Armenia: one step away from Bergamo

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Armenia: one step away from Bergamo
Armenia: one step away from Bergamo
Anonim

On May 4, 2020, quarantine measures were lifted in Armenia. As we wrote then, this inevitably led to an intensification of the epidemic outbreak in this country. Armenia broke into the world leaders in the number of cases per capita, which can mean sad records for deaths. Who is to blame for what happened? Could it be otherwise? Will Russia follow the Armenian path after the partial lifting of restrictions on May 11? Let's try to figure it out.

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On May 3, 2020, there were 2386 cases in Armenia with three million inhabitants - about 800 per million. Four weeks later, there were 9492 of them - about 3160 per million. The number of diagnosed cases increased 3.98 times - almost fourfold in four weeks. In terms of the number of diagnosed patients per million of the population, Armenia bypassed Iran and France, getting into the list of world leaders. Another four weeks of this rate of development of the epidemic could lead to disaster.

After all, it is not only a matter of the number of diagnosed patients per capita - according to them, Armenia is ahead of Russia by only 11%. It is also important that 11 million tests were carried out in Russia to identify 0.4 million patients (more than 27 tests per one detected), and in Armenia - less than 60 thousand tests (approximately six tests per one detected).

This means that in the Transcaucasian state there is a much higher proportion of undetected patients - and their total number is several times higher than that of those diagnosed. The more such people, the more vigorously the infection spreads: often they are not aware of their condition (it may be asymptomatic) and continue to go to work and the streets.

A more alarming sign is a sharp drop in the number of cases during the weekend. This has already happened in Sweden, which means that the health care system on weekends is not working at full capacity, which is unwise during an epidemic.

What is happening in Armenia is increasingly reminiscent of the outbreak in the Italian province of Bergamo, where the death rate from coronavirus was record high: up to one death in every 200 inhabitants.

A natural question arises: how did this happen?

First: inattention to other people's experience, especially the Far East

The first case of coronavirus in Armenia was registered on March 1. By this time, the epidemic in China had been going on for a long time, and quarantine was introduced there more than five weeks earlier. To avoid confusion, let us explain. "Quarantine", which is sometimes mentioned by politicians of countries outside East Asia, and quarantine, which was introduced by a number of East Asian countries, are fundamentally different things.

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The Chinese type of quarantine meant the complete closure of almost all types of enterprises, except for those responsible for certain types of activities: hospitals, pharmacies, electricity, a limited number of grocery stores.

People who found themselves in their homes during such a real quarantine were released from there only once every two days and no more than one person per apartment. Even the presence or absence of a dog could not give a local resident an unambiguous right to leave the house once a day. For walking, individual citizens were forced to lower the dogs down on the ropes, and then lift them back.

Stricter measures were applied to persons with suspected coronavirus. A “traffic light” application was installed on the smartphone of residents of Chinese cities, and if a person was under suspicion, his “red light” was on - then he could not go anywhere.Food could be delivered to him (sometimes by lifting it through the balcony, sometimes by putting it under the door), but he and his family members did not leave the house until suspicion was removed.

None of this happened in Armenia (as well as in Russia or the USA). Nobody limited the number of exits from one apartment or house per day. Therefore, for example, such messages were possible there: "Police officers are on duty at the buildings of banks, supermarkets and other establishments where crowds of people are possible, urging them to maintain a safe distance." In China, there was no question of possible gatherings of people near bank buildings: they simply did not work. And there were no passers-by on the streets.

But it was not only the Chinese experience that was not taken into account. Around the PRC, a number of countries in February made a seemingly obvious decision: it is cheaper to keep the virus out than to quarantine the entire economy later. Therefore, absolutely everyone entering the DPRK and Vietnam was placed in a two-week quarantine, where they were strictly isolated and could not go anywhere in principle (food was delivered to them).

Such measures sound just in words: both the DPRK and Vietnam have a huge number of citizens working abroad. Therefore, the measures taken affected hundreds of thousands of people. In a few cases of violations, society reacted extremely aggressively to such events, and there were massive public calls to imprison violators.

It was the complete two-week quarantine of those entering that was the main means of blocking the spread of the virus in these countries. When people flew to Vietnam from South Korea and some of them did not want to sit in quarantine, Hanoi paid for their tickets back, but the Koreans did not take to the streets. When the Korean media showed negative reports of the actions, masses of Vietnamese attacked the respective media's YouTube channel with angry comments and forced them to apologize and take the report.

Vietnam is a poor state, but due to a tough and timely response, it limited the number of imported cases, so the subsequent in-country quarantine quickly suppressed the epidemic. Having made 261 thousand tests, 328 patients were found there (one of 796 tested). There were no dead.

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By March 1, Vietnam's approach to solving the problem was known, and a small number of cases there too. Why didn't official Yerevan copy this approach? On the one hand, we face a clear mistake. On the other hand, this was not done by the authorities not only of Armenia, but also of practically all non-East Asian countries. Take Russia. So, on February 29, the head of Rospotrebnadzor, Anna Popova, told the press:

“Today, for good reason, we are not introducing mandatory quarantine for all who return from Italy. The country is large, and no one in the world has yet introduced such measures, there are no epidemiological grounds for this."

This was exactly the same disregard for the Vietnam experience as in Armenia. Now, when it is known that the coronavirus came to Russia through Italy, it is quite obvious that a complete mandatory quarantine for all those who entered this country and, later of all, the EU would be justified. He could save the situation and the lives of thousands of Russian residents who died during the epidemic - and those thousands who will still die.

It is not only the statement of the head of Rospotrebnadzor that such steps are unreasonable that is wrong. The following phrase is also incorrect: "The country is big, and no one in the world has introduced such measures yet." Vietnam is much larger in population than Italy. Nevertheless, he took such measures to those entering both the PRC and other countries many days before Popova said "no one in the world has yet introduced such measures." Obviously, she, like the Armenian authorities, simply did not attach importance to what was happening in Vietnam and other countries of the region.

Why - it is difficult to say for certain. The most obvious answer to the question of ignoring the Far Eastern experience is that the consciousness of the politicians of the countries of the former USSR is mainly West-centric.That is, they regard the Western, not the Eastern experience as a worthy role model, and this state of affairs will not change in any foreseeable future.

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It doesn't matter that China or Vietnam coped with the epidemic much better than Western countries: neither in Russia nor in Armenia was it possible to hear a single politician (or media) calling to repeat the Chinese or Vietnamese experience in the fight against coronavirus.

But in the press, there were regular references to the "German miracle" with its supposedly particularly low (in fact, not) mortality from the coronavirus. This contrasts sharply with the ability of the East Asian peoples themselves to copy reasonable experience: as we have already noted, in China, the introduction of quarantine went under the slogan "Write off Henan's homework" - the province that first introduced quarantine restrictions.

Armenia is now reaping the results of this inability to assimilate someone else's experience.

Second: unresolved test problem

If someone could not keep the disease in the early approaches, if not the most high-tech Vietnam, he needs to be able to limit the spread of the epidemic at home. The key element here is PCR tests. The more there are in the country, the more cases arriving in it can be tracked and isolated from society for two weeks, preventing them from infecting the rest.

Moreover, it is most important to provide many tests at the early stage of the epidemic, like South Korea, which was able to use them to identify almost all those infected with the coronavirus and to quarantine them. The offenders were tracked down by mobile phones and harsh measures were taken against them.

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In Armenia, it was proposed to introduce tracking of citizens by mobile phone, but nothing came of it. They called for the application to be installed on their phones, but the population simply took it and did not install it, motivating it by the fact that they had a push-button phone, or by something else.

Its production of tests was also not established: the first samples of tests only began to be produced at the very end of May, when the epidemic had long passed into a severe phase. Why? “Arsen Arakelyan, Director of the Institute of Molecular Biology, regrets that there is no scientific research infrastructure for biosafety in Armenia,” the local press comments on the situation.

Prior to that, Russia provided significant assistance, transferring 20 thousand test systems and 33, 5 thousand reagent kits (from which you can create a system). But 53.5 thousand is clearly not enough for really mass testing. This is understandable: Russia is undergoing its own epidemic, where the number of deaths is about the same as in the Second Chechen War. Obviously, she could not provide sufficient assistance to Yerevan.

It turns out that the authorities did not undertake the mass deployment of the production of test systems in time, hoping that everything would cost outside help. Such expectations were unduly optimistic.

Third: the decision to lift restrictions in the name of the economy

One of the most heavily debated decisions in Yerevan's fight against coronavirus was the lifting of restrictions on May 4, 2020, despite the fact that the epidemic was on the rise at that moment. Naked Science described this situation with considerable surprise: it was hard to believe that it was possible to complete the extinguishing of the fire for economic reasons.

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Armenian observers explained the decision by the fact that the fight against coronavirus was often entrusted to people without relevant experience. For example, they wrote: Commandant and Deputy Prime Minister Tigran Avinyan, “a young financier, owner of a small business and a deputy of the City Council, now the Deputy Prime Minister of the government, simply did not see the whole range of tasks facing him. Instead of dealing with issues of passport compliance, the state of emergency and security in a broad sense, he worries about finances and convinces the prime minister to open the economy when the quarantine has already begun to de facto fall apart. This decision has already cost tens of lives and will cost hundreds more.”

It is well known from the experience of other countries that lifting (or abandoning) quarantine restrictions for the sake of the economy does not justify itself. For example, the economic downturn in Sweden, where formally nothing was strictly introduced, is not weaker, and sometimes even stronger, than in neighboring Finland, Norway and Denmark, where quarantine measures were introduced.

However, it is not clear how long Armenia could not follow this path. It's all about the specifics of its economy: its own industry is moderately developed, the role of tourism is high. The volume of remittances from abroad (mainly from Armenians working in Russia), according to the CIA, can reach 12-14% of GDP, and it is through transfers from abroad that a significant part of imports is paid (which significantly exceeds exports).

This means that after the beginning of the crisis in Russia (during the period of self-isolation, the incomes of those employed in its service sector fell), the flow of money to Armenia also sank. Tourism collapsed. For a country to pay its bills, it needs economic activity. Usually, during crises, imports fall due to the devaluation of the national currency, but the Central Bank of Armenia decided to prevent this with foreign exchange reserves, which created an objectively difficult situation.

At the same time, local observers note: significant funds were allocated to support the population during the quarantine period, but most of them were not spent. Fearing spending, the authorities simply lifted the quarantine. This means that they could support him for a while longer. This would likely reduce the intensity of the May-June outbreak. But it is unlikely that this would be enough to suppress the epidemic at all.

Fourth: the population did not consider the coronavirus a serious enough threat for a long time - and the reason is in the media

In the paragraphs above, almost all the blame seems to fall on the government of this country. Nevertheless, a number of circumstances should be taken into account: firstly, politicians do not make decisions themselves, but in consultation with the environment, which, in turn, should ideally consult with experts.

Without access to the local internal political kitchen, it is difficult to understand at what stage inadequate decisions on the "soft quarantine" were made or why they thought about producing their own tests so late. It may very well be that the state leadership, which has never faced epidemiological problems, simply chose the path of trusting the environment and specialists from its own Ministry of Health.

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But another thing is no less important. Let us recall the reaction of the population of the same Vietnam: they consistently supported the strict measures of their authorities. This is clearly evidenced by the same incident with the South Koreans. How did the population in Armenia react?

Alas, tens of percent of the local population generally believe that there is no virus or that it is not terrible - and behave accordingly. Many who returned from abroad, instead of serving the prescribed two weeks of quarantine at home, walk freely outside it. Local authorities do not have a mass system for tracking their movement by mobile phones. When spot checks are made, numerous violations of such quarantine "after arrival" are revealed.

Despite repeated statements by the authorities about the undesirability of mass events, the population continues to attend them. On May 28, for example, it became known about such a case: two sisters contracted the coronavirus at their mother's funeral - and both died. In fact, this scenario is close to what has been repeatedly observed in the North Caucasian republics of Russia.

But even among those who at least believe in the existence of coronavirus, there is a large proportion of those who believe: it is enough to wear masks - and you can safely visit public places, despite the epidemic. As we already wrote, the real situation is terribly far from this. Although masks reduce the infection of the people around their wearer, they are far from a panacea. Their ability to reduce their own chances of getting infected is so low that it has not yet been possible to reliably identify it for viral diseases.

This does not mean that it does not exist: logic tells us that some part of the viruses must still be contained by the barrier. But, like gloves, this barrier does not always protect. It is much more effective to reduce unnecessary exits to the city in principle - but only a moderate part of the population goes to it.

Their logic, again, is somewhat reminiscent of the North Caucasian situation in Russia: the probability of contracting the virus is not one hundred percent. It means that it is some kind of non-specific, too abstract. But the risk of reducing one's income or social significance without being outside is one hundred percent, it is quite specific and therefore unacceptable.

It is not difficult to recognize the errors of such logic, but, despite this, it continues to be very common. Now there are fewer and fewer supporters of this point of view, but it comes at a high price. Often it is changed only when personally confronted with illness or death from a new illness of acquaintances, or even relatives.

The question naturally arises: why does the population of Armenia perceive the epidemic in this way? Where do all these wild thoughts come from that Bill Gates is behind the coronavirus story, "people interested in it", that someone draws numbers of sick people in order to intimidate everyone? Where does the idea come from that the epidemic is needed "to get compensation from the World Bank"?

The most likely reason lies in the problems of the media sphere in Armenia. There are no popular science sites there, and online media "about politics" do not always inspire the trust of readers. And those who fill them can not always immediately understand the rather unusual sphere of infectious diseases, which until 2020 generally passed by the local political agenda.

What will happen if you read for ten years that the next step of a politician is caused by one or another group of interests - but at the same time not come across news that analyze a difficult, from a scientific point of view, problem? You will inevitably get used to looking for "who benefits" even where - as with the current epidemic - it is not beneficial to anyone at all. But to find out what is the mechanism of spreading viruses, why masks from them help, but very weakly, what types of quarantine are and why a hard quarantine works, and a soft one does not, you will simply have nowhere to go.

It is worth remembering that the government ultimately consists of the same population of the country and often shares the same mistakes and delusions with it. Urging citizens not to gather and distance themselves, the country's leadership in the 20th of May itself held a banquet in the fresh air - without masks and social distancing. As always happens, the population cannot take seriously the restrictive measures that government officials suggest to people to observe, but do not comply with themselves.

Probably, now that the Prime Minister of Armenia, who participated in that banquet, became infected with the coronavirus, he should have changed his position and taken more seriously to contain this disease. Including giving citizens a personal example. Alas, instead he appeared in public, led the performance, being close to other people. Although, as we already wrote, even a mask worn on an infected person can in no way be considered reliable protection and does not give him the right to communicate with healthy people.

Armenian lesson for Russia

On May 3, 2020, we wrote: “Armenia … is a small state in which the infection can spread quickly. In addition, she is going to remove restrictions not like Israel, gradually and after reaching the plateau, but almost immediately and while still in the phase of active growth in the number of cases. This is the value of Armenia as a laboratory country. If the local authorities really lift the quarantine on May 4 this year, the Armenians will unwittingly become participants in a large, albeit inhuman experiment "What will happen if, in the midst of a strong outbreak, you just take it and just kill it."

Now the results of this experiment are obvious. According to official data, a couple of hundred people died, but how much these data manage to take into account the real situation is difficult to understand.A few days ago, before the weekend, 450 cases per day were registered in Armenia, and on weekends this figure dropped to 210. At first, local statisticians wrote “120” - and only then recovered, changing the order of the numbers.

There is already an example of a country in the world where registration numbers for new patients depend on the weekend - and this is a bad example - Sweden. There are already several thousand dead, with a population less than Moscow. This work of the health care system means that the registration of patients is carried out without much stress, which may not always be accurate.

Finally, with tens of thousands of detected cases and a clearly large number of undetected, the final number of deaths should be at least several hundred. If the number of cases continues to quadruple in four weeks, the count will go to thousands.

In such an environment, the only reasonable policy for Armenia would be to keep the quarantine as long as possible. Only not the one that was in April, when no one monitored its observance, but the actual one - as in China. This, together with an increase in temperature and humidity, could significantly reduce the number of victims.

Nevertheless, even now, when the prime minister of this country also fell ill, there are few chances for the implementation of such a scenario. The economic downturn to 17% in April is too strong for the authorities to muster the courage to repeat it. In addition, the new quarantine requires a change in the policy of spending foreign exchange reserves - from stabilizing the exchange rate to supporting citizens - which is always difficult. Economists will be against it, and the layman rarely dares to argue with them.

Therefore, the most likely scenario for Armenia is Bergamo. That is, the complete "burnout" of the epidemic due to its coverage of a large number of local residents. This means the risk of death of thousands of people, which is a lot for a small republic.

Definitely, the Armenian situation still looks far from the Russian one: it is a small country, so the process of infection is relatively fast, and it seems that this cannot be so in our country. But despite the smaller size of Armenia, in many ways the local situation is similar to the Russian one.

Just like there - and unlike Vietnam - we did not put people in strict quarantine for two weeks after they returned from abroad. Compliance with a two-week "self-quarantine" after arrival was assigned to the sick person: this naturally led to the fact that people steadily left the house. No one was placed in any locked rooms, as in Vietnam.

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Yes, more tests were carried out in Russia, which made it easier to contain the epidemic in the early stages. But, despite this, the absence of strict quarantine did not allow her to suppress the epidemic. Yes, Russian nine thousand cases per day per capita are less than 210 Armenians (data as of May 31).

And still, this is much more than the number of recoveries, that is, in fact, Covid-19 continues to spread actively in Russia. Moreover, the process here can continue for a very long time.

Upd.: During the day on June 1, 517 cases were detected in Armenia, which is why their total number exceeded ten thousand people.

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