The second wave of the pandemic in Russia and in the world: challenges, models of struggle, scenarios of the future

Analytical report

By the beginning of November, the incidence of a new coronavirus infection in the world has reached unprecedented proportions. There are about 45 million cases of the disease and more than a million deaths. Global statistics, according to Johns Hopkins University, are as follows:

1. The United States, nearly 9 million cases, about 230 thousand people died;
2. India, more than 8 million cases, about 120 thousand people died;
3. Brazil, 5.5 million cases, more than 150 thousand people died;
4. Russia, more than 1.5 million cases, about 27 thousand people died;
5. France, more than 1.3 million cases, about 36 thousand people died;
6. Spain, more than 1.1 million cases, about 35 thousand people died.

"Statistical" controversy

There are alternative approaches to assessing the incidence rate in countries around the world. If in absolute figures Russia is in fourth place, then in terms of incidence per 100 thousand population as of the end of October - only 49th (about 1000 cases per 100 thousand population). At the same time, the mortality statistics also have noticeable differences: in terms of mortality, Russia is in 105th place in the world, that is, this figure is 1.6% with the world average of 3%. When assessing the mortality rate per 100,000 population, Russia is in 46th place. As you can see, the global configuration changes depending on the criteria and counting methods. Russian mortality statistics are often questioned - both by experts and observers within the country, apart from foreign criticism, which is mainly politically motivated. For example, according to a summer study by FOM and the Levada Center, about 60% of Russian doctors consider the data on the number of infected and fatalities to be underestimated.

The "statistical" polemic has several important aspects, in addition to the general projection of the problems of trust in the authorities in socially significant areas. So, there is still no consensus on how to separate the deaths directly from the coronavirus and from complications caused by the infection. In other words, attempts to assess the degree of influence of infection on mortality create room for maneuver in the formation of the final statistics. In this case, the likelihood of a "reasonable" and at the same time artificial underestimation of statistics is not excluded if there is reason to consider some other factor as the cause of death. In world practice, by default, the opposite principle applies - regardless of what became the immediate cause of death, if COVID-19 is detected in a person, this case is recorded in the general mortality statistics. In addition, the underestimation of statistics can be quite deliberate on the ground - complaints and testimonies are constantly received from doctors from different parts of the country. At the same time, there is no reason to believe that such a line of conduct could have been agreed upon by the Kremlin.

Vaccine Race: Symbolic and Real Leadership

The world situation in the active phase of the second wave of the COVID-19 pandemic is ambiguous. It was assumed that by this time it would be possible to develop a more general effective treatment protocol and vaccine. Russia acquired the formal leadership by releasing the world's first coronavirus vaccine Sputnik V (Gam-COVID-Vac), developed by the N.F. Gamalei of the Ministry of Health of Russia. However, at the time of registration of the vaccine in August 2020, all the necessary stages of clinical trials had not been completed - this became a reason for criticism, although it was compensated by the fact that registration did not imply the beginning of large-scale vaccination, which has not yet begun. Post-registration tests on volunteers are ongoing. Gradually, some of the participants in the trials began to identify cases of COVID-19, but it is also known that a quarter of the volunteers during the third stage of the Sputnik V vaccine trial received a placebo. Since this information is not disclosed until the completion of all studies, there are no final conclusions about the effectiveness of the first vaccine. At the end of September, the second patented Russian vaccine against coronavirus, developed by the Novosibirsk center "Vector" - "EpiVacCorona", appeared. In addition, trials of the third vaccine have begun, which is being developed by the Federal Scientific Center for Research and Development of Immunobiological Preparations named after M.P. Chumakov RAS.

Immediately after registration, Russia received requests from 20 countries for the supply of more than 1 billion doses of vaccine. At the same time, the US and the EU have sharply criticized the Russian vaccine and do not hide the fact that they are putting pressure on partners for its possible purchase. So, in the official statement of the European Commission it is said that in relation to the EU countries that have made a decision to purchase the Russian vaccine against COVID-19 without an agreement at the level of the organization, measures will be taken (which are not specified). Hungary has already expressed this interest among the EU countries. Within the EU, a number of companies are developing the vaccine; vaccinations are expected to begin in 2021, although there are already difficulties with the distribution of future drugs. In the United States, the development of the vaccine has not yet been completed - the Trump administration expected to receive it before the end of the election campaign, that is, by the end of October, but the timing of its release has shifted to the end of 2020. It is significant that the thesis about the free provision of vaccines to the entire US population was used in campaigning by the Democratic Party candidate D. Biden. The American side also accused Russia of sabotaging the vaccine production process.

One way or another, in Western countries in the near future they expect the completion of the third stage of clinical trials, which in Russia actually fell into the post-registration phase for the Sputnik V vaccine. Despite the criticism, information about Russian vaccines is more open; about alternative foreign proposals, we only know that they are in development. From this point of view, Russia does retain the lead, but according to current realistic projections, mass vaccinations will begin in 2021, both in Russia and abroad. The final assessment of domestic and Western vaccine developments will depend on the scale and success of mass vaccination . For example, the Moscow authorities have already announced the start of mass vaccination within the next month - as soon as a sufficient number of vaccine batches are received. One way or another, it is unlikely that mass vaccination in the regions will begin earlier than 2021, given the fact that there are already interruptions in the supply of conventional drugs.

Russia has so far won the symbolic "race for the vaccine", but now there is a more difficult task ahead - to win the real one. Of no small importance will be the ability of the authorities to form confidence in the proposed developments. Fears of mass vaccinations are linked to political risks, but mandatory vaccinations are unlikely seen as a working strategy. Vaccines are likely to be scarce.

In addition to vaccines, by the beginning of the second wave, the first developments of a cure for coronavirus appeared. New drugs Areplivir and Coronavir have been registered on the Russian market , but their effectiveness is being questioned. Special recommendations of the Ministry of Healthcare have been developed, which include a list of drugs used in the treatment of coronavirus, but there is still no single treatment protocol either in Russia or in the world. This is noticeable in the higher mortality statistics during the second wave. One way or another, the effectiveness of the measures taken in medical care is comparable to the first wave - a significant breakthrough has not yet occurred.

Pandemic coping models

At the same time, the authorities of many states, including Russia, are abandoning the strategy of quarantine and suspension of social life, as was the case in the first wave. A full lockdown is becoming an exception, although recently, for example, measures comparable to those of spring have been introduced in France and Germany; other European countries also practice a "partial" lockdown - for example, entertainment establishments are closed, but organizations, schools and universities continue to operate. The experience of the countries called covid dissidents (primarily Sweden and Belarus) did not become fatal: at least, judging by the general level of sentiment regarding the coronavirus problem.

Russia refused to introduce a self-isolation regime. More precisely, compliance with it is strongly recommended to the most vulnerable categories of the population - pensioners and people with chronic diseases. Some restrictions have been imposed on the work of the catering establishment, but it is not planned to close them yet, as is the case with theaters, cinemas, gyms. The attitude towards transferring employees to a remote form of work remains, universities and schools are partially transferred to distance learning, but these measures are still less strict than in the spring. Consequently, in the sense of the regulation of morbidity, a rather tacit directive was made towards the development of the so-called "population immunity". It is understood that in this case the burden on the health care system should be comparable to its capabilities - this is fully implemented in Moscow, but not in all regions.

Fears and anxieties: unemployment, “remote work”, limited mobility

Public sentiment has been transformed. Despite the more intense growth in morbidity and even mortality, the main fears and anxieties are now more social in nature.

First of all , the economic recovery is of concern , but for many groups of the population this is an abstraction that is in the sphere of responsibility of the state, but at the same time manifestations of the crisis are obvious that concern certain social groups. For example, the segment of small and medium-sized businesses, which suffered from the introduction of the self-isolation regime during the first wave, fears a repetition of restrictive measures, which has already led to bankruptcy and the closure of a number of companies.

The unemployment rate is growing: by the fall, the number of unemployed in Russia is approaching five million people , while since the beginning of the epidemic, their number has increased by about a million. The average unemployment rate is estimated at 6.1%. Higher rates were recorded in the regions of the North Caucasus - for example, in Ingushetia, unemployment reaches 30%. The lowest unemployment rates are in Moscow (2.7%), St. Petersburg (3.6%), YaNAO (2.5%) and KhMAO (3.2%) . It is also important that the threat of the emergence of structural unemployment, which will be of a long-term nature , is growing - this is associated with the closure of enterprises and organizations and layoffs, with the "squeezing" of the market in some segments and the vulnerability of a number of professional groups in a pandemic. Thus, taking into account the systemic reduction in social contacts, soft and almost imperceptible deurbanization (with the onset of the epidemic, flows from city to village, including for permanent residence, intensified), the demand for usual services is decreasing.

From a labor market perspective, the implications of the spread of teleworking remain to be assessed. As practice shows, the transfer to the so-called “remote work” was accompanied by a reduction in salaries and other losses of prospects and social guarantees of employees.

Distance education itself is becoming an annoying factor, especially schooling. School as a social institution has always closed on itself a significant part of educational functions and reduced the burden on parents, now this balance is disturbed. Higher education also has special requirements that have not yet been fully implemented in a distance format. However, dissatisfaction with distance education is latent, and there is still a significant reserve of patience.

Disruption to the usual level of global mobility is an annoying factor with delayed effects , affecting significantly more social groups than it might seem (not only tourists). For example, the borders with the CIS countries are still closed, which limits many personal and professional contacts and changes the supply chains. For example, a trip from the cities of Kazakhstan to the Russian regions of Siberia, the distance between which is measured in hundreds of kilometers, it is forced to pass through Istanbul and Moscow. Opening borders with Western countries is a matter of the future, and it is already becoming the subject of political speculation. It is possible that later we will be able to observe a situation when an entry permit will be issued depending on the type of vaccine used.

The second wave of the pandemic: the situation in Moscow

The number of new cases of coronavirus in Russia is approaching 20 thousand people a day, in Moscow this figure already exceeds 5 thousand people. The number of hospitalizations is also growing: in Moscow alone there are more than a thousand of them per day, despite the fact that efforts are being made to establish the process of treatment at home for milder forms of the disease. The current Moscow mortality rate is also higher than the spring one: on average, more than 50 people die per day, but sometimes 60-70 people. Thus, by the beginning of November, the total number of active recorded cases in Moscow exceeded one hundred thousand; the mortality rate is 1.6%. Despite the general negative dynamics from the first wave of the epidemic, the current situation differs in a number of peculiarities.

First, the scale of testing has increased and it has become more accessible. Therefore, perhaps, more cases are recorded than in the spring, when this mechanism was not yet fully debugged. The question of how great the chance of error is and what are the consequences of an incorrect diagnosis is still debatable. This is partly offset by the need to do several "verification" tests in a row.

Secondly, in Moscow, a more even distribution of cases of illness and recovery is evident . The number of recovered cases is gradually approaching the number of new cases detected. In the spring, the discrepancy between the two was initially very strong.

Third, the rejection of the massive "self-isolation regime" during the second wave was significant in terms of morbidity statistics.

According to current forecasts, the peak of the coronavirus epidemic in Moscow will be on December 14 - this is the average estimate, in which case the number of cases will reach 192 thousand. To combat the epidemic , the Moscow authorities have taken a number of measures that largely coincide with the response strategy in the regions of Russia, but have their own specifics.

The common thing in this case is the introduction of a glove-and-mask mode, self-isolation (in current terminology - “home mode”) for pensioners over 65, people with chronic diseases and pregnant women, an attitude to expand remote work, partial transfer of schools and universities to remote mode learning.

Additional efforts are being made in Moscow to monitor compliance with these conditions, whether it be a social monitoring system to track quarantine compliance by people who test positive or a policy of fines. Fines became more widespread during the second wave, as it was decided not to curtail the social life of the city, so there was a need for additional disciplinary mechanisms.

The introduction of standards for the transfer of employees to remote work is a good practice. Nominally, this directive was voiced by many heads of regions, but in Moscow a minimum bar of 30% was set - as many employees (minimum) must leave institutions and organizations. In particular, it facilitated unloading of public transport and provided an opportunity to voluntarily isolate people who are more vulnerable.

An important factor is the general acceptance by the residents of Moscow of the rejection of the mass "self-isolation regime". Demands for a total restriction of social life are selective and do not affect the general level of socio-political attitudes. In this sense, the situation in Russia correlates with the global one. Moreover, open protests in the West took place precisely against the imposition of restrictions (even in the most affected countries - in Italy and Spain - such protests took rather aggressive forms), despite the high incidence rate. The situation is in a sense paradoxical: the more real the threat seems, the weaker the basic fears associated with the immediate spread of the pandemic .

The advantage of the Moscow situation is the higher capacity and level of preparedness of the healthcare system . Reserve hospitals are opening in Moscow, which provide a supply of several thousand free hospital beds as the incidence increases. By the end of October, reserve hospitals were opened in Kommunarka, Krylatskoye, Sokolniki, at VDNKh and Kashirskoye highway. According to the mayor of the capital S. Sobyanin, there is no need to redesign ordinary hospitals for the treatment of COVID-19. Maintaining the usual schedule for the provision of planned medical care in a pandemic can be considered an achievement of the Moscow healthcare system. However, negative aspects persist - mainly in the format of home treatment, which is poorly regulated, so that patients are left on their own as a result.

Other restrictive measures taken in Moscow during the second wave of the pandemic include the introduction of a registration system for visitors to new bars, cafes and restaurants, in contrast to St. Petersburg, where the authorities went further and completely restricted the work of nightlife after 11 pm.

The second wave of the pandemic: the situation in the regions

The situation with the development of the coronavirus epidemic in the Russian regions is characterized by an uneven distribution of risks and limited opportunities for the provision of medical care . The top ten regions in terms of the number of detected cases (including Moscow) by the beginning of November is as follows:

1. Moscow
2. Moscow region
3. St. Petersburg
4. Nizhny Novgorod Region
5. Sverdlovsk region
6. Rostov region
7. Khanty-Mansi Autonomous Okrug
8. Krasnoyarsk region
9. Voronezh region
10. Irkutsk region

The distribution of the epidemic by region is chaotic: it cannot be said that in some areas of the country there are territories that are not affected by the coronavirus . On the other hand, the number of detected cases does not always mean that the region is located in the so-called. The "red zone", where the most intensive increase in the incidence is noted. Different interpretations of the distribution of risks across regions appear from time to time. So, according to the data published at the end of October, in Russia there are no regions left in the "green zone", but at the same time the "dark red" zone is highlighted, which includes eight regions: Buryatia, Chukotka, Altai Republic, Novosibirsk region, Mari-El , Sevastopol, Novgorod region, Nenets Autonomous District. However, these estimates are rather informal, private and do not take into account the extremely mobile nature of the epidemic.

A problem for all regions, except for Moscow, is the burden on the health care system, which cannot cope with the crisis and does not have sufficient resources at its disposal for emergency mobilization and connection of reserve capacities. First of all, this is manifested in the shortage of doctors: even under normal conditions, even before the outbreak of the epidemic, negative consequences of optimization were noted, but now medical workers are increasingly either getting sick or leaving work due to difficult working conditions. A supporting factor in the spring was additional payments to doctors directly working with COVID-19, but now, when almost all doctors in the regions are focused on fighting the epidemic, the selective nature of payments is more likely to cause dissatisfaction. In addition, the additional assistance - attracting graduates and students of medical schools - is exhausting its potential. In the regions, there is a shortage of beds in hospitals and CT machines - it can take a week for this type of diagnosis. Information about the sale of seats in the queue for CT appears.

The responses of the authorities of the subjects to epidemiological challenges during the second wave are more universal. This is mainly a glove and mask mode, remote work and partly distance education. However, during the second wave, for the first time, restrictions in the regions surpassed those in Moscow, though not everywhere . For example, theaters and cinemas were closed almost all summer in many regions, and somewhere they did not even have time to reopen before the start of a new wave of coronavirus. Now in many regions there are restrictions on the operation of nightlife and public events - in fact, this means a moratorium on weddings and other mass celebrations in public places.

Three scenarios

The current epidemiological situation allows us to construct several potential scenarios for the development of events.

The first scenario is inertial. It partly echoes the situation of the "Hong Kong flu" of 1968-1969. The active phase of the pandemic occurs in the first year or two, with a higher rate of morbidity and mortality observed in the second wave. Then the so-called "population immunity", about which there is a lot of controversy, will actually develop, and the disease gradually declines, although a slightly higher mortality rate persists for several years. The key factor is the formation of immunity, but the priority functional task is to develop more effective treatments and strengthen the health care system.

Scenario two - betting on vaccinations . After the second wave of the pandemic, a significant recession does not occur, more precisely, the second wave smoothly flows into the third, possibly with small pauses. At the same time, vaccine trials are coming to an end successfully, and the authorities are faced with the challenge of mass vaccination, associated with socio-political risks in the case of choosing a "compulsory" strategy. The priority task is, of course, to improve the vaccine, which now excludes many vulnerable categories of citizens.

The third scenario is "apocalyptic". In the short term, current versions of the vaccine do not fully prove their effectiveness, and drugs do not meet all the challenges associated with treating the virus. At the same time, a steady upward trend in morbidity remains. There comes a global getting rid of illusions, understanding of the long-term and, possibly, total nature of the problem. The world is waiting for general autarchy, an increase in panic, a serious revision of the existing models of social interaction.