 Muscovites caught the coronavirus, but they died not from it, but from other diseases.

This point of view is questionable - and here's why.

In the first half of May, the same Department of Healthcare stated that in April 2020, the excess mortality was higher than the mortality rate in April 2019 by 1934 people. Of these, 805 people died from the coronavirus, and with it, but not from it - 756 people. At the same time, 636 people died from coronavirus and with a positive test for it, the ministry said. In May 2020, there were 2757 - 433 = 2324 such people, or 3.65 times more.

At the same time, the number of deaths among Covid-positive, but died without such a diagnosis, according to all the same data from the Department of Health, in May increased by 3, 31 times. Why? It is easy to see that mortality among coronavirus deaths "not from coronavirus" grew at about the same rate as mortality among coronavirus deaths, who died, according to the Department of Health, from coronavirus.

This does not happen: the excess mortality for Moscow May in itself cannot fluctuate by 1523 people without special reasons. In May 2020, there were no such special reasons: it was only slightly colder than normal. This is not April 2020, which was indeed much colder than normal.

Consequently, excess deaths among Covid-19 patients are clearly linked to the coronavirus epidemic. The Moscow medical authorities do not admit this, because they are on the positions of the WHO recommendations: “Persons with coronavirus infection can die from other diseases or accidents; such cases are not considered deaths from Covid-19 and should not be counted as such."

Formally, the position of the World Health Organization is correct. In ordinary times and with a well-studied disease, this is what should be adhered to.

But in practice, one must understand that following it makes Russian and Western mortality figures from coronavirus infection incomparable. The fact is that in Western countries no one does a complete autopsy of the dead from the virus, but in Moscow they do it - and in general for all the dead.

Therefore, in the same United States, almost everyone who died with a positive test for it is recorded as victims of the coronavirus. Exceptions are obvious accidents such as road accidents, but there are too few of them per capita, so they do not affect statistics. Similarly, deaths from a new disease were counted in Great Britain, Italy and Spain.

The reason is quite banal: the epidemics there proceeded more acutely than in Moscow, and there was absolutely no one to carry out a complete autopsy.

This is one of the most important reasons why the attempts of the Moscow Department of Health to pretend that the mortality rate from coronavirus in the city is lower than in other world capitals does not make sense. In the United States, due to the absence of autopsies there, all five thousand Muscovites who died with it would be considered dead from the coronavirus.

Another reason why such comparisons are unfounded is that much more PCR tests were performed in Moscow per capita than in London, Milan or New York. Therefore, the detection rate of patients was much higher. Consequently, the denominator in the mortality calculation was higher: that is, it is incorrect to compare Moscow with Western capitals in this way.

What follows from this: rose-colored glasses of the Moscow authorities - and not only her

The most obvious conclusion from the May death rate is simple: it is high, much more than the 2757 people announced by the Department of Health. It is even more than 2,757 plus 830 of those for whom the coronavirus "could become a catalyst," according to the Moscow authorities. Most likely, it is only slightly below all 5260 people who died from both (2757) and (2503) coronavirus.

Of course, among coronavirus deaths from other causes do not stop. In Moscow, about every 800th inhabitant dies a month. Covid-19 affects mainly elderly people with other chronic diseases, so among them more than one in 800 can die in a month. But if this were the case, then the number of deaths with coronavirus could not be practically the same as those who died from it.

It turns out that the WHO calculation method is not entirely accurate. The reason for this is not yet clear. A possible answer is that the coronavirus dramatically increases blood clotting, which provokes diseases of the circulatory system (heart attacks, strokes, etc.).

This question is far from purely academic. It is based on the figures for mortality and new infections that the authorities ultimately make decisions on the curtailment of quarantine measures. In Moscow, as you know, the restrictions were completely canceled from June 9th.

It would be one thing if 3562 people really died from the coronavirus in Moscow in April-May, as Dezdrav writes. Such a mortality rate is great - so many die here in a dozen days from all causes - but still not overwhelming.

It is quite a different matter if the number of deaths from Covid-19 is close to all those killed with coronavirus (including those who are recognized as such posthumously). This is 1,561 people in April, plus 5,260 in May, for a total of 6,821 people.

As we can see, with the second approach - which has developed spontaneously in the Western world due to the acute course of the epidemic - this figure is 1.9 times higher. And, most importantly, it better reflects reality.

Now the capital's Department of Health writes: “The mortality rate from coronavirus in Moscow for the entire period of the epidemic is 2%, if we take into account only cases where it was the main cause, and 3, 8% - if we take into account all cases where Covid acted as the main or concomitant disease ". 3, 8% is a fairly typical coronavirus mortality rate for the Western world, if extensive testing is conducted there.

That is, yes, in the UK, mortality is much higher, because there are simply few tests per capita and few identified patients.But in Germany (about 5%), it is very close to Moscow - despite the fact that the population of Russia is, on average, five years younger, so it should tolerate the disease easier than the Germans.

However, honest mortality figures from coronavirus are not needed at all in order to compare them with the West. More importantly, they make it possible to deal more sensibly with the epidemic here and now.

For example, in Moscow over the past day (June 9), 1195 patients with coronavirus were detected, and, based on a mortality rate of 3.8%, about 45 of them will die. And a few days ago, a couple of thousand a day were recorded - and then the mortality rate among them would have amounted to 76 people in the coming weeks. Peak infection figures in Moscow - more than six thousand per day - meant that 220-230 people would have died out of the identified patients.

Looking back at these numbers, the Moscow authorities might have opted for a less rapid exit from quarantine restrictions. Estimating mortality from coronavirus by about half the real values, they will inevitably consider the coronavirus threat through rose-colored glasses: that is, it is far from being as dangerous as it really is.

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The situation is even worse in St. Petersburg. As we wrote, 176 patients officially died there from coronavirus in May, and the excess death rate in May was generally one and a half thousand people. In other words, the authorities in the northern capital perceive the coronavirus threat more than eight times weaker than it is.

Why We Were Wrong With Cold Mortality

Readers of Naked Science will well remember that we took a different position on the April 2020 mortality. Based on data from the Moscow medical authorities, we calculated that the spurt in metropolitan mortality in April (an increase of 19% compared to April 2019) was caused by the cold weather of that month, and not by the underestimation of deaths from the coronavirus.

Our point of view was based on the fact that the number of deaths due to diseases of the circulatory system in Moscow in April increased by 1165 people, which, as it seemed then, explained two-thirds of all excess mortality.

We, in addition, expressed the point of view that over time, Russian mortality rates from coronavirus - then they were in the region of 1% - will sharply increase and exceed 3%. We believed that the main reason for this was that the main outbreak of coronavirus occurred in the second half of April - early May, and mortality from this disease goes with a significant lag - up to two to three weeks.

Our opponents, recruited by Novaya Gazeta as experts, did not predict that the Russian mortality rate would exceed 3% in the near future - or that it would begin to grow rapidly at all. Their expert, Boris Ovchinnikov from Data Insight, assumed that the death rate in Moscow in May would rise 60-80% above the norm and amount to 17 thousand people.

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What happened in practice? It is absolutely certain that the forecasts about 16 thousand and even more so 17 thousand people did not come true. Why Boris Ovchinnikov gave them is difficult to understand exactly.

Apparently, he simply believed - as the headline of Novaya Gazeta put it in May - that "the real death rate from Covid-2019 in Moscow is almost three times higher than the official figures." Multiplying the data of the officially dead from coronavirus in Moscow in May by three, you can really get a big figure. In fact, for May 2020, the real death rate from Covid-2019 was only 1.9 times higher than the official figures.

But our expectations were not fully justified - namely, that the official mortality rate in Moscow would exceed 3%: the Department of Healthcare, as we showed above, gives two estimates of mortality at once, one of which is 2% (from coronavirus), and the other is 3, 8 % (with coronavirus).

The key mistake of the author of these lines was the assumption that the bulk of the abnormal April mortality is related to cold mortality. The excess mortality rate in April 2020 among Muscovites was 1934 people, of which the mortality rate of covid - 1561, and non-covid - 373 people, that is, 19.3%.

Cold mortality may be among the 19.3%.In May, uneven excess deaths of Muscovites accounted for only 8.0% of the total number of excess deaths. What caused it is more difficult to say: the negative temperature anomaly in Moscow was weaker than in April. It is possible that the general stress of staying in apartments, without walking, could have affected to some extent.

But cold mortality is unlikely to refer to the deaths of those who have found SARS-CoV-2: otherwise, the number of deaths with coronavirus in May 2020 would not have increased more than three times, repeating the spurt of deaths from coronavirus.

That is, the cold April mortality can explain only a smaller, and not a larger, as we wrote then, part of the abnormal total April mortality.

What will happen next

New mortality data for May 2020 shows the following.

At first, comparisons of Western and Moscow mortality figures for coronavirus are incorrect, because Russia takes them into account on the recommendation of the WHO, and Western countries, due to their lack of a complete autopsy, do not. The WHO recommendations are not entirely correct: the coronavirus causes a new disease, so not all the mechanisms by which it kills a person are well understood. It is more reliable to consider the vast majority of those who died from the coronavirus dead from the coronavirus.

Secondlybased on official statistics, the actions of the Russian authorities may be inadequate. You cannot properly plan the fight against an epidemic if you underestimate the number of victims by 1, 9 times.

And underestimation is a very real fact. Let's give an example. On the official website of Stopkoronavirus.rf, the number of “active cases of coronavirus” is equal to the number of cases minus the number of people who recovered and died from Covid-19. In total, for Moscow there are 199 785 cases, 113 533 recovered, 83 167 still ill and 3095 dead.

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But this, as we have shown above, cannot be: in the capital alone, in April-May alone, the excess mortality of patients with coronavirus was 6065 people. That is, the number of those still ill is not 83 thousand, as indicated there, but only 80 thousand. The difference in the three thousand we indicated is the classic "dead souls".

The site simply counted as deceased those identified as victims of Covid-19 according to the WHO method. Thousands of those whom he recorded in "active cases", in practice, are already buried in the cemetery.

If the level of this underestimation in Russia is the same as in Moscow, then in reality 12 thousand have already died from the coronavirus in our country. Of course, if the authorities proceeded from the figure of 12 thousand deaths during the epidemic, they would have fought it more vigorously than now, when the estimate is about six thousand.

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Thirdly, underestimating the number of deaths from coronavirus harms not only the reaction of the authorities, but also the reaction of the population. The other day we had to visit a Russian hospital in the provinces, where local residents were lying. In the ward, there was a conversation between them that there was no coronavirus and that this was just an excuse to introduce chips to everyone under the guise of a vaccine against the new virus.

If these two patients knew that more people have already died from the coronavirus in Russia than in the Afghan war, their reaction to what is happening could be more reasonable.

And the matter is not limited to this particular example. A very large part of the Russian population ignores basic hygiene and safety measures precisely because they underestimate the threat of coronavirus. The share of those who ignore it would be noticeably smaller if they knew about 12 thousand dead.

The above three findings are unfortunate. Obviously, the excess mortality in Russia this year will exceed its losses in wars and from terrorist attacks over the entire post-Soviet period. These are very large numbers. Yes, per capita will be less than in the UK, States, Italy or Spain. But we already have a lot more victims than in Germany - and there will be many times more.

This would not have happened if our authorities and the population had looked the truth straight in the eyes - and through the prism of the most complete accounting, and not through the rose-colored glasses of the WHO recommendations.

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