‘We see growth of the death rate in Tatarstan, at first the level was the lowest in Russia’

As Realnoe Vremya’s analytic staff figured out after studying data of the Russian Statistics Service during the first five months of 2021, from January to May, a record-high decline in population (4,900), which even above the numbers during the pandemic last year (2,099) has been demonstrated in Tatarstan in the last 10 years. During the same period, Russia fell short of 360,000 citizens, which is twice more than during the same period in 2019. Such explanations for a worse situation in the death rate both in the republic and across the country are given in experts’ comments for our newspaper.

Record decline in population in Tatarstan and Russia

A record-high decline in the population in 10 years was registered in Tatarstan in January-May 2021, it reached 4,900 people. The population of the republic reduced more than twice during the second year of the pandemic compared to last year’s numbers for the same term (2,099 people). During the pre-pandemic times, for instance, a decrease in the population in the republic during the first five months of 2019 was 961 people.

The number of newborns in the republic from this year’s January to May shrank by 532 people (to 16,061 people), while the death rate rose by 2,269 people (to 20,961 people).

In the birth rate in general Tatarstan ranks first in the Volga Federal District, while a fall in five months of 2021 amounted to 3,2% (compared to last year’s analogous period). Moreover, the mortality rate in Tatarstan from January to May 2021 increased by 12,1% (compared to last year’s period). The death rate in the district in general went 16,3% up (from 164,271 to 191,008 people).

For the sake of justice, we should say that such a negative tendency is characteristic of all Russia this year. The natural decline in the population in five months this year reached a record in 10 years in the country — 360,100 people, which is twice bigger than the pre-pandemic level. In January-May 2019, the decline was 180,753 people. This year we have lost more citizens (by June) than during the first year of coronavirus infection (the decline in January-May 2020 totalled 221,304 people).

There was a slight decline in the population in Moscow Oblast (18,937 people) and Moscow (-16,569 people). Moreover, if 52,157 people were born in Moscow in January-May 2021, which is 5,973 more than a year earlier (46,184 people), in Moscow Oblast, the number of newborns decreased by 3,188 people, to 28,663 people. 47,600 people died in Moscow Oblast during this period, which is 4,108 people more during last year’s (43,492) analogous period. 68,726 died in Moscow in January-May 2021 (58,547 in 2020). Rostov Oblast (-15,487 people) is also in the top region with the biggest population decline.

However, the population in some Russian regions increased during the period (January-May). The Republic of Dagestan where the population rose by 9,630 people, the Chechen Republic (+7,840 people), Tyumen Oblast (+3,759 people) and others are among such regions.

Nationwide, the statistics read that the death rate in January-May 2021 decreased by 1,5% (from 562,477 people in 2020 to 554,289 people in 2021) and the death rate rose by 16,7% to 914,389 people.

Fall in elective health care and “Russian cross”

Talking about such a sharp rise in the natural decline in population during the second year of the pandemic State Duma deputy Ayrat Farrakhov, former Tatarstan health care minister, indicated that the causes would rather be considered at the end of the year:

“We could receive more serious summaries from experts at the end of 2021. As for the natural decline in population, Tatarstan in general repeats the all Russian tendency, vector. We are in a zone of the natural decline in population. We see growth of the death rate in Tatarstan. Moreover, we should note that at first the death rate in the republic was the lowest in Russia,” the parliamentarian stressed.

According to him, Tatarstan envisages a huge amount of elective health care in high-tech medical centres not only in Kazan — the Interregional Clinical and Diagnostic Centre, Republic Clinical Hospital — but also in Naberezhnye Chelny, Almetyevsk, which are designed to reduce the death rate, including from cardiovascular diseases. However, as a result of a fall in elective health care because all health workers put all their effort to fight COVID-19 and big hospital areas and staff were used for COVID-19 hospitals, this led to such a sad result: “When the mortality rate became a bit higher, due to a very low base during the previous years too (we managed to achieve), these dynamics became a bit higher.”

In Ayrat Farrakhov’s opinion, the uncertainty caused by the novel coronavirus infection is putting the main pressure on this process:

“We endlessly create additional spaces. As soon as the process calms down, another wave, an altered variant comes. We have to restrict elective health care again. And of course, it is serious risks for people who might need it: a shunt, angiography, heart surgeries and so on.”

The deputy says the faster we cope with COVID-19 the faster we will go back to the numbers we reached, it is a death rate with 13 and fewer deaths per 1,000 people.

“It is almost an unattainable indicator for most regions today. We have trained specialists, good equipment, good clinics. The faster we are vaccinated, the faster we will get immunity, the faster we can return this time.”

Also, Ayrat Farrakhov reminded us that Russia is now experiencing a decade of the so-called “Russian cross” when there is a sudden decline in natality and worsening of demographic indicators over some period of time (20-30 years):

“I think this decade when natality and decline prevail natality will end approximately after 2025. This is why even when we cope with the novel coronavirus infection, this won’t necessarily happen either, I assume the death rate will stabilise, and the death rate will go back to a previous level,” Ayrat Farrakhov claimed.

“All efforts were put into the fight against COVID-19”

Chairman of the Supervisory Council of the Institute of Demography, Migration and Regional Development Yury Krupnov agreed with the previous speaker that the demographic situation in Tatarstan is better than in Russia. However, there is a significant rise in excess deaths across the country from last April till now:

“This is determined by an extraordinary situation that spreads in numerous measures: social isolation, lockdown, transfer of the health care system to a mobilised system, devotion of the whole treatment process and health care system to COVID-19. The extraordinary situation that was created, mainly manually, and disproportionate danger of coronavirus, as many experts think, it led to a significant excessive death rate. Real causes rest in a colossally depressive state of the population, the absence of serious preventive work on health care, the absence of proper elective health care (a fall in availability and quality of medical services) due to mobilisation.”

The expert noted that the situation with COVID-19 overlapped the health care system that was optimised in 2010-2014 when reserve capacities disappeared in the country. For instance, excessive hospitals closed, the number of beds decreased in 2014:

“It was said that they were not full, excessive, but they forgot that in any complex system, while health care is one of the most complex, there must always be reserve capacities where mobilisation in tough situations goes through.”

To stop the negative trend, the expert thinks “it is necessary to stop all this ‘extraordinary’ situation, which is absolutely invented, and switch to considering COVID-19 as one of the many dangerous diseases, one of many, but not the main and only.” He adds that it is necessary to completely, dramatically reform the system of health care by transferring it into the population’s health care.

“The situation is complicated, there is a decline,” agrees Chairman of the Public Council in the Tatarstan Ministry of Health Care Chingiz Makhmutov. “And it related to both COVID-19 and the change in the work of our health care system. Some hospitals started to operate in the ‘red’ zone, which disrupted the rhythm and scheme of work. A significant part of our health establishments and specialists have still been fighting COVID-19. The primary health care chain had problems last year. All efforts were put into the fight against COVID-19.”

All these factors, the expert says, brought to the growth of the death rate: “If people 20-30% depended on health care, now they do 70-80%. This is why any difficulties in the health care system make themselves know immediately.” The specialist noted that Tatarstan residents themselves were afraid of going to the hospital out of fear of contracting coronavirus, especially those categories of citizens that had to regularly see doctors and be examined due to chronic diseases:

“Due to the spread of coronavirus infection, they stood home. And when they contracted COVID-19, they turned out in the red zone of risk.

Last year, screenings were suspended for some time and then resumed. But this pause also gave a result. “During some periods, it is probably undesirable for everybody to appear in polyclinics when there was a big number of COVID-19 infections. The job was done considering the situation.”

“Now a big job is done to rehabilitate patients who had COVID-19 because there are a lot of complications,” the expert concluded.

As Realnoe Vremya wrote earlier, the share of terminal stages of malignant tumours increased in the first half of 2021 in Tatarstan. Commenting on the situation, chief visiting oncologist of the Tatarstan Ministry of Health Care Eduard Nagumanov also noted that suspended preventive work during the pandemic became the cause.

Statistically, in 2020, the number of appointments in polyclinics reduced by 4,7 million, to 25,3 million. There have been about 30 million appointments every year in the last five years, except for 2020. Also, the number of inpatients has reached the lowest number in five years (by 65,000, or 26,4%). In 2019, 246,000 people received inpatient treatment, just 181,000 people did in 2020.

Yevgeny Khramov