On February 3, five experts from Russia’s Ministry of Health and the Rospotrebnadzor, the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing,arrived to Beijing, China.Their main goal was to get briefed on the situation with the novel coronavirus.
The purpose of the trip was to get as much information as possible about the epidemiological and clinical component of the infectious disease COVID-19. The trip plan included visiting hospitals and research institutes where the new virus is being studied. The experts also had with them test systems, newly developed by the Vektor State Virology and Biotechnology Centre in the city of Novosibirsk. They hoped to test the tests to confirm their accuracy. However, during this visit, the Russian experts were unable to inspect any hospitals or laboratories.
Very little official information is available about this, most about this visit was posted by the liberal sources that are specifically concerned with undermining relations between Russia and China. They reported that China refused to hand their viral specimens to Russian experts. The liberal media provided no explanation or background to these actions of the Chinese authorities.
A recently published interview with Professor Vladimir Nikiforov, MD, head of the Department of Infectious Diseases of the Pirogov Russian National Research Medical University, the UN expert on bioterrorism and one of the most experienced infectious diseases specialists in Russia, shed some light on the Chinese actions.
The Chinese refused to hand the samples of the the novel coronavirus to the Russian experts, because, as they said, it was of the “dual-use” technology. Meaning it was a biological weapon, and, probably, they couldn’t share specimens of the viral materials without to be accused in a violation of the U.N. Security Council Resolution 1540 on the WMD Nonproliferation Program.
Vladimir Nikiforov: we don’t have a single serious patient, inexplicable panic, counterproductive
The questions about coronavirus were answered by a leading Russian infectious disease specialist, Professor Vladimir Nikiforov.
Q: We are visiting Professor Vladimir Nikiforov, MD, head of the Department of infectious diseases of Pirogov Medical University, UN expert on bioterrorism and one of the most experienced infectious diseases specialists in our country. You have experience fighting with cholera in the North Caucasus, and with typhoid fever. You’re probably studying the coronavirus now. You even traveled to China. How complete is the scientific picture of what is happening in Russia? How dangerous is this virus?
Vladimir Nikiforov: The picture is twofold. On the one hand, yes, the problem is quite serious . Yes, people get sick, Yes, some die. But they were getting sick prior to this, and they were dying prior, and some were even more seriously ill, and some had died in larger numbers. On the other hand, there is an absolutely inexplicable panic, an absolutely counterproductive campaign of fear and hysteria, not without the participation of the media. We can’t say that there is no problem, but it is not so terrifying, not the Apocalypse that we are being told over the Internet. About 200 thousand cases in the world and more than 8 thousand [victims] (as of March 22, Coronavirus cases top 300,000 worldwide and at least 12,944 have died and 95.7 thousand of infected recovered). In other words, the mortality rate is quite low. Mostly the elderly die, for a reason. This is not the greatest lethality that medicine knows, not the greatest incidence of infections. Under this hype, they forgot a little about the flu. But, according to American estimates, since September 2019, 15-20 million people have fallen ill with the flu, and about 20 thousand have died from it. Only in the United States. But [the current pandemic] is poorly understood, unexpected, and that’s why a little scary. Everything new seems scary, and people also like to be afraid, they do it willingly. This led to a somewhat inadequate response from the society. Just professional medics like the infectious diseases specialists, pulmonologists – they are quite calm. Especially since China has already demonstrated itself very famously in dealing with this. Including through their efforts, the virus has behaved quite predictably. A standard SARS outbreak, which the coronavirus belongs to, lasts six to eight weeks. It started in December. Now we can say that China has nearly ran out, they describe 13-14 cases [per day]. How quickly they built these 16 hospitals, and quickly they dismantled them as unnecessary! And now the virus has spread to Europe. I have some questions for Europe as a professional, which I can’t answer and, in my opinion, no one can: why such a jump in Italy, with such a high mortality rate suddenly? In principle, everything is understandable in China. Here… hell knows, I’ll be honest. But for now, if we go back to the standard story of SARS outbreaks, four weeks of growth — four weeks of decline. We haven’t had four weeks yet. So far, everything is invested in the standard development scheme.
Q: I want to talk about numbers. There are about 80 thousand registered cases in China. About 3 thousand deaths. These figures give rise to a 3% statistic. In South Korea, after mass testing began, many more infected people were detected, and the mortality rate began to decrease — to 0.7%. In Germany, it is formed at the level of 0.2%, which is equal to the values of all SARS and flus, because it happens that pneumonia develops as a result of SARS and flu, and people often die from pneumonia. In Russia, as I have seen, on average more than 20 thousand people die from pneumonia a year. This is usually the result of SARS. Then why, if this is almost the same as the usual SARS and flu in terms of fatality figures, is there such fear and such insane quarantine measures that the world has never known before?
Vladimir Nikiforov: In my 64 years with 40 years of experience, I can already afford to say that I do not know and do not understand, and this will not harm my image. What you said is absolutely true. By the way, this time it’s a little different. After all, China was allowed to make a diagnosis clinically, without any test systems, they finally gave up, and they also do not have all the figures confirmed. But I can give you another explanation, it’s not that simple. In China, there was a primary focus, the so-called patient zero, the first patients, and, according to the general logic of the infectious process, the first contact obtained infection has a severe course with high mortality. This is clearly a new virus, of course. Where it came from? I am not going to discuss this now. There are a lot of all sorts of theories, whether this is a spontaneous mutation or it was helped by somebody’s crafty hands. I don’t want to comment in this case. But in Wuhan – the clinical picture was clear of the first level contact of a person with this type of coronavirus, naturally severe course with high mortality. As the virus passes through a person, it will naturally reduce virulence, that is, aggressiveness. Again, the infection doesn’t want to kill anyone.
Q: That is, not only a person adapts to it, but it also adapts to a person?
Vladimir Nikiforov: Absolutely. Virus is a parasite. Only an idiot would want to kill his host as a parasite, and infection is not stupid. Infection needs a sick host, not a dead one. There is also a possibility that a virus that has already come to South Korea was slightly dulled down and has lost the desire to kill right and left. Here add the increased number of confirmed diagnoses, on the other hand — a clear decrease in virulence. After all, mark my words, I may be in a hurry, although with China I was not mistaken when I said that in a month everything will start to fade, in China it happened, I just did not consider that it will take and spread to Europe. And Europe just repeats the model of China, but I don’t understand why Italy has such a lethality rate. This impression is formed, if you stand on the point of an outsider, that they have the second completely independent center of infection. Or, if you take a conspiracy point of view, this is the second throw-in: one was in Wuhan, the second – in Italy, assuming that these all was done by someone’s crafty hands. To say that Italy has such an aged population and therefore there is such a high mortality rate… in general, you can guess, but the puzzle does not add up.
Q: And further in Europe – Germany, France, now these data suggests that, too, as in China, it begins to fade?
Vladimir Nikiforov: not yet, but it will start fading. Believe me, the weather and everything else should work well by summer. The British quite interestingly solved the problem. In principle they…
Q: They didn’t close anything.
Vladimir Nikiforov: Yes. The truth is actually in the middle. Infection does not like two things: hysteria, as we now have in Europe, and chumminess. It won’t forgive either of those.
Q: People who follow the published data see a rapid drop in the mortality rate to the values of the average flu, people are perplexed, looking for an explanation why such unusual and destructive measures for the economy are being taken in Europe. And I read an explanation of the danger of this virus — the speed of its spread, its infectivity is much higher than that of ordinary flu: one infected infects two people at once, and then exponentially — one to two, two to four, four to eight, eight to 16, and an instant increase in the incidence. They say that a very small number of people are at risk of death, but still so many people can get sick at once in two or three weeks, and this happened in Italy, that there will not be enough ventilators for those who need it, who will be ill in a severe form. Therefore, the main task, as they seem to say in Europe — is to stretch all this out over time with strict quarantine measures. What do you think about these ratings?
Vladimir Nikiforov: Perhaps, but I would not say that the coronavirus is so highly virulent. For example, one person with measles infects about 16-18 people. About the coronavirus, they say two-three, well, maybe three-four. I say that measles is many times more virulent. Another thing is that there is a measles vaccination. Well, maybe so. Five years ago, everything was quiet, we had an excess of infectious beds, they weren’t needed. There were only three infectious diseases hospitals in Moscow: the first, second and third in Kuryanov. It was liquidated as unnecessary, because the beds were empty, there was an overabundance. Well, now we grab our heads in a hurry.
Q: Everywhere, after all, there was a tendency to reduce time spent in hospital and, consequently, reduce the number of beds. And when exactly this epidemic situation arose, then it turned out to be…
Vladimir Nikiforov: Yes, I understand that Soviet healthcare was very expensive, but it worked. It was necessary to build in parallel, maybe some other system. And we have the anthem of morons as a reminder: the whole world we will destroy to the ground with violence. Why do we always need to build from scratch? Why do we have to destroy all what was created before? Let’s build in parallel, and slowly eliminate what is not necessary. First, everything was destroyed. Now, everyone started pouring money in. But the infection can not be cured by transfers of money. As one smart Frenchman said, “whoever doesn’t want to feed their own army will feed someone else’s.” And infection is, basically, the same as the army. Only we rush to provide security when this army is already here. And we must have some supply, some free beds, even if they will eat up finances. Yes, they will. It’s like a Fire Department. If you haven’t had a fire in a year, let’s eliminate fire crews, scrap fire trucks for metal and live in peace. That’s what had happened. It was relatively quiet, and the infection beds were unprofitable.
Q: We have seen the Chinese outbreak, and now this new, yet incomprehensible Italian outbreak, and with a high lethality. Around, for example, in Germany, the figures are already much lower, everything is calmer. An unscientific approach comes to mind: wouldn’t it be easier not to close anything? Let it, this outbreak, pass naturally, how does SARS pass? They say that, as a rule, 100 out of a thousand infected people get sick. 80 of them are ill in a mild form, and 900 have already been vaccinated, and this is how it ends. Why was this approach, which has always been applicable to SARS epidemics, influenza, diseases that have always given rise to complications, excluded from all such pandemics, and why did we start such strict quarantine measures, and what is the scientific point of view of this good? Aren’t we simply stretching things that would naturally settle down much faster?
Vladimir Nikiforov: you know, it is difficult to say here, and maybe you are right. The English, for example, went this way. But in general, the Chinese set the tone. For the first time in our lives, in the history of mankind, we saw such a tough maneuver on the part of the Chinese, who started this panic. In fact, there was an impression that they knew what they were dealing with, that they had prepared for it in advance, and then there was an instant such a harsh reaction that surprised the whole world. Well, big deal, after all, flu season. Frankly speaking, let me now take a purely cynical position. Given: one and a half billion people in China. Well, Wuhan, there are 80-100 thousand sick and 3 thousand dead. Believe me, China wouldn’t have noticed. And suddenly, boom, tanks, closures. And this was the instant reaction of the Chinese leadership.
Q: They set the trend. Wuhan for China is less than 1%. It is clear that the huge China in regard to 11 million Wuhan can pick it up, pack, transfer from one life to another, without destroying everything around. But when factories close in Europe, people stay at home, they don’t work, and obviously don’t earn money. Tomorrow they will not get paid en masse. And not 1% of the population, but much more. Here, too, what is Wuhan for China and what is the whole north of Italy? What is closed Volkswagen, closed Airbus, we have here plans to close Moscow are announced, fortunately, are not yet applied.
Vladimir Nikiforov: we generally have a tendency to justify all sorts of bad rumors, as I have already noticed. But, on the other hand, Wuhan is like a solar plexus, there are railways, it is a transit point, they could be afraid that from there [the disease will go further].
Q: Did you go there?
Vladimir Nikiforov: Not in Wuhan. My task was to look like someone from the Health Ministry, but the Chinese guessed that I was an expert, so everything ended in Beijing. I think that, of course, not because of me, we had a representative team, there were eight or seven of us, only two were representatives of the Ministry of Health, the rest were representatives of Rospotrebnadzor. I was from the Ministry of Health, I wanted to see everything. Okay, I thought the hell with it, they didn’t let me go to Wuhan, let’s show me a hospital in Beijing. They didn’t let me in either. We came with our own test systems and said: let us test them. We were told : “We will not let you into the laboratory, give us your test systems.” They took it, went to their lab, came back a few hours later, and said that our tests were working. All we could do was to trust them. We said: “Give us the virus.” They answer: “We can’t, it’s a dual-use technology.” Then we got the virus in a different way.
Q: What does “dual-use” mean?
Vladimir Nikiforov: You can make a vaccine, or you can do the opposite.
Q: Where did we get it from?
Vladimir Nikiforov: We got it. Or, do you think that we are asleep at the wheel, or what? As the saying goes, we are peaceful people, but we keep our armored train. Do you know what we needed the virus for? Not for this “dual-use.” If you want, I will assemble such a virus for you in a few days. You need to have the original to make the vaccine. You can take RNA and build it like Lego. In principle, this is possible, it will be an artificial virus, an ersatz virus. A likeness, a copy is always worse than the original. You need to have a real virus from the patient, then you can really create a complete vaccine that will really work.
Q: What do you think about these strict quarantine measures? How justified are they really?
Vladimir Nikiforov: I Don’t know. They think it’s necessary. I’m an infectious disease specialist. Here I will take advantage of the fact that this is not my diocese, I do not meddle, my business is to treat. But I can say that I still have no one to treat, really no one. These snot and screams on the Internet that the government is hiding mountains of corpses, I have also been sent this audio message that we are being deceived — in fact, no, we are not. I can clearly say that we have non-hospital [stastistics], which you mentioned, quite correctly. But I can tell you more, 700 thousand officially community-acquired pneumonia a year. For a little Russia – 700 thousand. Lethality is about 2-3%. You said 20 thousand die. Yes, from 700 [thousand].
Q: I looked at the statistics: for the three quarters of last year, 18 thousand, that is, 6 thousand per quarter, if you add up – 24 thousand.
Vladimir Nikiforov: the Patient is diagnosed with community-acquired pneumonia, because he did not get it in the hospital, it is not a hospital, he has already had the flu on his feet somewhere, then got pneumonia, the flu has already passed, and now it’s pneumonia. And we begin to decipher them. Let’s say they’re doing this to us, our test system is completely bad, it just doesn’t work. I’ll take it, okay. But then we would have a growing share of undeciphered (of unknown etiology) pneumonia. And we would write simply: community-acquired pneumonia without identifying an infectious agent. And we have deciphered, that is, we do not have a mountain of corpses with a diagnosis of pneumonia of unknown etiology. There is no such thing. If you blame it on a bad test system, you get a bunch of unencrypted corpses. But there is no such thing. They die, but we know the diagnosis more or less. And we are not littered with dead people.
Q: Now simple tips for people what to do.
Vladimir Nikiforov: the coronavirus didn’t bring anything new. Washing hands has not been canceled. Moreover, if I “pour” the virus on your palm, nothing will happen to you. Washing your hands, not pocking your fingers into your eyes, don’t touch your face and nose. If you just drop the virus on the tongue, I do not believe that the virus can pass through the digestive tract because it is designed receptors in the tracheobronchial tree, and the intestine are lined with different types of cells, so the virus will not be able to grab onto them. Like this. It also won’t penetrate through skin.
Q: They say it stays on paper money for a long time, on cash.
Vladimir Nikiforov: Paper money, especially old banknotes – it is not only a battery of coronavirus, but many other viruses and bacteria, in general. If you look at a frayed banknote, it’s a piece of biological weapons. I strongly advise not to chew on it, this is generally known, so that’s why they are being destroyed. I do not remember what country but they were impregnating paper money with disinfectant. I’m afraid to lie now, but somewhere they even released paper money with a disinfectant impregnation, but then they discontinued since the allergy went up in people. So, this wasn’t a solution to the problem, as well as it’s not a solution to washing your hands with soap and disinfectant too often. You can’t always wash your hands with a disinfectant, because our hands are covered with protective fat, that our specific, we have characteristic microbial ensemble living here. This is your personal flora, which should not be touched. If you persist in destroying it every day several times a day with disinfectant soap, then you will have eczema up to your elbows, and in the end, you will violate the microbial ecology of your skin. That is, wash your hands with simple soap, take a shower at least ten times a day, but do not try to do it with any antibacterial soaps, otherwise you will go covered in spots.
Q: I have this question about China. In Wuhan, there is a strict quarantine, and somewhere in Beijing, a quarantine was introduced. In total, 100,000 people were ill, and now everything is virtually over. If this virus is really so volatile, it still remains somewhere, and most of the population, the vast majority of the population, according to statistics, has not yet been sick. How can it be that it doesn’t float back up?
Vladimir Nikiforov: Two options. Either it has completely reduced virulence there, and they have it, but it does not give a special “clinic” — for example, young people get sick, without clinical manifestations, and the virus has weakened enough, maybe so. I don’t exclude that it will return later, it can mutate back and forth in some form. Hard to say. And how do we, well, where do we have the virus? There are questions that are easy to ask, but difficult to answer. Where does SARS go in the summer and where does it come from again? It will move with the migrating birds, but I will explain to you that the virus went to Australia, then it will come back. But also, not all of it has gone, somewhere it is, and not all of it has arrived. It means that somewhere some fires might be smouldering. Not all Chinese, not all 1.5 billion people on the whole territory of China were tested for coronavirus.
Q: What is your forecast for Russia?
Vladimir Nikiforov: there are two options — good and bad. The good news is that we really don’t have any serious patients right now and that it will stay that way. It has reached us, now the borders are closed, that is, we have already [come] to the original source, the virus of that Wuhan or some new focus.
Q: Most of the infected people came to us from Italy.
Vladimir Nikiforov: But the question is, where did they get infected? From the original source that was sitting there somewhere? But the original source in Wuhan was not a man: some say that it was a bat. If it was the patient, then from somewhere he got the virus, this very first case. In Wuhan, there was a mass infection at once, and here, it can happen, also. I think that those who were infected and came from Italy, have already been infected from other Italians, who have already picked it up from some Italian, that is, an already weakened version.
Q: That’s why we don’t have any serious [patients].
Vladimir Nikiforov: Yes, that’s the whole point. We have one or two. We already have viral transmissions, but they are also light. That is, in theory, if it goes according to the standard scheme, it will degenerate into a regular seasonal ARI. All the steam will go into the whistle. And the second option is that we are just beginning the path, and every long way begins with the first step. And so, maybe this is the first step, and now we have a candle will go up. But frankly, I don’t believe it. Most likely, it will go exactly like this, it will just increase. In fact, if there was no test system, you would not have noticed that we have some kind of coronavirus, you would have put him with community-acquired pneumonia, well, he is sick and sick, well, a virus, but what virus, the devil knows. But that would have been the end of it, and they wouldn’t have ringing the bells. This is a laboratory diagnosis.
Q: And the authorities that are currently developing various measures, do they generally check these plans with the scientific community, or what are they guided by? Or do they watch what they are doing in other countries?
Vladimir Nikiforov: In any case, not with infectious science. With epidemiologists? Yes. A very long time ago we had made a great stupidity: we divided the medical science in my field into two components. There is the Ministry of Health and and there is the Rospotrebnadzor. It used to be a unified whole, everything was clear. And now what used to be Gossanepidnadzor, now… In other words, there used to be hospitals and sanitary-epidemic stations, it was all one unified structure. The sanitary-epidemic station was engaged in the analysis of morbidity, it checked the activities of hospitals, food outlets, the sanitary station included zoologists who looked at how many wild field mice were sick with the virus, how many were affected, that is, predicted the possibility of developing hemorrhagic fevers. There were entomologists who monitored the breeding of blood-sucking insects, so it all worked. And now everything is separate. We, the hospitals, are separate, and the Rospotrebnadzor is separate. In other words, we treat them, the Rospotrebnadzor inoculates them and analyzes them. How can this be done? It should be unified, under one leadership. And we have a Health Minister and a chief health officer, and before all this was one thing, I think it is wrong. And all the issues of quarantine — this is Rospotrebnadzor. I only look from the outside, my opinion does not interest anyone. I’m an infectious disease specialist. You know, you don’t have to go to the point of idiocy to block [the city], I’m starting to think that this is already crossing some reasonable line, but it’s better to overdo it than under-do it. Once started, well, let’s go, but without blocking the subway. If Moscow is closed? How to restart it? How do I start trains? I don’t really see it that way, but it’s going to be chaos, that’s all.
Q: And against this background, if [they close] the metro, which has millions of people and hundreds in cars during rush hour, is it worth closing the theaters?
Vladimir Nikiforov: This is what we are talking about, I have a lot of questions, so I prefer to be a bystander, because I can’t change anything, I just stand in the position of a bystander. Nothing can be changed, really. I also don’t understand: the metro is working, and the theaters are closed. Again, I want to say once again that this is not such a contagious disease. If it was like measles, then with only one infected riding the metro, in two weeks we would have almost all of Moscow in bed with a skin rash, with even worse mortality rates.
Q: If suddenly, let’s say, God forbid, Moscow will close the metro, what would you say, how would you assess it?
Vladimir Nikiforov: This will be a disaster incomparable to any epidemic. It will be even worse.
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