United states could then be on their blogs or bull explanations for that except when it actually cooking the numbers well to discuss that im now joined by robert primary professor of epidemiology of microbial diseases at condell school of Public Health professor hi mary its so good to talk to you thank you very much for your time well thank you for inviting me now i heard you say recently that your sounds of history leads you to believe that the United States and russia countries separated at birth and this is definitely not a new idea though theres been a number of scholars who looked into russia as this dark double american greatness but i think your idea is different you argue. They reacted very similarly to these latest and damage if so what explains such drastically death friends just numbers. I think the issue about how deaths are found in how death certificates are written explains much of that difference i come from this from my experience with with the aids epidemic. And in that situation aids deaths always seem to be undercounted in russia when you looked into it was really because peoples deaths were attributed to whenever it was the problem we call the proximate cause of death and whether it was de burgh yellow says or pneumonia or our. Own immunocompromised fungal disease or viral disease that was an h i b hiv and the thing that was going to be killing who was going to allow all these other pathogens to come in in turn immunocompromised and killian a similar thing is happening here with corona virus is that people are dying of pneumonia people are dying of heart complications or other organ failures and thats whats being written down as the cause of death well professor henry there is definitely a difference in how the death toll is counted and i do want to look into it from a scientific perspective but before we go there if we take all axes dacs the seas and if we actually did all of them to call the thank you very still and massive difference between russia on the one hand and the United States and the United Kingdom on the other hand what could possibly explain died friends with the epidemic deaths have been concentrated in a place like the United States in many parts of the country so far has been facilities called Nursing Homes where the elderly are are out. With the elderly who live in congregate settings and once the virus enters those facilities theyre spread very rapidly in a population and. They were very susceptible to dying in my state Christian Science think now 70 so doing 50 and 60 percent. Of the deaths are among people who contract the disease while in Nursing Homes yes that means ease does affect the elderly more than younger people right now in the elderly and a very myself so im very worried i have the luxury of staying at home a lot of other people dont even if we account for that and if we strictly compare large metropolitan areas like moscow to large metropolitan areas like new york london and we take into account all axis death the season again the the difference is huge the death rate from combat 19 would be presumed to be at the around 3 percent and i think in new york it would be around 13 in london it would be around 23. 00 so is there still even if you take that into account there are still a massive difference i dont think the death rate in new york is anywhere near 13 percent but clearly you know in. The number of deaths even in new york was under was under reportage for a while. Among the elderly because many of them were dying at all. And i dont think where there are far enough into the kind of epidemic. Epidemiological investigations yet to draw any conclusions in any any final and well as you say its not done that its not you know proper time to draw conclusions and yet to be seen numerous stories in American Press as well as you are numerous Public Health panels essentially accusing russia of cooking the numbers thats why im asking those questions and i dont i dont know where this is they did in one of those where you did not made that accusation per se but the general. Holland was that russia has an institutional interest in under reporting those cases what im trying to. Ask you about here is whether russia could indeed be performing batter objectively that the United States i think this becomes a very silly argument about who is killing more people and not reporting it as i think thats not a particularly useful way to think about this i think the thing to to look at is why both russia and the United States now stand one in 2 in the total number of cases reported and outlaws cases. Turn out to kill people and how those cases turn out to be reported as gold related deaths or are any irrelevant sideshow what im interested in is trying to understand why it is that in certain places certain settings like congregate settings of Nursing Homes lead to higher rates of death among the elderly and the elderly are more spread out and the n. L. Then fewer of them initially will get infected but in the end the elderly are more susceptible the average age for people in russia you know is in the fortys there are a lot of old people around but i think where were at now is that. What were seeing in russia is a delayed epidemic compared to western europe. A delayed epidemic compared to the United States and its too early to predict where its going to go and i certainly dont have access to a sufficient amount of epidemiological information inside russia to to be asked to weigh in in an informative way why there are differences in the real indepth reporting honest on the counting this is a longstanding question in scientific debate the socalled waste off wrong problem whether everyone known to have a particular faction should be recorded as having dies on that infection even though that person happened to have lets say stage 4 cancer or i believe the addition of the russian doctors not the bureaucrats but the russian doctors well they havent said that you have to distinguish between the primary cause and the catalyst in eightys debolt are recorded in the death report what is the problem with a surprise. Im mentioning theres any problem at all i just think that in order to interpret this you have to you know you have to understand the difference i dont have a problem with that approach. What the problem the only problem with that approach is a is a Public Relations approach it does raise. Perhaps inappropriate but nevertheless does raise. Suspicions among people who want to score political points. On the side on the other side of the ocean you mean those people on both sides of the ocean you know you know i am not i mean just that i work in russia so you know for a very long period of time and not interested in fueling any kind of divide i would not be interested in that either but thats why im i actually asking you the scientific question because the russian doctors do not take those diagnosis on the top of that i have in order to make that conclusion they have to conduct an autopsy its written into the law russia has cost more to make salmon nations also all dads reach is a different story of for example for many countries in western europe its also a different story for the United States because from what i know you know the every lability of postmortem examination differs from state to state dont you think that russian doctors have a reason to feel its not superior adenike least considine the data and isnt that actually good from a scientific point of view that theyre coming to the Global Community of scientists with the data establishing was was the main cause of the disease and what was the air pump and an accompanying cost there is no a priori reason. To think that russia is going to be any different from most of the other countries in in the region. He in that new more developed world in having the same in the end attributable fraction of deaths once you adjust for differences in population age distribution and population density. Well thats thats an interesting point i want to talk about that a little bit later but before we go into that you highlighted one specific similarity in the russian and the american response to that pandemic and this is a delegation of the Decision Making to the territories states in the american context and the regions of russia and i heard some people call that an abdication of responsibility on the part of the federal authorities but user that the only way the only professional way of dealing with the conduct make in a large country where you can indeed have very different density of population in various localities and the b. S. P. The mill logical conditions would also be very different on the ground why should putin or trial for that matter be involved in making decisions about some tiny town be it in primordial or ill ask you when youre hey but whatever decisions about when to close down things decisions about when to. Reopen them are probably best made at a local level but not and in national. The abdication of responsibility that i was referring to as a as a disaster for both countries is the lack of attention of the federal government to giving the local regions sufficient authority sufficient finances and sufficient concentration of energy necessary to respond in time energy you mean resources right i mean i also mean. Yet it isnt both federal governments. Were catastrophic will misaligned to the size and the consequences of ignoring the pandemic in its earliest age professor primer told governments friday its in russia or in the United States are on deriding the magical expanse goals of making the necessary Resources Available to unite all down. And i dont know i dont know what russian is but certainly the United States federal government is not giving resources to the States States who are competing with female and the federal government for masks and protect the president protect their requirement. Both countries and i cant speak for russia because i really dont know the situation you know the people ive talked to my colleagues in russia even though many of them are Infectious Disease doctors and people who are Infectious Disease Public Health people dont seem to have the answers to the questions i have been asking them but. I am. And im not going to you know. Speak beyond what im capable of knowing but i do know that our state has has not gotten a coordinated effort of the states most hardest hit here in the northeast have not gotten a coordinated effort. And yet you compare that and then their eyes are none the less even though russia made it made a concerted efforts you build designated called it 19 hospitals for the resources into the region compensated doctors all across the country you say that you dont have enough information about russia and yet you make merry you know broad ranging statements that i respond the response of the 2 governments is pretty much the same i i dont. I dont see. Based on the numbers that. Russias response has been particularly affected. Yet you cannot you cannot argue with the continued increase of 10000 new diagnoses a day and suggest russia is there when ever russia has done has proven effective well professor hammer we have to take a very short break now but people back in just a few moments stay tuned. Join me every thursday on the alex salmond show and ill be speaking to get out of the world of politics or business im show business ill see you then. So what weve got to do is identify the threats that we have its crazy Going Foundation let it be an arms race of his own often scary Dramatic Development only really im going to resist i dont see how that strategy will be successful but he came to kill a guy in time to sit down and talk. Welcome back to world im part of that drug are the primary professor of health and a good meal a g. O. P. Microbial disease this ad school of Public Health professor hamer what matters is not the diagnosis what matters it is the motel its a rate speaking of which i think this is actually a very important question because im sure you would agree with me professor heimer that this is very which been done with we spend i make a fact any given country has 2 major factors 1st is the attic the Immediate Response nearly distinct the provision of bad self ventilators etc and the 2nd is the preexisting condition of the nation its not called that 1000 per se thats so scary its the complications caused by the by its interaction with the chronic and Metabolic Diseases and here in the United States has by far the worst record in the world of all developed countries and you cant put that exclusively on trial now if you just if youre just going to talk about death rates in the United States is in the middle of the pack in terms of death rates from. Death rate of about 5 percent you know countries in europe that have far greater death rates so and i dont know what the true death rate is in russia i am not going to argue with you about how doctors assign death rays but it does seem to me that there is no reason to expect that russia should be so so much lower than any other mostly developed country with the possible exception of a different recording mechanism. But there are still other crew that was true for h. I. V. And i dont see any reason to think why its any different now for covert its not i dont think its malicious i think its systemic and i think its a its a failure to recognize that a precipitating event in the deaths of lots and lots of people in russia right now is the spread of aids very serious and potentially lethal respiratory virus that is continuing to infect tens of thousands of people every day in your country professor hamer i get your point that you believe there is no reason why russia should be different on that front but there is a very interesting paper published in the lancet just recently and it suggested that by early may the worlds richest countries a content for more than 90 percent of all report that called it 900. 00 deaths where is countries in south asia in africa with far Poorer Health infrastructure and very dense populations they have witnessed so far laura my talents and despite being pretty advanced in terms of testing maybe its not so much about how good your Health Infrastructure is maybe its indeed the creeks this thing they dont know about like how with differences about age is tribulation. Will be very simple 80 years. Outside of europe and United States in other developed countries is a is. A well known a well known demographic fact that you know you have many many younger people this disease is not as dangerous for younger people but it is not the only variable maybe of the complications are seen in the middle aged people while they have chronic conditions like diabetes type 2 like cardiovascular diseases cancer etc maybe mad a ball of diseases Metabolic Diseases per se is a major risk factor regardless of age and we know that in western countries the proportion of people with metabolic conditions is much higher do you think that would be a factor this is a very important why and im not trying to blame the United States is actually a monkey the increase. You know take 2 diabetes is a disease that is growing in prevalence all over the world it is not unique to western europe it is not unique to the United States its pretty common in in in the more developing countries in many parts of the world the only reason youre seeing more of it in in europe is that as the population ages the need to develop that those diseases increase so yes if you have an older population youre going to see a higher prevalence of those underlying an arkansas register realtor not time to time using children already come on the crank are not going to be a type one diabetes in children is a relatively rare condition really decreasing. In older. Well professor hammer i think ribery are basing our conversation on a very different sets of data and pretty sure that the prevalence of type 2 diabetes in the United States and in many western countries with western lifestyle with standard and mary can dive which is based primarily on sugar and Simple Carbohydrates has a major negative impact on did Metabolic Health by extension only me and how can i you disregarding the site or at all i am not i know i am not i am not disagreeing with you of all im saying is in many other parts of the world once you account for the difference in age youre seeing an increase in the ada relative age of the population youre seeing increases in the same kinds of Metabolic Diseases universally. Yes but not to the same extent the rates are very narrow your question cant be the same extent the west has a as a 100 year head start on on an india and china. But theyre catching up and you go absolutely up as they continue to choose to eat you know the foods that are available. Deaths just. I guess how things are turning out at so many attempts to get people to. Eat a better diet now we do know that for instance that the mediterranean diet you know is supposed to be particularly useful in preventing these Metabolic Diseases medha you know that that has not helped a place like spain and italy i want to bring you back to you know that interaction between infectious and simple and diseases because if thats the case isnt it and beat misleading to be thinking about public 900 as streatley in virus rather than this hybrid in taxes math the ball is patent and thats rather like a virus but whos mortality is primarily driven by mutable exact areas or mits and all of this regulation and wondered that in fact a fact how we think about preventing Goldman Sachs amicable and diseases well in the short run you cant change peoples you know in the face of a pandemic in face of a virus that spread so rapidly and so quickly throughout the global population you cant really think in the short run about changing peoples underlying metabolic states you have to you have to work with what they are you have to try to protect those people from becoming infected in the 1st place you have to provide sufficient testing to know whats going on and where the disease is spreading but even there. The testing the hospitalizations the cases that are. Symptomatic they are lagging indicators. But they still are not telling us the true dimension of the way this disease is spreading in the population in any real time sense we are always one or 2 hyrule you know generations infectious generations behind the curve which means were somewhere siva to 10 days behind knowing where things really are and that thats pretty much clear and that they did the same situation with any virus but i mean im sure youre with a remedy that these coronavirus is not the 1st and not the last you know strike humanity so we feel we have to think about. The way the policy has to change and wouldnt that be what it would be easier to implement those changes you know in terms of regulating quick companies around the bend locking down you know how from the global population for months on that in the short run stopping the spread of the virus in the immediate present present is is the clear priority one hopes that we can learn something from this to in the long run. Develop healthier. Lifestyles to create. A more. Healthy planet. Im not all that optimistic. That deaths going to happen but that doesnt mean im going to stop working towards that. We take this creagh system state of Public Health as an important variable wouldnt be and batter explanation for why russia has lower mind mortality downby United States because an average russian just like an average bangladeshi an average india and average pakistani an average nationalist pretty much any country is mitten bollock least healthier than the average american or an average britain for that matter. If that were true then the Life Expectancy would be greater in russia than in britain and its not. Well when it comes to women its great for bill and when it comes to math its a different story well i so you know that math and the fact is that this virus seems to be about a factor of 10 to 15 percent more dangerous for men than for women well because you know if we could take your last theyre very bad elf in russia is bad and men are dying at a younger age maybe your death rate is lower because you have fewer older men. Thats also a possibility to me thats all and thats a real possibility maybe if you do mail it just actually consider that indeed the percentage of man about 65 in russia is relatively small yes and many of the people who are taking to hospital are older women that i mean it sounds like a job but its not no its not a joke well its a cruel joke. Well 7 maybe they didnt because some russian women are indeed i mean then you can look at maybe that is they are taking better care of their health and the health of their children that man typically and they are more likely to engage in house the prosocial behavior has been professor heim are way out of time on this subject that i really appreciate your being able to talk to us about those subjects and this is definitely a fascinating topic do you think about it and there are still so many unknown student be nice to. At some point when when the dust as they say the dust has settled and. We can more leisure really explore our. Some of these interesting underlying conditions go back and try to figure out what we can do to move forward to improve the General Health of the populations of both russia and the United States well im pretty sure that sugar will be a line of gets after his dad but anyway we have to leave it there thank you very much for your insight youre welcome thank you for the opportunity. And thank you for watching i hope to see you all next week on of all the part of. Our. International memorial awards im now open for entries all media professionals are eligible whether you are freelance journalist work for all terms of media or part of a global news platform. Participate send us your published works in video all written for not go to a war dot altie dot com and then to now. Is your media a reflection of reality. In a world transformed. What will make you feel safe. Isolation full community. Are you going the right way or are you being led. Directly to what is true what is faith. 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