This is the point on which there is no disagreement, not now at least. But how restrictive for the economy the anti-contagion measures should be, and at what cost compared to the cost of the virus impact on life and death, is a point of considerable debate, inside Russia as everywhere else. That is the point which Putin avoided. He is not alone among the heads of state or government in the rest of the world. What is the difference then between Putin and all of them?

“Our most crucial task is to ensure stability in the labour market and to prevent a surge in unemployment”, Putin added in his March 25 speech, announcing a combination of small social welfare and employment compensation measures, with tax relief and loan deferment for businesses, and Central Bank support for “stable lending to the real economy, including through state guarantees and subsidies.”

The subsequent meeting of Prime Minister Mikhail Mishustin with his 9-member “Presidium of the Government Coordination Council to control the incidence of novel coronavirus infection” on March 27 [4] spelled out the anti-contagion policies — especially in Moscow where two-thirds of the recorded cases are concentrated — with an attempt to show that mobilization of supply of testing and treatment measures will more than match the demand for treatment for infected cases. This is the anti-surge strategy, following the China model [5]. The message is that there will be no Italian or Spanish course in Russia. There will also be no failures on the supply side – masks, tests, ventilators, intensive care beds – as there are in the UK, US, and France. Saying so explicitly is a policy designed to combat confusion down the line of command, and stop panic in the population.

Mishustin referred to the government’s calculations for rapid testing and treatment, according to the state plan already drafted by ministers working under First Deputy Prime Minister Andrei Belousov; he was the chief economic advisor to Putin until Mishustin’s appointment [6]in mid-January.

At Mishustin’s cabinet meeting, Moscow Mayor Sergei Sobyanin said “we have calculated the required number of hospital beds for every region [of the city]. We have stipulated clear requirements for buildings and hospitals that will be treating coronavirus patients: the number of respirators they must have, intensive care units, oxygen supply, etc., as well as general requirements for buildings, personnel and equipment. All regions have received these requirements in line with your instruction. I believe that most of them have actively launched this work.”

Putin had been at that point himself with Sobyanin two days earlier. Accompanied by the mayor and health minister, he visited the Kommunarka Hospital, where he was briefed by one of the leading medical policy-makers at the moment, Denis Protsenko.

“From a medical perspective,” Protsenko told Putin, “there are essentially two possible scenarios right now: the Asian one where the spread of the virus quickly subsides, and the Italian scenario with a growing infection rate. As a doctor, an anaesthesiologist and an emergency room practitioner, not just a chief medical officer at a clinic, I believe it is essential that we work [to prevent] the Italian scenario. If one day we see a major surge in infections, and Moscow is already moving in this direction, we are ready to convert this hospital to accommodate… At this very moment, we are ready to repurpose 190 of 606 beds to intensive care units. We are taking lung ventilators from storage and installing them, so these 600 beds can form a major intensive care clinic bringing together highly competent experts from across the city. This is what the Italian model is all about. If we suddenly shift to the Chinese or Korean scenario and it all ends in April or May, I think this would make our doctors happier than anybody. Still, I think we need to be ready to face a worst-case scenario.”

The Kremlin record also reveals that Protsenko has been working with Chinese doctors and planners on treatment therapies which the Chinese have tested for their effectiveness as the seriousness of case infections grows. “Extracorporeal membrane oxygenation (ECMO) is a technology that has returned to our ICUs from the operating rooms after the swine flu outbreak. The city has sufficient ECMO capacity, and an ECMO centre has been set up at one of our hospitals. Today, our department gathered for a roundtable discussion with our Chinese colleagues. They said that this time, unlike during the swine flu, the ECMO was not used that much at their hospital, with only 11 ECMO cases in a total of 6,000 patients.”

More than a month ago, in mid-February there was a semi-official announcement [8]from Beijing that “Chinese experts, based on the result of clinical trials, have confirmed that Chloroquine Phosphate, an antimalarial drug, has a certain curative effect on the novel coronavirus disease (COVID-19), a Chinese official said here Monday. The experts have ‘unanimously’ suggested the drug be included in the next version of the treatment guidelines and applied in wider clinical trials as soon as possible, Sun Yanrong, deputy head of the China National Center for Biotechnology Development under the Ministry of Science and Technology (MOST), said at a press conference.” Thus did the Chinese put a stop to the bitter medical and political controversy in France over the efficacy of chloroquine in treating patients at the intensive care unit (ICU) stage. The controversy has also triggered panic buying of chloroquine in France and Switzerland. The case for and against Didier Raoult, chief promoter of chloroquine therapy in France, can be followed here [9] and here [10].

Chloroquine has been one of several therapies tested and applied in China; it has not been a priority or a command protocol [11]. A Chinese medical source comments: “Azithromycin and other antibiotics may be used for treatment of potentially superimposed bacteria infection. The main successful treatment in China so far is supportive treatment: remove the excessive secretions in lungs and ensure adequate oxygenation. The principles would be supportive measures plus broad anti-infective and anti-inflammation agents.”

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