In a vast Russian region that is frequently hit by flooding and wildfires and has not been spared from the coronavirus, ticks and the diseases they transmit are shaping up as another major challenge this year.
"I was just walking along a paved path when a tick bit me," says Tatyana Redko, a resident of Krasnoyarsk, a regional capital and the third-largest city in Siberia. "They say they are everywhere in the grass. We have a lot of ticks this year. Not only in the parks and the forest, but even on city streets."
Reported tick bites in the sprawling Krasnoyarsk region, which stretches up from the lands north of Mongolia to the Arctic shore, are up 400 percent over the same time last year and the tick season is only just getting under way. According to government statistics, 1,925 people reported bites in the week of May 22-28 in the region, and more than 10,000 bites have already been reported in 2020. Cases of ticks found to be infected with tick-borne encephalitis have been identified in 57 of the region's 61 administrative districts. The problem is equally prevalent in other regions of Siberia and the Russian Far East, as well as parts of western Russia.
Encephalitis is an inflammation of the brain that is caused by a number of viruses, many of which can be transmitted to humans by ticks. Without timely diagnosis and treatment, it can cause permanent damage or even death.
"We are seeing a high level of activity of naturally occurring tick-borne infections," the press service of the Krasnoyarsk branch of Rospotrebnadzor, the state consumer-protection agency, told RFE/RL. "The number of ticks is significantly greater than average."
The cause, the officials said, was the region's unusually mild winter followed by the early onset of spring.
"The weather conditions enabled the main hosts for ticks -- forest-dwelling rodents -- to survive the winter well," the agency said. "Their numbers have grown and the number of ticks has increased correspondingly. As a result, the 2020 season has seen an active outbreak of tick-borne encephalitis."
Ticks are a perennial problem in many parts of Siberia. Many locals have grown used to purchasing annual "tick insurance," a policy sold by the insurance company Rosgosstrakh. The policy is supposed to guarantee treatment with immunoglobulin, an antibody that is believed to prevent encephalitis infection if introduced soon enough, usually within three days.
But many policyholders say they are being turned away, told that there is no immunoglobulin in Russia at all this year.
"My brother was bitten by a tick on a Friday evening," Redko says. "He couldn't find anyone to help him, so he removed it himself. We began calling around. We called the ambulance service and they directed us to a clinic. They gave us the wrong phone number, but I found another number on our insurance policy. They told me that they didn't have any immunoglobulin."
The clinic took the tick that bit Redko's brother for analysis, confirmed the absence of immunoglobulin, and sent him home.
Earlier, Redko's aunt faced the same problem and was given an antiviral medication, an antibiotic, and an antihistamine. None of those treatments was covered by the Rosgosstrakh policy, so she ended up paying 7,000 rubles ($100) out of pocket.
Tatyana Fyodorova, who heads a Krasnoyarsk nongovernmental charity, says her daughter was bitten by a tick on May 24 during a camping trip. Rosgosstrakh sent her to a local clinic called Santem.
"The manager of the clinic said that they didn’t have any immunoglobulin and that they wouldn't have any for at least two months," Fyodorova recalls. "I wrote an angry post on Facebook that was noticed by some journalists."
She says she continued to badger Rosgosstrakh. "They told me that there is no immunoglobulin in Russia and that I was to blame myself, for taking my daughter to the forest," she told RFE/RL.
In the end, Fyodorova was sent to another clinic. She saw a specialist there on May 27, after which she was able to speak with the regional management of Rosgosstrakh. She was told the company had "found" some immunoglobulin for her daughter, who was given an injection the same day.
Fyodorova is certain she achieved success only because she was "raising a stink," was in contact with journalists, and threatened a lawsuit.
"No one in the city knows about the lack of immunoglobulin, but they are still selling these policies," she says. "They don't tell people anything and articles only started appearing in the press after my case."
The press service of Rosgosstrakh did not accept calls for comment for this article for three days.
The medicine has been hard to find in other regions as well. In Khabarovsk, a city near the Pacific coast, resident Inna Aslamova says that she was unable to find any when she was bitten.
"The doctors said there was none in the city or in the whole region," Aslamova says. "I searched all the pharmacies and they didn't have any."
In Novosibirsk, the biggest city in Siberia, the head doctor of City Hospital No. 3, Aleksandr Asadchy, told journalists last month that there was no immunoglobulin in his city either. "We have sent two orders to the Novosibirsk region Health Ministry, but without any results," he was quoted by local media as saying.
Natalya Shekhodanova, director of the Nadezhda private insurance firm in Krasnoyarsk, however, explains why there is no immunoglobulin. "It is missing for two reasons," she says. "First, it simply was not produced and certified in time because of the coronavirus pandemic. Second, commercial clinics have not purchased it because it is expensive."
"Who could have predicted we would have such a year?" she adds. "No one knew. Insurance companies signed agreements with private clinics that promised to buy immunoglobulin. So, who didn't fulfill their obligations?"
Avoid 'Natural Places'
Yelena Averyanova, a doctor and lecturer at Pskov State University in western Russia, says it is a mistake to focus on the cost of immunoglobulin.
"The government is not taking into account the likelihood of people being disabled for life or the costs of rehabilitating patients," she says. "They only talk about the price of the immunoglobulin, but the miser pays twice.... It is illogical that we win tactically while losing strategically in the battle against this small but dangerous tick."
To make matters worse, scientists of the Siberian branch of the Russian Academy of Sciences say they have they are tracking a relatively new tick that is a hybrid of the common taiga (Ixodes persulcatus) and Far Eastern (Ixodes pavlovskyi) ticks. The hybrid tick seems to be capable of transmitting to humans all the parasites of both the more common types, including four types of the bacteria that causes Lyme disease, encephalitis, Kemerovo tick-borne viral fever, and Siberian tick-borne typhus (Rickettsia).
In addition, experts believe the hybrid tick might be more adaptable to various environments and capable of vastly expanding its geographical range.
In a post on the official website of the governor of the Pskov region, local resident Olga Kolesnikova wrote that she had waited in a long line of children and adults suffering from tick bites to see the city's only specialist.
"There is no immunoglobulin in the hospitals or in the pharmacies," she wrote. "There are no substitutes either. How can this be? How can I protect my child? The consequences of a tick bite are no less frightening than those of the coronavirus. But we are not prepared for this threat."
The head of the regional Health Committee, Marina Garashchenko, responded by saying, "At present, there is no immunoglobulin for the prevention of tick-borne encephalitis in the Russian Federation."
Citizens, she wrote, had been repeatedly advised "to refrain from visiting natural places not treated against ticks."