Having spent decades misleading the public and promoting false information on medical practices, diseases and public health policy, the Russian government and the healthcare system it oversees are now facing profound distrust and suspicion. This atmosphere of doubt and fear is deepening, just as the coronavirus pandemic is poised to engulf the country.

The Russian government has taken serious measures to combat COVID-19, which to date has killed more than 7,000 people worldwide. The Kremlin has closed most entry points along the country’s 2,600 mile border with China, ordered people returning from high-risk areas to self-quarantine, banned many flights and public gatherings, and is rushing to build a new $135 million hospital on the outskirts of Moscow.

But the numbers of confirmed coronavirus cases – 147 as of March 18, with zero fatalities, in a country of 140 million – strike many Russians as outlandishly small and suggest that public health information is being hijacked by political considerations.

Already, Russian state television and media outlets with ties to the Kremlin have promoted the hoax that the coronavirus is a U.S.-created bioweapon. It is not alone in making such accusations, either. The conspiracy theory that COVID-19 is a bioweapon manufactured by hostile foreign powers has been advanced by politicians and commentators in nations including China, India, Iran and the U.S.

While Kremlin-propagated disinformation campaigns are usually meant to influence Western audiences, Russian coronavirus disinformation appears to be designed for domestic consumption. But, according to Natalia Krapiva, legal counsel with the digital rights and privacy advocacy organization Access Now, this strategy may not be wholly successful.

“We are closely following public discourse, and I noticed that serious doubts are surfacing about how realistic the numbers are,” Krapiva told Coda Story. “These doubts have grown over the past few days, turning into open distrust, because people are seeing what is happening in Europe and connecting it to the fact that in Russia doctors are suddenly reporting a big increase in pneumonia cases.”

Krapiva cited the example of a March 12 tweet by the mayor of Moscow, which claimed that the Department of Health was in a heightened state of preparedness for the treatment of the condition. Krapiva added, “People took the use of the word ‘pneumonia’ as a sign that the authorities are hiding something.”

Valery Solovei, a well-known Russian history professor and political commentator, has accused authorities of mismanaging the crisis and issuing false statistics. In an interview on a Moscow radio station on March 16, he said that doctors were attributing COVID-19 deaths to pneumonia. “They use the diagnosis of a side effect as the cause of death,” he alleged, “to show that our country isn’t cursed by ‘freedom’ and that political, state management is marvelous.”

Solovei also invoked a history of cover-ups stretching back to the country’s Soviet past. “The explanation is simple,” he told radio listeners. “Remember Chernobyl? Everything is always hidden here.”

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Some Russian doctors have echoed Solovei’s accusations. While no direct evidence has surfaced connecting Kremlin directives to underreported cases of coronavirus, five Russian virologists contacted by Coda Story described overwhelmed respiratory wards in hospitals widely believed to be designated to treat COVID-19 patients, shortages of protective gear and severe delays in testing for infection. All five doctors declined to go on the record, for fear of retribution.

Doctors and nurses spoken to by Coda Story detailed chaotic conditions in Russian hospitals. “You can’t imagine what is happening,” said one staff member at Mukhin State Hospital, on the eastern edge of Moscow, which has witnessed a surge in pneumonia patients. ”We don’t even have gloves sometimes, let alone face masks.”

“We are sterilizing disposable equipment,” she added. “If you throw it out, out of habit, you are forced to replace it out of pocket.”

A doctor in Saint Petersburg said the situation is reminiscent of the way the Soviet government dealt with another global disease outbreak. HIV and AIDS has long been in retreat around the world, but the virus continues to affect large numbers of Russians. Unlike most countries, Russia’s HIV epidemic is worsening – new cases are increasing by as much as 15 per cent every year. Meanwhile, HIV denialism and conspiracy theories run rampant, encouraged by a government eager to ingratiate itself with a socially conservative Orthodox Church.

“The problem here is not a lack of resources, because the Russian government has the resources to end the AIDS epidemic,” UNAIDS Special Advisor Vinay P Saldanha recently told The Los Angeles Times. “The problem has been for too long that HIV infection in Russia has not been given the attention and resources that are consistent with the magnitude of the epidemic.”

Russia’s inability to truthfully engage with AIDS can be traced back to the 1980s, when the KGB’s “active measures” agents successfully promoted the conspiracy theory that the disease was hatched in American bioweapons programs. Eventually, strategies of contriving false narratives around matters of global health results in deadly blowback.

“Misinformation can affect society’s ability to deal with a pandemic at many different levels,” wrote Bruce Schneier last year in a prescient New York Times column titled “We Must Prepare for the Next Pandemic – We’ll have to battle both the disease and the fake news.” In the piece, Schneier cited how Ebola relief efforts in the Democratic Republic of the Congo were stymied by mistrust of health workers and government officials who had lost credibility with the public.

The same dynamic of government disinformation, deception and distraction seems to be playing out with COVID-19. Anastasia Vassileva, a close associate of the Russian opposition leader Alexey Navalny and head of a trade union of doctors called the Alliance of Medics, posted a video on YouTube on March 10. In it, she spoke of being contacted by doctors who had told her that their hospital was “being turned into corona treatment wards, but instead of talking about it honestly, the government is hiding what these beds are being used for.”

Vassileva also claims that doctors told her that, in the event of any fatalities, they have been instructed not to name COVID-19 as the cause of death. “You can’t write coronavirus,” she said in an interview with Coda Story.

Owing to the school of diagnostics adhered to in Russia, official causes of death must always be attributed to the condition that directly leads to loss of life, rather than any precipitating illness. While this is standard practice in Russian hospitals, it still means that the country could be grossly underreporting the lethality of its COVID-19 outbreak.

A patient inside Mukhin State Hospital, one of the Moscow hospitals allegedly designated to care for respiratory patients, sent Coda Story text messages on Monday that described waiting for more than a week for the results of his COVID-19 test. In this time, he said, new patients had arrived and shared the same facilities as those awaiting test results. He also described alarming conditions in the hospital’s temporary infectious diseases ward.

He wrote that everyone in the ward is terrified of going home. “You are let go, and then you find out that you were there next to a corona patient and your entire family is infected,” he said.

Meanwhile, the government denies designating any hospitals for the treatment of COVID-19 patients. The Moscow Health Department last week issued a statement that “all the social media reports about repurposing of hospitals into facilities for coronavirus patients are untrue and highly provocative.”

The staff member at Mukhin State Hospital said that the day after Vassileva’s video was posted and viewed by 200,000 people, doctors and nurses were suddenly handed masks, goggles and gloves. A camera crew was on hand to document the equipment being used.

Mukhin State Hospital promptly posted a video on its Facebook page, showing doctors in protective gear caring for patients. Looking straight into the camera, the hospital’s head doctor Aleksander Izvekov refuted what he described as rumors about the situation inside the hospital. However, he confirmed that the hospital had been recently repurposed to receive patients with respiratory problems, that all are tested for COVID-19 and, if the virus is confirmed, individuals are then transferred to special facilities.

The hospital staff member said that once the camera crew had left, “I went to check myself and everything that was here for filming – all the goggles and face masks – all of it had been taken away.”

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Russia is not the only place where a low number of confirmed cases of COVID-19 has drawn widespread suspicion of underreporting. Other nations, including Iran, Italy and China have all been accused of not releasing accurate figures. Many other countries are also struggling to provide medical staff with sufficient protective clothing and equipment, but in Russia’s case, it appears that the authorities are in denial that any of these vital measures are even necessary.

Natalia Antelava contributed to the reporting.