K.KAZENIN AND I. STARODUBROVSKAYA: WHY DAGESTAN IS BADLY-HIT BY THE EPIDEMIC
The RBK daily published a joint survey by the Gaidar Institute’s researchers Irina Starodubrovskaya and Konstantin Kazenin. The survey deals with the analysis of the factors behind the grave epidemiologic situation in Dagestan caused by the outbreak of the coronavirus COVID-19.
“The specifics of the organization of the society in the North Caucasus facilitating the outspread of the epidemic is observed most evidently in Dagestan.
The Republic of Dagestan has become the only Russian region where the epidemiologic situation required the interference of the President: on May 18, President Vladimir Putin held a meeting with the Republic’s leadership and community leaders where it was recognized that the epidemiologic situation was critical and the aid fr om the federal center was needed.
What has caused such a situation? We put aside the medical aspects of the issue because we are not experts in them. Let’s focus on the specifics of the social pattern of modern Dagestan, public conscience and networking between the authorities and the civil society.
Daily life patterns
There are some specifics of the daily life patterns of the modern North Caucasus which are particularly evident in Dagestan and stood behind the outbreak of the infection.
It is primarily the high mobility of the population. A large part of residents leave their villages to go to make their earnings in towns and other regions and then come back. The worsening economic situation made lots of them return home. Traditionally, when people return they meet with relatives, neighbors and friends and it means dozens of handshakes.
Also, the situation is complicated by the tradition of large gatherings of people at weddings, funerals and child-birth celebrations. As per numerous evidence, funerals facilitated largely the spread of the infection: after the ceremony of expressing condolences mass outbreaks of the infection were registered. Even being aware of the risk of catching the infection, in most cases people did not refuse to come: the public opinion mattered more to them. In Dagestan, the closure of mosques took place later than in other North Caucasian republics.
Also, the lockdown measures in Dagestan are difficult to implement because a large number of people is engaged in the small business which cannot preserve the employment and pay wages even during a short-term shutdown period. Numerous small businesses kept operating in the delivery mode. Though we have no actual confirmation of mass contamination at work places or in the process of rendering services to the population, this risk cannot be excluded completely. In April, sellers at marketplaces in Dagestan did not wear gloves and protective masks.
The situation was made even worse by the spread among people of conspiracy theories dismissing the existence of the virus. In social networks, they claimed that a line of ambulances was fake news and there was nobody inside those cars.
All these things point to a dramatic confidence crisis in the community where the traditional life pattern was seriously modified in the past few decades, but no modern forms of trust between people have emerged yet. At the Republican level, there are neither traditional leaders nor people who have won the respect by their competence and active public posture, so that they could influence the society and promote a more responsible attitude to the risk of the coronavirus. All these developments took place amid mistrust to the ruling deep-rooted establishment formed during the existence of the post-Soviet clan system in the region.
Artificial Respiratory Units (ARU) fr om sponsors
On the other side, close social ties which facilitated the outspread of the infection permitted to combat it by means of the initiative from the below. Non-profit organizations (NPO) (for example, “Monitor Patsienta”) and individual public activists started the explanatory work informing people of the danger of the virus and inadmissibility of self-treatment and engaged doctors who advised people on preventive treatment methods and actions to be taken in case of getting infected with the virus. Charity funds (such as Insan, Nadezhda and Chistoe Serdtse) helped those in need or who lost incomes or a job and purchased PPE for medical workers.
There are cases of self-organization at the village level. They are mostly limited to the regulation of entry: former residents of villages who live in other territories are asked not to come, while strangers are simply not allowed in. Some communities went even further: for example, in the Kara Village of the Laksky District the outbreaks of the virus were stopped from spreading by means of introduction of tough control over the health of residents who had to report their temperature every day in the WhatsApp group, limitation of entry, as well as regular disinfection of premises. Sponsors, descendants from the village, provided their fellow-villagers with PPE and ARUs.
Another example is the Gimry Village wh ere the head of the village, imam and chief physician called on the villagers to wear protective masks and gloves, lim it their contacts, stay within the borders of the village, refrain from visiting funerals and condolences ceremonies and postpone weddings and child birthday celebrations. However, these measures were introduced too late as it happened in lots of other places after the first fatal case and failed to prevent completely people from being infected. Apart from that, a nearby large highway did not permit to exclude the contacts between transit travelers and the locals.
Vertical lockdown
The leadership of Dagestan is in no way to blame for the delayed response to the epidemic. As early as March 31, Vladimir Vasilyev, Head of the region introduced the lockdown. On the next day, in his address to the people of Dagestan Vladimir Vasilyev said that the number of COVID-19 cases had increased in the region.
But the overall level of compliance with the lockdown measures in the cities of Dagestan was low in April-May. It is to be specified that according to the Yandex’s data only in the first week of April the compliance with the lockdown regime was measured at 3.4-3.7 grades on the five-grade rating scale and then it fell to the unacceptably low level of 2.7-3.2 grades. Apart from the abovementioned problems, it depended on the way how efficiently the lockdown was enforced.
First, according to numerous reports from the spots the “enforcement” component was of a rather chaotic nature and failed to be accompanied by the required explanations. Local residents were not often informed of restrictions on entry to one or another city. All these factors did not contribute to growth in the population’s trust to the authorities.
Second, the authorities did not network with the activists, nor supported their activities. In enforcing the lockdown, the emphasis was made exclusively on the vertical. But in a problematic region with active civil society such method of enforcement of the lockdown was not very effective.
At last, the problems related to the official information about the course of the epidemic increased tensions. Numerous reports about villages which lost a dozen or more people, fatal cases at hospitals, including deaths of medical workers and serious outbreaks of the infection in some mountain and submontane districts were not in harmony with the official statistics, particularly, as regards death cases. On one side, it gave rise to the sentiments that the authorities did not tell the truth, while, on the other side, it led to the underestimation of the real danger. In mid-May, the Republic’s authorities started to report separately the data on deaths of patients from community-acquired pneumonia who were tested negative for COVID-19. But it happened only several weeks after citizens started to voice their concerns.
What should be changed?
As it can be seen, the complicated situation in Dagestan is related not to medicine alone. Amid the conditions of formation of all-out mistrust to the authorities, their low efficiency and prevailing corrupt practices, it will be infeasible to combat the epidemic if they rely on bureaucrats alone.
The authorities of Dagestan should use more civil society resources, seek to mobilize both traditional opinion leaders and civilian leaders for the explanation of this serious situation and proceed from the experience of the best practices used in Dagestanian communities.
Also, it would be expedient to support social protection mechanism formed from the below amid the crisis. Joint efforts and the exchange of the information between the authorities and the “third sector” will permit to use effectively the limited resources which can be mobilized in Dagestan for combating the epidemic and its implications.”
The Republic of Dagestan has become the only Russian region where the epidemiologic situation required the interference of the President: on May 18, President Vladimir Putin held a meeting with the Republic’s leadership and community leaders where it was recognized that the epidemiologic situation was critical and the aid fr om the federal center was needed.
What has caused such a situation? We put aside the medical aspects of the issue because we are not experts in them. Let’s focus on the specifics of the social pattern of modern Dagestan, public conscience and networking between the authorities and the civil society.
Daily life patterns
There are some specifics of the daily life patterns of the modern North Caucasus which are particularly evident in Dagestan and stood behind the outbreak of the infection.
It is primarily the high mobility of the population. A large part of residents leave their villages to go to make their earnings in towns and other regions and then come back. The worsening economic situation made lots of them return home. Traditionally, when people return they meet with relatives, neighbors and friends and it means dozens of handshakes.
Also, the situation is complicated by the tradition of large gatherings of people at weddings, funerals and child-birth celebrations. As per numerous evidence, funerals facilitated largely the spread of the infection: after the ceremony of expressing condolences mass outbreaks of the infection were registered. Even being aware of the risk of catching the infection, in most cases people did not refuse to come: the public opinion mattered more to them. In Dagestan, the closure of mosques took place later than in other North Caucasian republics.
Also, the lockdown measures in Dagestan are difficult to implement because a large number of people is engaged in the small business which cannot preserve the employment and pay wages even during a short-term shutdown period. Numerous small businesses kept operating in the delivery mode. Though we have no actual confirmation of mass contamination at work places or in the process of rendering services to the population, this risk cannot be excluded completely. In April, sellers at marketplaces in Dagestan did not wear gloves and protective masks.
The situation was made even worse by the spread among people of conspiracy theories dismissing the existence of the virus. In social networks, they claimed that a line of ambulances was fake news and there was nobody inside those cars.
All these things point to a dramatic confidence crisis in the community where the traditional life pattern was seriously modified in the past few decades, but no modern forms of trust between people have emerged yet. At the Republican level, there are neither traditional leaders nor people who have won the respect by their competence and active public posture, so that they could influence the society and promote a more responsible attitude to the risk of the coronavirus. All these developments took place amid mistrust to the ruling deep-rooted establishment formed during the existence of the post-Soviet clan system in the region.
Artificial Respiratory Units (ARU) fr om sponsors
On the other side, close social ties which facilitated the outspread of the infection permitted to combat it by means of the initiative from the below. Non-profit organizations (NPO) (for example, “Monitor Patsienta”) and individual public activists started the explanatory work informing people of the danger of the virus and inadmissibility of self-treatment and engaged doctors who advised people on preventive treatment methods and actions to be taken in case of getting infected with the virus. Charity funds (such as Insan, Nadezhda and Chistoe Serdtse) helped those in need or who lost incomes or a job and purchased PPE for medical workers.
There are cases of self-organization at the village level. They are mostly limited to the regulation of entry: former residents of villages who live in other territories are asked not to come, while strangers are simply not allowed in. Some communities went even further: for example, in the Kara Village of the Laksky District the outbreaks of the virus were stopped from spreading by means of introduction of tough control over the health of residents who had to report their temperature every day in the WhatsApp group, limitation of entry, as well as regular disinfection of premises. Sponsors, descendants from the village, provided their fellow-villagers with PPE and ARUs.
Another example is the Gimry Village wh ere the head of the village, imam and chief physician called on the villagers to wear protective masks and gloves, lim it their contacts, stay within the borders of the village, refrain from visiting funerals and condolences ceremonies and postpone weddings and child birthday celebrations. However, these measures were introduced too late as it happened in lots of other places after the first fatal case and failed to prevent completely people from being infected. Apart from that, a nearby large highway did not permit to exclude the contacts between transit travelers and the locals.
Vertical lockdown
The leadership of Dagestan is in no way to blame for the delayed response to the epidemic. As early as March 31, Vladimir Vasilyev, Head of the region introduced the lockdown. On the next day, in his address to the people of Dagestan Vladimir Vasilyev said that the number of COVID-19 cases had increased in the region.
But the overall level of compliance with the lockdown measures in the cities of Dagestan was low in April-May. It is to be specified that according to the Yandex’s data only in the first week of April the compliance with the lockdown regime was measured at 3.4-3.7 grades on the five-grade rating scale and then it fell to the unacceptably low level of 2.7-3.2 grades. Apart from the abovementioned problems, it depended on the way how efficiently the lockdown was enforced.
First, according to numerous reports from the spots the “enforcement” component was of a rather chaotic nature and failed to be accompanied by the required explanations. Local residents were not often informed of restrictions on entry to one or another city. All these factors did not contribute to growth in the population’s trust to the authorities.
Second, the authorities did not network with the activists, nor supported their activities. In enforcing the lockdown, the emphasis was made exclusively on the vertical. But in a problematic region with active civil society such method of enforcement of the lockdown was not very effective.
At last, the problems related to the official information about the course of the epidemic increased tensions. Numerous reports about villages which lost a dozen or more people, fatal cases at hospitals, including deaths of medical workers and serious outbreaks of the infection in some mountain and submontane districts were not in harmony with the official statistics, particularly, as regards death cases. On one side, it gave rise to the sentiments that the authorities did not tell the truth, while, on the other side, it led to the underestimation of the real danger. In mid-May, the Republic’s authorities started to report separately the data on deaths of patients from community-acquired pneumonia who were tested negative for COVID-19. But it happened only several weeks after citizens started to voice their concerns.
What should be changed?
As it can be seen, the complicated situation in Dagestan is related not to medicine alone. Amid the conditions of formation of all-out mistrust to the authorities, their low efficiency and prevailing corrupt practices, it will be infeasible to combat the epidemic if they rely on bureaucrats alone.
The authorities of Dagestan should use more civil society resources, seek to mobilize both traditional opinion leaders and civilian leaders for the explanation of this serious situation and proceed from the experience of the best practices used in Dagestanian communities.
Also, it would be expedient to support social protection mechanism formed from the below amid the crisis. Joint efforts and the exchange of the information between the authorities and the “third sector” will permit to use effectively the limited resources which can be mobilized in Dagestan for combating the epidemic and its implications.”