As the number of coronavirus infections surges in Russia, observers have puzzled over a mystery: How is it that a country with over 250,000 suspected cases, and a shaky health care system, has had relatively few deaths?
The answer appears to be the Russian approach to pathology — an approach that has the Kremlin and government health officials in a bitter feud with media organizations over how Moscow interprets, or possibly manipulates, its data.
Since the outbreak took hold in Russia, the Kremlin has touted the government response — initially for holding the outbreak at bay and later for keeping deaths to a minimum as infections have risen.
Russia is currently second in the global rankings for infections but 18th in mortality — with just over 2,300 deaths from COVID-19 reported.
Some statisticians have long eyed those figures with suspicion.
"I think it's safe to say that if you multiply official death count by a factor of three, you will get a more or less true picture," says Aleksei Raksha, an independent demographer in Moscow.
"I work with numbers, and numbers tell me what's going on, not people," he tells NPR.
Raksha was among a group of researchers who discovered possible evidence of hidden COVID-19 deaths amid recent Moscow city mortality figures.
The data, first published this week by The Moscow Times, showed nearly 20% more fatalities this April than in the same month in the previous 10 years.
Subsequent reporting from The New York Times and the Financial Times made similar claims.
Russian health officials have strongly disputed the findings — and suggestions of data manipulation — saying the difference merely reflects Russia's thorough approach to certifying the cause of patient deaths.
"In Russian medical tradition the main cause of death should be the cause of failure of particular organ," notes Raksha, the demographer.
The distinction allows doctors to assign COVID-19 patients as dying from other factors — such as heart, respiratory or kidney failure — unless the virus played a direct role in a patient's death.
On Wednesday, Moscow's Department of Health confirmed that approach, saying 60% of patients with the virus died from other factors.
But critics point to statistical glitches in regions away from Moscow, where President Vladimir Putin put governors in charge of the coronavirus response.
Critics argue many are hiding bad news.
"It's a hierarchy. Statistics in Russia have traditionally been managed according to political ambitions at the very top of government," says Anastasia Vasilyeva of the medical group Doctors' Alliance.
"It's almost as if governors have declared no one's allowed to die from COVID-19," says the demographer Raksha. "I don't know why they're doing it, but I'm a statistician and I see it."
As the story has generated world headlines, Russia's government is pushing back.
At a news conference this week, Deputy Prime Minister Tatyana Golikova insisted fewer Russians were dying from COVID-19 than in other countries because of smart government policies, not fake numbers.
"We never manipulate statistics," Golikova said.
Russian lawmakers have suggested foreign media are carrying out a smear campaign on behalf of the U.S. and other Western governments eager to distract from their own rising death tolls at home.
"It's a political hit," said Andrei Klimov from the Foreign Affairs Council in Russia's Upper House in an interview with the state Rossiya-24 channel.
"The traditional organs of anti-Russian propaganda, particularly in the U.S., have started pushing this idea that we — allegedly — lowered the numbers of infected and the number of dead."
Russia's Foreign Ministry has also demanded retractions from the Financial Times and The New York Times over their investigations — and hinted at pulling press credentials for the journalists involved.
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