Realnoe Vremya analytics: COVID-19 hidden behind flu and pneumonia?

uelledNo mortality upsurge earlier this year

The Ministry of Health Care issued temporary methodical recommendations on 12 April, according to which amid the growing coronavirus incidence any flu case should be considered as suspected of COVID-19 depending on the epidemiological background. This fuelled the rumours that the cases of death from the coronavirus are hidden behind similar diseases — pneumonia, acute respiratory infection or flu.

In this context, Realnoe Vremya’s analytic staff decided to study the latest currently available mortality statistics — particularly to find out what happened to the acute respiratory infection and pneumonia death toll. Such data is now available until February 2020 — and despite some rumours, some of them suggest that there wasn’t registered a mortality upsurge in Russia either in general or because of acute respiratory infection or respiratory diseases.

Over the first two months in 2020, 307,000 people died in Russia — this is 5% less than a year ago. Cardiovascular diseases (almost half, 145,000 cases), tumours (48,000 cases), external causes of death (21,300 cases), diseases of the nervous system and digestive organs (about 17,000 cases each) are the main causes. There are 5-10% fewer deaths in the first three cases compared to last year’s analogous period, in case of the nervous system and digestion — 10% and 2% more.

As for specific diseases that caused death, coronary heart disease with 75,400 deaths is first. Malignant tumours (47,000) are second, cerebrovascular diseases with 44,000 cases come next. There are 5-11% deaths less.

Twice fewer people died from acute respiratory infection and flu than from COVID-19

There were relatively few deaths from the flu and acute respiratory infection in January and February — just 95. Most importantly, this number significantly decreased over the year — 197 people died from these diseases during the first two months in 2019. So we can assume here that if there were patients with non-diagnosed coronavirus among the dead people, this didn’t lead to a higher mortality rate — January and February were average.

It is noteworthy that the acute respiratory infection death toll in general is comparable with the number of coronavirus deaths in Russia or, more precisely, the difference isn’t big. 148 people died from the coronavirus in Russia as of 13 April (approximately a month since the death of the first patient in the country).

At the moment this indicator isn’t very high (though the number during the month is already 1,5 times higher than the number over two months in the case of the flu and acute respiratory infection). To understand it, now fewer people have died from the coronavirus in Russia than in January and February from accidental drowning (202 people), poisoning and alcohol intake (314 people).

Pneumonia deaths in Russia like coronavirus deaths in Iran

Apart from the flu and acute respiratory infection, there is another disease that can be disguised as COVID-19, especially if the coronavirus isn’t diagnosed — it is pneumonia. However, there wasn’t registered any growth in January-February compared to last year too. 4,125 people died from pneumonia in Russia during the first two months in 2020. It is 15% less than during the analogous period last year.

We should remind you that the first death from the coronavirus in Russia was registered only on 19 March — so there is no coronavirus case among these 4,100 deaths (at least according to those diagnosed). Nevertheless, it is interesting that the death toll even from usual pneumonia in Russia is comparable with, for instance, with the coronavirus mortality rate in Iran. The first death was registered there on 21 February, during almost two months the indicator rose to almost 4,500 people. We also should note that more people died from pneumonia in Russia in January-February than from coronavirus in his “homeland,” in China, over three months since the first death: 3,341 people died from COVID-19 in China as of 13 April, while the first death was registered on 9 January.

The COVID-19 death toll nowadays in some countries is comparable with the pneumonia mortality rate in Russia in January-February. For instance, it is Belgium (3,900 deaths since first death on 11 March), Germany (3,000 deaths since 9 March), the Netherlands (2,700 deaths since 6 March). However, it is important to understand here that generally speaking such indicators accumulated in these countries not during two months but over a month since the first coronavirus death. This is why it is more correct to compare this indicator with the pneumonia death toll a month. In Russia, 1,929 people died from pneumonia in February 2020. It is more than from the coronavirus in less than a month since March 17 in Turkey (1,198 people), Brazil (1,230 people from the same date), Switzerland (1,115 people from March 5). So, with the proper level of containment of the epidemic, regular pneumonia in Russia claims more lives than the coronavirus in these countries.

10k deaths from respiratory diseases in two months

This comparison, of course, should not cause vain hopes or carelessness. In the leading countries in terms of mortality, the figures are much higher (and the population in most of them is lower, so the per capita mortality rate is, of course, ahead of the Russian rate of pneumonia). Besides, the key difference that makes the coronavirus “no more dangerous than regular pneumonia” is the transmission rate. The mortality rate from COVID-19 is not a stable result, consisting of many days with approximately the same number of deaths, they tend to increase significantly, despite all the efforts being made to contain the epidemic — as a result, they lead to very significant peaks. For example, on the highest for Italy peak day by death toll — March 27 — the figure was 919 people, in France on April 7 the death toll a day reached 1,417 people, and in the United States on April 10 — 2,035 people died from coronavirus. That is, on April 10, more people died from coronavirus in the United States than in Russia from pneumonia over the entire February.

However, we would like to note that if we count not only deaths from pneumonia but also from other respiratory diseases (this includes, for example, the flu, acute respiratory infections and other respiratory diseases), the death rate for the first two months of 2020 in Russia is 10,300. This figure is less than a year ago by 11%. However, in general, this death toll is comparable, for example, with the coronavirus death toll in the UK (10,600 deaths from COVID-19 since March 5) and France (14,400 people).

The situation with the dynamics of mortality from respiratory diseases is quite heterogeneous. While the national figure has decreased by 11%, there are cases of quite significant growth in some regions. For example, Ryazan Oblast with an increase in the pneumonia death toll by 46% (from 106 a year ago to 155 in January-February this year), the figure has jumped by 35% in Mari El (from 74 to 100 deaths), by 29% — in Kalmykia, by 25% — in Ulyanovsk Oblast and Kaluga Oblast, by 23% — in Moscow Oblast (while in Moscow itself it has fallen by 16%). There is also growth in Tatarstan — by 16%. At the same time, in some regions, the mortality rate from respiratory diseases has decreased significantly: in Sevastopol — by 61%, in Magadan Oblast — by 48%, in Kurgan Oblast and the Komi Republic — by 43%.