The Washington PostDemocracy Dies in Darkness

In Russia, sick people often treat themselves. That’s not helping in the coronavirus fight.

A medical specialist exits an ambulance Oct. 8 at a hospital for coronavirus patients on the outskirts of Moscow. (Maxim Shemetov/Reuters)
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MOSCOW — When Moscow tech specialist Vasily Korobtsov had early symptoms of what might have been covid-19, the 37-year-old consulted family and the Internet. But he avoided taking a test or going to a clinic.

Igor Silayev, 50, also did not take a test when he had possible symptoms — a cough and runny nose — after traveling to a Moscow hospital by ambulance with his parents, who both had covid-19, the disease caused by the novel coronavirus.

Silayev simply bought the same drugs his parents were given and treated himself.

It was another example of Russians’ DIY pandemic response.

Russians are generally suspicious of doctors and state hospitals, polls show, partly a hangover from Soviet times when hospitals were free but forbidding places. Many prefer self-diagnosis and self-medication. For them, going to the doctor is a last resort.

Distrust of the state health system, coupled with the tendency to ignore rules on self-distancing and mask-wearing, provides additional clues to why the country is struggling to stem the spread of the virus.

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In recent weeks, cases have spiraled upward in an alarming new wave, breaching records almost daily.

Russia is seeing more than 15,000 cases a day, nearly 28 percent of them asymptomatic. There are stiff penalties — and even jail — for knowingly hiding an infection. But it is difficult to determine when people knew they had the virus.

In addition, many people with minor symptoms are steering clear of tests rather than risking compulsory isolation, mandatory tracking via their smartphones and possible fines — and are advising their friends on social media to do the same.

“Getting into a hospital can be more dangerous than the disease itself,” a post on Facebook by a Russian doctor, Artemy Okhotin, warned in April, advising people not to take a test — because of the risk of contracting the virus while getting the test and the high number of false negative results.

If you get a positive test result, “you’re under house arrest with the risk of being put in quarantine,” warned one Facebook user, Olga Prokhonova. Russia’s smartphone case-tracking app issues stiff fines for those who fail to upload geo-located selfies at specified times to prove they are at home, penalizing many people too sick to post.

In a country where antibiotics are freely available over the counter, about 60 percent of Russians prefer to self-diagnose and select their own medicines, the Tass news agency reported in April 2019, citing a survey by About 74 percent consult doctors only when their symptoms are strange or serious.

A poll by the VTsIOM polling agency last year reported that the level of trust in doctors declined from 54 percent in 2010 to 36 percent in 2017. That compares with 74 percent in the United States, according to a January 2019 Pew Research survey.

Russians often turn to pharmacies because of a lack of primary-care doctors, said Maxim Osipov, a cardiologist and writer who founded a nongovernmental organization to equip and improve the municipal hospital in Tarusa, a town about 85 miles south of Moscow.

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“Mainly people treat themselves,” he said. “In Tarusa, all the pharmacists know me and I stand in line and hear them consulting patients: ‘This is for your stomach. This is for your heart. This is for blood pressure. This is for that.’ ”

Russian doubts about doctors date to the Soviet era and are understandable, he said, given the shortage of well-trained doctors. In the Soviet Union, medical care was free but the sprawling hospital system was inefficient and, according to Osipov, often heavy-handed in its approach to patients. Patients, distrustful and used to the lies of Soviet authorities, often felt like reluctant inmates.

And because people do not trust authorities to act in their best interests, they tend to ignore their advice on wearing masks, social distancing and taking tests, Osipov said.

“I myself, if I got infected, would not like to be involved in the measures taken by officials,” he said. “I would like to keep it as private and separate from them as possible because my interests and the interests of the medical system and the state are not the same.”

Korobstov, the tech specialist, avoids doctors as a rule. “There’s always the Internet, and you can look up what new methods are used,” he said. His family also follows a mustachioed YouTube doctor, Yevgeny Komarovsky, who has 2.6 million subscribers.

When Korobstov got a fever and headache in April, he kept to his bedroom for three days whenever his 91-year-old grandmother was not in her room. After his symptoms disappeared, he took a test and breathed a sigh of relief when the result was negative. But soon his grandmother got symptoms, followed by his mother.

He was out of the apartment when his grandmother collapsed on the floor, where she lay for hours. A few days later, weak and feverish, she was taken to a hospital. She died two days later. Only after her death was she diagnosed with covid-19.

Five days later, Korobstov’s mother, Elena, got symptoms but decided against going to the local clinic. Instead the family researched antibiotics and antiviral medications online and purchased them. But her fever persisted and Korobstov, afraid he might lose her, too, spent two days unsuccessfully trying to phone the local clinic.

“It’s impossible to get a doctor,” he said. “I called everywhere.”

He finally walked there to get an ambulance — which did not come. Several days later, after the worst was over, a doctor finally arrived and handed his mother a notice to stay at home and told her to take medicine for a sore throat.

“Medical workers don’t know what to do. It’s a complete collapse and helplessness,” Korobstov said. “They didn’t do any tests, just issued that stupid order saying they will be tracking her with the stupid social media monitoring app.”

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Silayev, who avoided testing to be sure he could shop for his parents, took a test two weeks after he felt he had recovered. It was negative.

“I don’t know whether I had covid or not,” he said, “but I treated myself preventively, and maybe this was irresponsible and not very clever, but I thought if I feel really bad I will go to the doctor or call an ambulance.”

Billionaire Alexey Repik trusts doctors and drugs, but then, he can afford the best.

The Russian pharmaceuticals tycoon (who attended President Trump’s 2017 inauguration) heads R-Pharm, a Russian company manufacturing a generic version of favipiravir, an influenza drug developed by Fujifilm Toyama Chemical and approved in Japan in 2014.

Only the elite in Russia could afford the daily coronavirus test he has taken through the pandemic because of his wife’s pregnancy.

He tested positive in August and immediately began a course of favipiravir, prescribed by his physician. The drug was first used in Wuhan as a possible treatment during the early weeks of the coronavirus outbreak in China. It has been approved for emergency use in Russia (produced by Repik’s company) and in Japan and several other countries in Asia, Europe and the Middle East. Some studies are ongoing in the United States, but favipiravir has not been cleared for commercial use.

The drug is sold in Russia at $186 a pack, beyond the reach of all but the wealthiest Russians.

“Do we need to change the attitude of the people in terms of visiting the doctor or using medical advice at an early stage? Yes, we do,” Repik said.

Silayev said he could not have afforded the drug for his parents, even if it had been available when they were sick.

“I don’t know who will be buying them,” he said. “Who can afford it? And who would trust such expensive new medicines?”

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