Yet, according to official data, Russia is one of the countries with the lowest mortality rate from coronavirus infection. “Kommersant” talked with the head of the International laboratory for research of population and health, Higher school of Economics (HSE) Evgeny Andreev about how in Russia generates statistics of mortality and its causes, about when it will be possible to obtain definitive data on the number of deaths during the epidemic, and why the existing international comparisons is incorrect.— Now in connection with the epidemic of the coronavirus, discussions have arisen about how reliable data on mortality from this disease collected in Russia. The reason for this talk, in particular, have low values of this index in Russia compared with other countries. To begin with — as in a whole is the collection of data on deaths in our country? — Of course, let’s start from the beginning. Information about the death goes to a medical facility and the police for verification as to whether there has been a violent death. In a facility (in most cases in the pathology Department) made an autopsy of the corpse, and then determine the cause of death. Data in the medical death certificate, which also contains General information about the person who died. Death certificate, in turn, together with the passport of the deceased or other document falls to the local office of the Registrar, where their base is another document — certificate record about death, which is assigned a unique identification number. Further data from the death record entered into the unified state register of records of acts of civil status, which exists since the end of the 2018 and maintained in electronic form. Access to this registry have a broad range of agencies — from tax service and the Pension Fund and ending the Federal state statistics service.— What about these data makes Rosstat?— Rosstat is tables with different characteristics of the deceased, taking into account their gender, age and cause of death. Calculated on the basis of one of the main indicators of mortality — mortality rate per 100 thousand people, to define groups died from various causes. Then built more complex models, for example — life expectancy.— Rosstat publishes data on mortality and its causes with different frequency — there are monthly, semi-annual, annual. How do they differ?— There are differences between them, and they are quite substantial. Once a month, Rosstat provides data on registered deaths. Please note — not about the actual. Because people can die in April, and documents his family will take the Department of the registry office in may. It’s the same with causes of death: post-mortem diagnosis may vary as due to ��of anopaci with the relatives of the deceased, and due to new data, for example, as a result of additional analysis.The information that we see in a month, can not fully reflect the real picture of deaths and their causes. Including why Rosstat and shall prepare an annual report — it is expected that early next year, most of the data will already be free from such inaccuracies.— As far as the Russian approach to the collection and analysis of mortality data differs from overseas?— Only in unimportant details. Globally, the statistics of the Russian Federation in this sphere I think it is absolutely accurate — as we enter, we can say in club 42 developed countries that provide information to an international database The Human Mortality Database.— Does this mean that Russian statistics on deaths remain fully trust?— I don’t think we can seriously talk about falsification of the number of deaths. But the process of establishment of causes of death may not be as transparent. First, we have there are differences in the methods of diagnosis of the causes of death at the regional level, as different management of regional health systems. Secondly, again at the regional level, the statistics of causes of death may be tailored for the current tasks of the government. The first time it became known in Soviet times, when the then Minister of health Chazov said that deaths from cardiovascular disease as much, and the regions have begun to record those who died at the age of 80 years as a cause of death old age.— Are there any examples of such practices in the recent history of Russia?— Yes, such cases appeared after the may presidential decrees in 2012, which he demanded to reduce mortality from cardiovascular disease. I would say that up to half of decline that then occurred, was provided by action with statistics. What? For example, dies of a heart attack man, he has other serious illness — and it might instead of heart attack as the cause of death to specify one of them. Of course, in the absence of concomitant diseases change the cause of death was impossible — for an otherwise healthy man died of a heart attack, then no one would have indicated that he was conked on the head. Well, with the General principles of collecting data on mortality, we understand. And how to construct statistics on died of coronavirus?— As I understand it, it is going the other way — hospitals every day in writing or orally report on how many people and what kind of diagnosis they have died. Here, the scope for inaccuracy is much greater, because such statements are more difficult to control and at the end of the month it can be corrected. It is unclear then as it is now determined that the cause of death of a person is it�� coronavirus. At the direction of the Ministry of health is supposed to show the autopsy, but it is obvious that in some regions, where there are folk traditions of burial, for example in Dagestan, don’t do it.— That is, we can see the low statistics of deaths from coronavirus infection?— I have no doubt that in comparison with many countries it is, but not because it deliberately massively falsifiziert. Russia has always held a certain approach to the analysis of the causes of death, it must come from definitely proven diagnosis.In the case of coronavirus, this means that if the patient in the post-mortem autopsies revealed characteristic changes in the lungs, he died from the disease. But if him being sick with coronavirus, has died from a stroke, the cause of death he will write a stroke. Does not such an approach recommended by who?— If you translate the latest who recommendations on establishing the causes of death in an epidemic of coronavirus, it says the following: count the dead from the coronavirus that causes all who have it if there is no other obvious cause such as trauma. This definition is rather vague in itself and if a patient with a coronavirus not injury and terminal cancer? What to do in this case? And than then it differs fundamentally from the approach of Russia?— How do you think the deaths from coronavirus in other countries? As they follow the methodology of the who?— In General, most countries, faced with the epidemic, writes in deaths from coronavirus everyone who was infected, regardless of the severity of other illnesses and ultimate causes of death. But there are differences — for example, in Italy the analysis of the coronavirus was done posthumously, and in the UK at some point ceased to include in the General statistics of death living in nursing homes. Then it is canceled.— And what, then, is based is now published cross-country comparison of mortality?— Using this statistics, which is not comparable. Any valid comparison in the number of deaths from the coronavirus in different countries can be made only in a year when the who and all countries will be able to unify the current data. Myself who while not repeatedly stated that her recommendation to the determination of the number of the dead — time.— Some media suggestions to consider deaths from the coronavirus on the basis of exceeding the total number of deaths the previous level. That is, here in Moscow, as they found out in April of this year, died 20% more than the average for April in previous years. How reliably can say that it is the victim of coronavirus, not included in official statistics?— This, of course, victims of coronavirus, but in a broader sense. As I said, in Russia of deaths from this disease believe the lower boundary, it is therefore likely that the number of deaths has increased at the expense of those who died with a coronavirus, from the aggravation of other disease. You also cannot forget that the contribution to the increase in the number of deaths contributed and raised the burden on the health system because of what someone suffering from cancer or cardiovascular disease was not able to get help in time.I mean, Yes, all these people are victims of the epidemic, but not all of them died directly from the coronavirus.— That is, until the damage from the coronavirus can be estimated by additional mortality in General?— Yes, this is a more valid approach. A number of European demographers, including my colleagues at the International laboratory for population and health Students of Vladimir and David Leon, have turned to the statistical office of the European Union with a proposal to organize a weekly publication of all member countries data on overall mortality. Comparing them with the data of previous years over the same periods, they will be able to evaluate the mortality during the epidemic and, thus, to obtain the figure of total casualties.— Are you talking about all those people who, if the epidemic had not happened, could live? Yes, the only question is how long they would have lived. Yet, we see that the mass coronavirus difficult to tolerate people who already have the disease. We cannot know for certain how long they would have died from his underlying disease. Maybe in a few years, and maybe in a year or a month.— If in Russia die each year about 1.9 million people, mostly from disease and not from injuries at the end of the year we may not see the changes of this figure because of the coronavirus?— I would not like to make such forecasts in a situation when everything can change, but it’s possible.Interview by Anastasia manuylova
