As the Russian government mobilises the military to help Daghestan combat one of the worst outbreaks of COVID-19 in the Russian Federation, doctors say that the scope of illness and death is still greatly underreported. 

Over this weekend Russian armed forces have set up two mobile hospitals in central Daghestan’s Buynaksk and Botlikh districts to ease the burden on healthcare capabilities of the North Caucasus republic. 

Logistical and medical units of the army were dispatched from Russia's other regions last week, on the order of Russian Minister of Defense, Sergey Shoygu on behalf of Russian President Vladimir Putin on 21 May.

New infectious hospitals for COVID-19 patients are also being built in Daghestan’s cities of Derbent, Khasavyurt and Kaspiysk by Russia’s Ministry of Defence.

Currently, Daghestan remains the fifth among the most severely ravaged Russian regions due to the outbreak of COVID-19 pandemic in the country, with 4455 confirmed cases and 130 fatalities as of publication.

However, doctors warn that the actual number of infections is likely much higher.

Community-acquired pneumonia and COVID-19

Irina Tragira, a senior doctor at Daghestan’s Research Centre for Physiology and Infectious Diseases, warned on 22 May that many people with symptoms of COVID-19 are being misdiagnosed with community-acquired pneumonia.

‘In Daghestan, 36 deaths from COVID-19 have been officially registered —  unofficially, 820 people died from pneumonia that was not registered as COVID-19, she said.

The head of Daghestan Vladimir Vasiliyev said on 12 May that in Daghestan this April, compared with the same month last year, the numbers of viral pneumonia grew by 33.6%. 

Vasiliyev noted that the authorities are not trying to hide the statistics of COVID-19 cases, but at the same time, ‘before the autopsy results, it is difficult to make a final diagnosis of whether [the patient had ] pneumonia or the coronavirus’.

Meanwhile, doctors at the Khasavyurt Hospital and the Second City Hospital in Makhachkala have told OC Media that in Daghestan they do not usually perform post-mortems since most relatives of the deceased refuse the procedure due to their religious beliefs.

One doctor told OC Media that many of their patients have not been diagnosed with COVID-19 because before 8 May, they simply had no COVID-19 tests. As a result, the patients were registered as having community-acquired pneumonia.

Community-acquired pneumonia is pneumonia caused by either viruses, bacteria, or fungi that the patient has developed outside of the healthcare system — as contrasted with hospital-acquired pneumonia. 

On 16 May, the Health Minister of Daghestan, Dzhamaludin Gadzhiibragimov, told blogger Ruslan Kurbanov that if considered together, there have been nearly 14,000 registered cases of COVID-19 and community-acquired pneumonia.

Gadzhiibragimov said in his interview with Kurbanov that in Daghestan all cases of community-acquired pneumonia are being registered and that they are treated with the same seriousness as cases of COVID-19.

‘But since we do not have laboratory-confirmed data, statistics are kept the way that they are’, said Gadzhiibragimov.

Nabi Kalamutdinov, a doctor at the Second City Hospital of Makhachkala, where patients with bilateral pneumonia are admitted, explained to OC Media that the symptoms of pneumonia caused by COVID-19 can be similar to ordinary pneumonia, that is, fever, cough, chest pain, and shortness of breath.

At the same time, according to him, pneumonia caused by COVID-19 virus is serious enough that it often requires the use of a ventilator.

A doctor at the Makhachkala Infectious Diseases Hospital told OC Media there has been a massive growth in the number of pneumonia cases in the beginning of May with hundreds of new pneumonia cases every day — which has since been confirmed by authorities. While in the month of March, before the outbreak was widespread, there were only 709 recorded cases of pneumonia.

Lack of tests, equipment and doctors

Aishat Nazhmudinova, an obstetrician-gynaecologist at the Central District Hospital in the village of Levashi in central Daghestan, told OC Media on 4 May that there had been massive numbers of cases of pneumonia among the medical staff at their hospital.

According to her, they could not tell whether the disease was caused by the novel coronavirus because of the lack of tests for COVID-19 in the hospital and the absence of CT scanner machines for lung screening.

[Read more on OC Media: ‘Critical shortages‘ of protective equipment reported in Daghestan’s hospitals]

On 8 May, the Russian Ministry of Health recognised the situation with COVID-19 in the region as the most alarming in the country.

Abdul Isaev, who was suffering from pneumonia, told OC Media that he had been tested for COVID-19 in the Second City Hospital of Makhachkala. He said that two weeks later he was not given his results.

According to Isaev, during his stay in the hospital, he, like other patients, purchased almost all medicines, especially the more costly ones with their own money. His test for COVID-19 was, however, provided free of charge.

On 14 May, health authorities in Daghestan admitted that the testing of the population for COVID-19 had been insufficient, due to a lack of tests and laboratory facilities. 

‘No statistics on people who died at home’

Magomedali Aliyev, a resident of the village of Gubden in the south of Daghestan, told OC Media that about 40 people have died in his village in the second half of April. Gubden has a population of only 9,000. 

According to him, the deceased were primarily elderly and had suffered from pre-existing health problems, and because they died at home they ‘were not included in the statistics of patients with coronavirus or pneumonia’.

A doctor at the Second City Hospital of Makhachkala, who requested to remain anonymous, told OC Media in early May that they had to send patients with severe symptoms home ‘due to lack of space’.  

Mufti Ahmad Abdulayev, the official religious leader of the Muslim community in Daghestan, told Putin on Monday that ‘no one keeps statistics on the illnesses and deaths of people who died in their homes’.

Doctors at the Khasavyurt hospital and the Second City Hospital in Makhachkala have explained to OC Media that in part death misregistration occurs because pneumonia, including when it is caused by COVID-19, causes serious and often fatal complications of pre-existing cardiovascular diseases — as well as other health problems such as diabetes — which are then indicated as the cause of death instead of COVID-19.