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Russia: Does The Poor Health Infrastructure Leave It Vulnerable To SARS?

With over 20 suspected cases of SARS now reported in Russia, fears are growing that the disease may spread quickly through the sprawling, poorly regulated country. Officials say they have the necessary means to deal with the threat. But with a border with China -- where SARS is thought to have originated, and where thousands of cases have been registered -- as well as a miserable track record in combating such diseases as AIDS and tuberculosis, there are worries that Russia is wide open to contagion, RFE/RL reports.

Moscow, 7 May 2003 (RFE/RL) -- With a border with China and vast stretches of territory traversed by many untracked migrants, Russia faces a serious threat from the fast-developing severe acute respiratory syndrome (SARS).

Officials say there are no confirmed cases of the illness -- called "atypical pneumonia" in Russia -- but the number of suspected cases is growing. The country's chief health inspector, Gennady Onishchenko, spoke to reporters yesterday, commenting on the first suspected case in the country's Far East.

"Today we have more than 20 suspected cases of this disease [SARS]. Right now I'm most worried about the situation in Blagoveshchensk. A 25-year-old person who lived in a hostel in Blagoveshchensk was hospitalized there on 1 May," Onishchenko said.

New research was published today showing that SARS -- which has killed hundreds of people so far, mostly in China and Hong Kong -- is far deadlier than other respiratory illnesses. But Russian officials maintain they have the means to fight the spread of the highly contagious disease.

Deputy Prime Minister Boris Alyoshin said yesterday in a statement reported by Itar-Tass, "We fully possess the technology capable of telling 'atypical pneumonia' from the flu or a cold."

Officials say they are setting up a system of measures around the country, including checkpoints in Moscow airports and railway stations. Efforts are particularly concentrated on the Far East, where the disease is most prevalent.

The government says it is considering fully closing the border with China, where the virus is thought to have originated and where almost 4,500 cases have been officially registered. Reports say 214 have died of the killer disease in China. The global death toll is estimated to be at least 497.

Onishchenko says, "After the holidays of 1 and 2 May, the border [with China] was closed. Then it reopened. As of today, it is practically closed again. We let the Chinese go back to China, we let our citizens back in, but there is no intensive exchange anymore."

Travel to other Asian countries is also being restricted.

Russian doctors generally back official statements, saying the government is capable of dealing effectively with SARS.

Pyotr Deryabin, deputy head of research at Moscow's Institute of Virology, says only time will tell how the disease develops, but that health authorities are doing everything they can to identify and isolate suspected SARS cases.

"A serious program already exists in Russia's state health inspections service, setting out which regional infectious-diseases departments have to be activated in cases of mandatory hospitalization and isolation in suspected cases of SARS," Deryabin says.

Despite the threat of SARS, Deryabin says all staff at his institute is on holiday until 12 May as the country celebrates Victory in Europe Day. The "Gazeta" newspaper reported today that it is unclear exactly which Russian institutions are actually conducting research into the disease.

Neither the Moscow office nor the European regional office of the World Health Organization (WHO) -- which is spearheading global efforts to combat SARS -- responded to requests for comments on Russia's preventative measures. But independent experts say SARS poses a major threat to Russia.

Andrei Slavutsky, a medical coordinator at the Moscow office of the Belgian branch of Doctors Without Borders, says despite official statements to the contrary, it is difficult to discriminate between SARS and other respiratory diseases because often the symptoms are similar.

"A significantly large amount of work has to be done to be able to diagnose [SARS] and rule out other diseases. I'm not sure [Russian] health care departments on various levels have [the] ability to diagnose them -- to confirm or rule out other diseases -- quickly enough," Slavutsky says.

Slavutsky says it is impossible to say exactly how serious a threat SARS poses because much about the disease is still unknown.

He says changing seasons represent one variable, with respiratory diseases in the northern hemisphere tending to spread more quickly from October to May. The question is whether SARS will also drop off "naturally" during the summer.

Critics of official statements meanwhile say state authorities cannot possibly control the country's porous borders.

Slavutsky says rather than trying to shut down legal and illegal entry points, efforts should be focused on providing mobile, highly specialized medical teams to help try to contain outbreaks of SARS.

He adds that finding suspected cases and submitting the patients to the required 10-day isolation is complicated by the fact that a significant part of Russia's population does not have access to even the most basic health care. Russia's health services have seen a steady decline in the years following the collapse of the Soviet Union.

Past experience does not offer much hope. The Russian health care system has been unable to combat fast-spreading HIV/AIDS. The number of registered cases is more than 230,000, but medical experts say the actual figure could reach up to 1 million, with only a tiny fraction receiving treatment. Public prevention measures for HIV/AIDS have been minimal.

A WHO report says Russia's health care infrastructure is also unable to deal with the spread of tuberculosis (TB), a disease that has been largely eradicated in other parts of the globe.

Russia has one of the world's highest rates, with around 30,000 dying from TB each year. The WHO says the main problem is a lack of funds for drug treatment and for training health care providers.

The disease is particularly rampant in the vastly overcrowded prison system, which releases infected inmates into the general public.

Slavutsky says the health care system actually has the potential to work more effectively to combat infectious diseases, but it is largely hamstrung by a Soviet-era, centralized approach.

"Unfortunately, the ability to enact quick and effective control [over the spread of disease] is adapting very slowly to the changing social and economic situation," Slavutsky says.

Evidence of measures taken by authorities against SARS so far is slim, with Russian television today showing passengers -- many of them small-time traders -- disembarking from trains in the Far East after they crossed the border from Mongolia and China.

But Slavutsky says he hopes the appearance of the illness in Russia will jolt the country's medical authorities into finally changing their approach to containing epidemics.