The coronavirus has yet to hit Russia hard. But when it does, as many experts soon expect, it could prove a huge challenge to Russian President Vladimir Putin during a fragile time for his rule.

Putin markets himself as Russia’s hero, the only man who can restore the former Soviet Union’s greatness and bring stability to his country. Anything that messes with that image, whether it’s large-scale protests, a prominent opposition leader, or questions about his leadership, ruins the myth he and his allies have cultivated for decades.

A significant Covid-19 outbreak in Russia, and particularly in the densely populated capital of Moscow, would be devastating to the dictator. If tens of thousands get sick and die, it would puncture the narrative armor Putin has around himself. That high death toll is distinctly possible, as medical resources outside Russia’s major cities are scarce and the country’s older population is at high risk.

The looming crisis couldn’t come at a worse time for Russia. Oil prices, the lifeblood of its economy, have tanked. A transition plan to keep Putin in power until 2036 is delayed. And early data this year shows Russians are contracting “pneumonia” at higher rates than in the past; some critics say that it’s actually Covid-19, and that the government is manipulating statistics to make it seem like the spread isn’t that bad.

Put together, this is a “perfect storm of problems for the Kremlin,” said Alina Polyakova, a Russia expert and president of the Center for European Policy Analysis in Washington.

It doesn’t help that despite some early aggressive measures like closing its borders, including the 2,600-mile one with China, experts say the Russian government response was not enough. Doctors have conducted few tests for the virus, blinding authorities to just how widespread the outbreak might be.

Concerns have risen to the point that Moscow’s mayor, a Putin ally, has continuously and openly asserted the situation is surely worse than it appears.

The stream of bad news had Putin hiding in the shadows, not wanting to take the fall for the deadly mishaps. But now that the number of cases continues to rise — and quickly — Putin has visibly taken command of the response. After all, he, more than anyone, is aware of the precarious moment in his leadership.

Yet a top Russian doctor who shook hands with Putin during a recent hospital tour tested positive for the coronavirus last week — underscoring how perilous the situation is.

“It’s a big challenge,” Tatiana Stanovaya, a Russia expert at the Carnegie Moscow Center, told me.

And there’s a chance Putin can’t withstand it.

Russia is headed for a US-sized crisis

No one can accuse the Russian government of standing by as the coronavirus swept across the globe.

On January 30, the government closed its large, far-eastern border with China and suspended the issue of electronic visas to Chinese people. Days later, it evacuated Russians in China on military airplanes and threatened to deport foreigners who tested positive for the disease.

That same month, passengers flying into Moscow from China, Iran, and South Korea — the coronavirus epicenters at the time — had to undergo tests once they stepped off the plane. Meanwhile, citizens returning from Europe would have their temperatures checked and be ordered to quarantine for 14 days at home.

Experts note these measures, while tough, at best limited the number of infected people in the country and perhaps prevented a larger outbreak. On their own, though, they weren’t enough — and that’s where Russia went wrong.

Covid-19 tests had to be conducted with a locally made device many viewed as faulty. All completed tests had to be sent to a single lab in Siberia for results, causing a massive backlog at the facility. This allowed Russians to continue living their normal lives without knowing if they carried the disease or not, and blinded the Kremlin from tracking the spread.

Weeks went by before Russia took additive measures. It wasn’t until mid-March that Russia chose to close schools and certain businesses, limit air travel, and consider a large economic stimulus package to alleviate financial strain on the people. But by then, it was all but assured that the small number of cases Russia had early on would grow.

It’s not that Russia responded slowly, said Dr. Vasiliy Vlassov, an epidemiologist at the Higher School of Economics in Moscow, it’s that “the response from the beginning was not adequate.”

It hasn’t gotten much better. Last week, Putin announced a week-long vacation for the entire country, hoping that would compel Russians to stay home and socially distance from one another. Instead, thousands in Moscow and around the nation went outside to enjoy the nice weather and time off. It forced the Kremlin two days later to reiterate that the government wanted everyone to stay inside, not go out for joy rides.

And as major regional governments imposed shelter-in-place rules last week, people continued to ignore the orders. even as police drove around to remind everyone to head back inside. That’s a quintessentially Russian trait, according to experts.

“The people were not forced from the beginning” to stay inside, Vlassov told me. “That’s because they actually adapted to be forced from the Soviet time. If no one is forced, then it can’t be that serious.”

Trying to make people take the orders more seriously, the Kremlin passed a measure that could see those found violating the lockdown measures imprisoned for up to seven years.

More video footage of the strict Moscow region curfew from 8pm-8am being enforced by police cars with loudspeakers and adhered to. pic.twitter.com/z3XqYOGh6g — Jason Corcoran (@jason_corcoran) March 29, 2020

Those heavy-handed measures may do some good, experts say, but it probably still isn’t enough. “It’s my fear that it’s too little, too late,” Judy Twigg, an expert on health care in Russia at Virginia Commonwealth University, told me.

What comes next could be catastrophic.

Russia is “probably in the early stage of the same epidemic which is going on in the United States now,” Michael Favorov, who led the US Center for Disease Control and Prevention’s Eastern European and Central Asian programs, told me. “They are facing significant increases of cases within the next month” in the capital and beyond, “and a significant increase in the number of deaths.”

The question, then, is why Putin and his allies failed to impose all necessary measures early on when they likely could have done the most good. The answer is that Putin prioritized politics over public health.

Putin’s precarious political position

In a way, Putin brought this dire predicament upon himself.

Back in January, Russia’s entire government resigned as part of a major constitutional reform to give Putin more power and extend his rule 12 years beyond his current end date in 2024.

As Vox’s Jen Kirby explained at the time:

Putin’s proposed constitutional reforms broadly seek to limit the power of the presidency and give more responsibilities to the Parliament, including the job of choosing the country’s prime minister. He also intends to give more power to the State Council, an advisory body to the head of state that doesn’t have a ton of authority right now... The problem is that Putin’s constitutional changes intend to limit the power of a president who is not him, thus ensuring his successor is far weaker than he has been.

The referendum vote to give him that authority — which he was widely expected win — was scheduled for April 22. But due to the outbreak, the Russian leader last week postponed the vote, saying medical professionals will tell him when the time is right to schedule it again.

“You know that this is a very serious matter for me. Of course, I will ask you to go to the polling stations to express your opinion on this issue of fundamental and crucial importance to the country and society,” Putin said in his March 25 address to the nation. “Our absolute priority is the health, life and safety of the people. This is why I believe the vote should be postponed.”

In the meantime, Putin doesn’t want to make millions of Russian lives miserable ahead of the vote, or at a minimum give them more reason to question his bid for power. Draconian measures would make it look like his government doesn’t have the situation under control, and the Center for European Analysis’s Polyakova said stability is central to Putin’s pitch.

Politically speaking, “this crisis comes at the worst moment for him,” she told me.

He also made a big miscalculation. In early March, members of the Organization of the Petroleum Exporting Countries (OPEC), a cartel of 15 countries of oil-producing nations, met at OPEC’s headquarters in Vienna to discuss what to do as the disease’s impact has lowered global demand for oil.

Russia is not part of the bloc, but Russian officials were invited to the meeting. That’s because three years ago Russia made a deal to coordinate its production levels with the group, in a pact known as OPEC+.

At the meeting, Saudi Arabia, the cartel’s leader, suggested the participants collectively cut their oil production by about 1 million barrels per day, with Russia making the most dramatic cut of around 500,000 barrels a day.

Doing so would have kept oil prices higher, which would bring in more revenue for nations in the bloc whose economies are heavily dependent on crude exports. Saudi Arabia considered the move necessary because demand from Asia, which has been hit hard by the coronavirus, plummeted.

The Russians, long wary of such a move, opted against the plan. It’s still unclear exactly why, but some said Putin wanted prices to stay low to hurt the American shale oil industry or was gearing up to seize a bigger sliver of Asian and global oil demand for Russia.

Saudi Arabia didn’t take too kindly to the Kremlin’s decision and responded by slashing its export prices that weekend to start a price war with Russia. That brought the price per barrel down by about $11 to $35 a barrel — the biggest one-day drop since 1991.

As of April 6, oil stands around $30 a barrel, and that’s disastrous from Russia’s point of view. The country heavily depends on oil revenues to fill the government’s coffers. Without a large, reliable amount of money coming in, Putin will have fewer funds to spend on his nation, let alone deal with a growing health crisis at home.

For Putin to mess with the oil market as Covid-19 cases grew around the world, Polyakova says, shows he sometimes lets short-term thinking drive his long-lasting, impactful decision-making.

And now that the coronavirus crisis is growing in Russia, Putin will surely wish he could take that blunder back.

Russia’s health care system is fairly well prepared, but the coronavirus will likely overwhelm it

Favorov, the former CDC official, told me that the current Russian health care system was built in the Soviet era, with its focus primarily on preventing large-scale disasters. In 1919, for example, Vladimir Lenin issued a nationwide decree that everyone should get a smallpox vaccination. Those who didn’t follow the order at best were jailed, and at worst killed.

To this day, a focus on preventing public health crises remains, Favorov said. “The system is highly sensitive to any diseases which might be a threat to public health.”

Dr. Melita Vujnovic, the World Health Organization’s representative to Russia, told me the country is fairly well prepared for an outbreak. It has “a massive public health information campaign to raise awareness and preventive measures,” she said, with around 70,000 hospital beds and 40,000 ventilators.

But, she made sure to note, “it is human behavior that determines the outcome of outbreaks and that is why public health information [is] of highest importance to address any health challenge.”

Russia’s health care system isn’t in poor shape. In fact, Russian propaganda continues to claim that the country is better prepared than the United States for what’s coming, even noting how Putin offered President Donald Trump assistance. In fact, a Russian plane with medical equipment was dispatched to the US already.

There’s no doubt Russia can handle a major outbreak better than many nations, if and when it gets really bad, because it has the means. But there are still major problems that will affect care in the country.

VCU’s Twigg said that a lot of the equipment Russian hospitals have, including ventilators, break down with alarming frequency. Russia is having more produced, but it’s unclear if those who need them will have them in time, especially as the rich hoard them. Further, Russia is short of the equipment that goes with ventilators, like oxygen or anesthetic sedatives. And, Twigg says, it’s unclear if the country has enough well-trained 24/7 intensive care nurses to staff patients on ventilators.

That’s not all: According to Vlassov, the epidemiologist in Moscow, Russia increased salaries for physicians in recent years. While that helped attract top talent, it lowered the amount of funds available to buy top-of-the-line materials for medical care. What’s more, the government’s focus in spending more on the health care sector was on building new hospitals, not investing in protective equipment for doctors.

Beyond that, the system may have failed in a greater sense.

According to the Russian government’s own official statistics, Moscow saw 6,921 pneumonia cases in January, compared to 5,058 during the same period the year before. That’s a 37 percent increase, and those figures come from physicians who report them to the government.

It’s possible that Russia had a spike of pneumonia cases, experts tell me, and some pneumonia cases have gone undiagnosed as Covid-19 cases in other countries. Some, though, have alleged that the statistics may have been manipulated to make it seem like the outbreak wasn’t so bad.

“While the whole world is facing an outbreak of a new coronavirus, Russia is facing an outbreak of a community-acquired pneumonia. And as usual, we’re facing the lie of the authorities,” Anastasia Vasilyeva, president of the Doctors’ Alliance trade union and an ally of a top Putin opponent, said in a YouTube video last month. She was detained on April 3 by Russian authorities.

It may sound like a conspiracy theory, but there’s precedent for this view. In 2015, Putin said he wanted to lower the death rate caused by cardiovascular disease in Russia. Almost immediately, hospitals began to report that fewer people were dying from heart conditions. What made that more suspicious is that there was a rise — at about the same rate — of deaths from other causes.

The only thing that could assure Russia can deal with what’s coming, then, is massive interest and involvement from Putin. Despite many earlier stumbles, he may have just started to take the crisis very seriously.

Can Putin be Russia’s coronavirus hero?

Putin doesn’t like to be the bearer of bad news. When things look to be headed the wrong way, he usually asks a loyalist to be the face of the government response in case it fails.

“There’s a big joke in Russia that the person who gets the finance portfolio will be the person everyone’s going to hate,” CEPA’s Polyakova told me, chuckling.

Putin followed that playbook with Russia’s initial response to the coronavirus. He had a loyalist, Moscow Mayor Sergei Sobyanin, take charge, allowing Putin to remain in the shadows. The appointment had a veneer of legitimacy, as Moscow was the epicenter of the country’s outbreak, but experts agree Putin aimed to distance himself from the situation.

That position soon became untenable, especially once Sobyanin continued to make clear that the problem likely was worse than it seemed. “Nobody knows the real picture,” the mayor openly told Putin last week, alluding to the lack of widespread testing. “In reality, there are far more people who are infected.”

It’s why few are surprised that Putin has become a much more visible figure in recent days. He was seen sporting a yellow hazmat suit while visiting a coronavirus hospital in Moscow. Incidentally, the top doctor at that hospital who was pictured shaking hands with Putin tested positive this week for Covid-19, causing Putin to work remotely for the time being.

And in a recent videoconference with government members, Putin told them to start getting serious and tell him truthful information when he needs it. “The results of our work should correspond to what is happening at present,” he said. That, for VCU’s Twigg, was surprising. “It was an implicit admission that what’s been going on until now was everybody lying to each other,” she told me.

Putin, then, is on the case — but he still faces serious hurdles to get the response right.

The most important will be quashing the expected major outbreak in Moscow. Many experts told me the disease spread there could end up being worse than the one in New York City, partly because of how densely populated the Russian capital is. That’d be extremely damaging for Putin: If he can’t keep people in the showpiece capital safe, it would hurt his image as the country’s protector.

That has many worried Putin will zero in on Moscow at the expense of other parts of the country.

It could pose serious problems, as the many Russians who defied orders to stay inside may have traveled to nearby vacation spots of their hometowns. If they brought the disease with them, an outbreak could pop up across the country’s 11 time zones while Putin solely tackles the Moscow challenge. Russia is already using surveillance tools on phones to track people during the outbreak.

Hospitals outside the major cities aren’t well-equipped, experts told me, with some estimates saying they’ve cumulatively lost about 50 percent of their capacity over the last decade. If they’re outside Putin’s interests, they will struggle to care for patients.

“For big cities, the situation may be rather manageable,” Carnegie’s Stanovaya told me, “but in the countryside, it will be difficult.”

But another problem arises if the Moscow outbreak gets significantly worse. If the number of positive cases and deaths tick upward, there will be immense pressure on Putin to take drastic measures to stop the spread. That could mean sending out law enforcement on the streets, experts say, forcing people inside. It’d be a very visible symbol of just how out of control the situation had become.

Vlassov, the epidemiologist in Moscow, relayed a broader worry he has. Apartment buildings in the capital generally have an electronic system to get inside, as well as cameras at the entrance. If the Kremlin decides the people can’t be trusted to stay in their homes, he says many in the city fear the government will move to enforce lock-ins of millions of inhabitants. After all, those locks are part of a city-wide, state-approved system.

“People discuss it in the context of an epidemic, but also in the context of a public uprising against the government,” he said.

It’s unclear what Putin plans to do next, or if his newfound vigor in dealing with the health crisis will keep Russia from ruin. Most agree, though, that Putin will take whatever steps he must to ensure the crisis doesn’t bring his country to a breaking point.

“It all depends on the magnitude of the outbreak,” said Favorov, the former CDC official. But, he added, as soon as the Kremlin needs to ramp up its efforts, “they will do it in the old Soviet style.”