Officials representing the Moscow Department of Health deny that Russia’s official COVID-19 statistics underestimate the number of coronavirus-caused deaths in the country. Such information earlier appeared in a number of publications that analyzed open data on monthly mortality rates.
According to officials of the Moscow Department of Health, 11,846 deaths were registered in the Russian capital in April 2020, which was 1,841 deaths more than was recorded in April 2019. Journalists concluded that 1,800 deaths might not have been accounted for as coronavirus-caused deaths. "A comparison of mortality rates from the point of view of monthly dynamics is incorrect and does not serve as clear evidence of any trends," department officials said.
The ministry emphasized that in Russia and Moscow, unlike in many other countries, autopsies of bodies of deceased persons with suspected or confirmed COVID-19 are performed in 100% of cases. Therefore, posthumous diagnoses and causes of death are ultimately "highly accurate." Thus, according to the department, coronavirus and its complications, most often pneumonia, have claimed the lives of 639 people from the total number of deaths reported in April.
"It is impossible to establish the cause of death as COVID-19 in other cases. For example, over 60% of deaths were caused by obviously alternative reasons, such as vascular diseases (myocardial infarction and stroke), stage 4 malignant diseases (essentially palliative patients), leukemia, "systemic diseases with the development of organ failure (for example, amyloidosis and terminal renal failure) and other incurable fatal diseases," a message posted on the website of the department said.
The department also noted that any seasonal increase in the incidence of ARVI (acute respiratory viral infection) leads to an increase in mortality, let alone the coronavirus pandemic.
"In these cases, the infectious onset acts as a catalyst for the rapid progression of chronic diseases and for the manifestation of new diseases," representatives of the department said.
Even if all the additional mortality rate for April in Moscow is attributed to coronavirus, the mortality from COVID-19 will be “slightly more than three percent, which is lower than the official mortality rates in New York and London (10 and 23 percent respectively),” the department concluded.
Earlier, Russia’s Ministry of Health and Deputy Prime Minister Tatyana Golikova, commenting on an article by The Financial Times, which said that the coronavirus mortality rate in Russia could be 70 percent higher than official statistics, expressed a similar point of view.
The Ministry of Health said that health workers are guided by the rules of the "International Statistical Classification of Diseases and Health Related Problems, 10th Revision.” In cases of the coronavirus infection, “International Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death” are used.
The documents are designed to encode COVID-19 as the main cause of death in almost all cases, when a COVID-positive patient dies despite other illnesses that he or she may have had.
“A death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death. A death due toCOVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19,” the document published on the website of the World Health Organization says.
However, the current version of temporary recommendations from the Ministry of Health of the Russian Federation titled “Prevention, Diagnosis and Treatment of the New Coronavirus Infection (COVID-19),” which Russian doctors use as guidelines, say that when formulating a pathoanatomical diagnosis, one should differentiate between deaths caused by COVID-19 as the main disease and deaths against the background of the coronavirus infection, "but without its clinical and morphological manifestations that could become the cause of death." Therefore, a significant part of those who died having COVID-19 in Russia may not be included in the stats as those who died from coronavirus.