the Chief pathologist of Moscow Oleg Zairatyants — on account of deaths from the coronavirus.

the Authorities in Moscow today summarized the results of the mortality in the capital in April this year, when the epidemic of the coronavirus was in full swing. “Kommersant” talked with the chief freelance specialist of the Moscow health Department for pathological anatomy Oleg Zairatyants about how many deaths in the city were directly or indirectly linked to the coronavirus, which explains the “supermortality” of citizens this month and as mortality statistics may change by the end of may.

— Today, the Moscow government presented the statistics of mortality in the city in April of this year, which includes death directly or indirectly caused by coronavirus. Until the official data there has been much discussion of how these deaths occurred and how they were calculated. Therefore, before proceeding directly to the monthly statistics, I would like to hear from you, as in whole Russian Federation method of determining causes of death?

— Yes, of course. The Russian approach to the definition of causes of death based on who recommendations, including recommendations in relation to infectious diseases, and international qualification of diseases, or ICD.

In Russia, I note, an autopsy is carried out on average in 60% of cases, and in Moscow — 80%, while overseas — only in 2-4%.

— in this approach, Moscow pathoanatomical service determined the cause of death in cases where the deceased was a coronavirus?

In Moscow since the beginning of the epidemic postmortem autopsy was dead.

We (also due to the fact that began to establish the final diagnosis in the period not exceeding two weeks, while the norm is 45 days) at the beginning of April I realized how to modify the method of determining causes of death in strict accordance with the recommendations of the who coronavirus. It has become evident that there is, so to speak, the first group of dead are those whose death is caused directly by the coronavirus. I would like to note that this category includes not only those who have the coronavirus has caused irreversible changes in the lungs.

Notice that we immediately offered to use our conclusions about the picture of the disease in clinical practice and from the beginning of April the clinical Committee of the Department of health of Moscow began to change the treatment protocols of patients with coronavirus, in order to reduce the degree of disease involving not only the lungs but and other bodies.

— How many cases of “direct” deaths from coronavirus have you recorded?

In April, according to our data, there were 805. On most of them, more precisely, about 639 cases, Moscow authorities ��was allali before, since it was obvious cases. People had tested positive for coronavirus, and the autopsy confirmed this diagnosis and the appropriate cause of death. Then they added another 40 people who have to establish the cause of death was possible only after additional morphological studies. And finally, another 126 people who had negative tests for coronavirus — however, the autopsy confirmed that he was the cause of death.

— Okay, with the first group we understand. But were there others?

— Yes, another 333 deaths should be attributed to the second group. All those who, having tested positive for the coronavirus, has died however from worsening due to coronavirus any already had their severe chronic disease.

— what determines that it is the disease, not the coronavirus has played a crucial role in a patient’s death?

We determined that, based on morphological pattern, which allows to assess the severity, and accordingly, the contribution of each of the diseases of the deceased to his death. That is, if damage is caused to the body by a coronavirus, were absent or were significantly less than those lesions for which it was responsible in another disease, it was determined the main cause of death. We also identified a third group of dead — those with a positive analysis of the coronavirus has died from the condition, which had nothing to do with him.

Then there are those, for example, who, being infected with coronavirus, has died from fatal injuries or, for example, ulcer bleeding.

Those we counted 423 people.

— as a result, if you add up all these groups are dead, we get the 1561 people who died, being infected with coronavirus, but not necessarily directly from him. A number of media have noticed that in April the number of acts of death in Moscow on 20% exceeds a similar indicator for April past years. As this excess is correlated with the number of deaths that have been infected with coronavirus?

— See in absolute terms, the excess mortality in April of this year on average, which was recorded in April over the last ten years is 1753 people. Of them, as I said, 805 people died in the immediate coronavirus, another 333 and to the exacerbation of already existing disease on the background of the coronavirus, and another 423 people died, having tested positive for the coronavirus, but the cause of their death was not caused by the virus disease.

— That is, a significant portion of the increase in the number of deaths can be attributed to the influence of coronavirus? But what about those who, infected by the coronavirus, has died from it? It turns out that these people still would have died even if the epidemic would not be?

— the average in Moscow from month to month, the mortality may be about 11-13 thousand.

At the end of the year you still get about 115 thousand deaths, however, within year variation in the number of deaths.

In the first three months of this year we recorded a lower death rate of Muscovites, therefore, not surprising that in April, the figure could rise. I will also add that at the end of the epidemic we will undoubtedly see a reduction in the monthly number of deaths in the city.

— still 192 cases of “additional” deaths — what’s the connection?

— as far As we know it including people who died outside of Moscow, but the fact of their death was recorded in the Moscow registry offices. Their deaths were not linked to a coronavirus.

— Could some of these people die from what they are in due to a large load on the health system of the city was not provided with timely assistance due to their underlying disease?

— Strongly disagree. I can’t speak for those who provide in Moscow medical help, but I can appreciate the volume of treatment indirectly, the impact on the pathology service. We only have 10-15% of workload associated with post-mortem examinations, and the remainder being clinical tests. I can say that 70 of the pathology departments (municipal and Federal) work with the coronavirus was engaged only in 14 urban and six Federal jurisdiction — and the other worked in a usual mode, was performed in vivo diagnosis of cancer and other diseases, and have not seen a reduction in requests from medical institutions.

— How the new data affect the mortality rate of coronavirus in Moscow?

— If we value only those who died directly from the coronavirus, the case-fatality rate is 1.4%. If we are talking generally about all the dead who have been recorded virus, the ratio is equal to 2.8.

— So, all the same indicator of Moscow considerably lower than similar data on deaths from the coronavirus in other cities of the world?

— Turns. But it is premature to draw such comparisons. In the world there are different schools determine the cause of death and in this situation they interpreted the who recommendations, hard to say. I hope that using something United international analysis of mortality will be possible, however, given the fact that the approaches to defining causes of death even in long-known diseases continue to differ, this is unlikely to be soon. For example, still remain differences in the approaches to the definition of mortality from cardiovascular and cerebrovascular diseases.

— is it possible on the basis of data for April to make predictions according to the statistics for may?

— it is Obvious that the number of deaths directly from the coronavirus and acute diseases on the background will grow. It is quite predictable, unfortunately: when peak incidence and peak of mortality do not coincide in time. If from the moment of infection to death takes considerable time, incidentally, this is an indication that the patient assistance that the health system tried to save him. If they match, then it would mean that people not offered treatment. Whether the growth in the number of deaths will also increase and the mortality rate is hard to say, it depends on the number of infections.