What do you do when a country denies the Coronavirus?
By: Sara Cooper
Tags: Health, Journalism, World, Covid 19, Data

Amendment: April 30, 2020 (8:55 PM) — the data listed in the original publication of this article included quarantine numbers that were double-counted across different press releases. The edited version corrects for this.

Tajikistan is a country with nine million inhabitants, yet only fifteen cases of COVID-19. It is not that Tajikistan, which shares a border with China, got lucky. Rather, diagnoses have been covered up by the country’s government who, until today, denied that the country was affected by the virus. Even when the head of the Department for Supervision over the Internal Affairs Agencies, Jaloliddin Pirov, died of a virus with symptoms similar to those of COVID-19, the Ministry of Health and Social Protection claimed cause of death as pneumonia and swine flu.

Despite pleas from within the country for official recognition of the global pandemic, even the WHO has not yet interfered with the Tajik government’s denial of COVID-19. When a government denies a pandemic or deals with infections and deaths under suspicious terms, it can be difficult to get a grasp on the scale of viral spread. In this case, though, the government is not denying the existence of COVID-19 outright. The Ministry of Health has been testing people with coronavirus-like symptoms (all negative) and quarantining sick citizens and travellers arriving from other countries. The Ministry has released numbers of quarantined persons in periodic press releases.

As with every modern pandemic, statistical modeling has been used to forecast the spread of COVID-19. With all the results from other studies, as well as the data released by the Ministry of Health, it could be possible to create a model that retroactively constructs the potential spread of COVID-19 in Tajikistan.

Methodology

The data collected for this study was compiled by Franziska Buhre, a Berlin-based freelance journalist who spent three months living in Tajikistan in 2019, through a grant from the Institut für Auslandsbeziehungen. The data is extracted from press briefings published by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. The data given in the briefings supplies the total number of persons placed in quarantine in cases such as citizens returning from China, South Korea, Japan, Italy, Iran and Afghanistan, or people who have arrived from “foreign states”.

To understand the potential spread of COVID-19, an estimate is needed for how many of this quarantined population may be carriers for the virus. In a February study done in Japan, researchers examined 565 Japanese citizens who were evacuated from Wuhan, China on three chartered flights to understand the prevalence of COVID-19 among passengers. Of the passengers tested, 1.4% were positive for COVID-19. Applying this metric to the dataset, we can derive a possible infection rate among the sample population. In the table below, one can see that, even in a minimum-case-scenario, there would potentially be around 114 cases of COVID-19 in Tajikistan just from the number of quarantined individuals.

The goal of placing a suspected carrier of a virus under quarantine is to limit their contact with the rest of society, and, therefore, stop the spread of the virus. However, in her reporting, Buhre found that people are not placed under quarantine at home, but “are sent to camps, hospitals, sanatorium facilities, many of them from the Soviet era and with disastrous conditions.” As such, the time spent in quarantine is variable, with reports of some patients making bribes to go free.

The number of infected persons in the table above does not, then, represent the number of persons who would effectively be contagious to the rest of the Tajik population. In the best-case scenario, all would be placed in isolation until no longer contagious. However, the model must account for a certain amount of “leakage”. In a 2011 study done with patients of H1N1 (swine flu), researchers in Australia found that only 35% to 55% fully complied with their instructions. Taking that as a base, we can optimistically assume around a 50% rate of leakage in Tajikistan. Meaning that of every two patients placed in quarantine, one will be contagious to the rest of Tajik society.

The threat of a virus, what makes it so scary and deadly, is that it spreads. What would be the effect of 57 potentially contagious individuals potentially moving through Tajikistan? This, too, can be modeled given the data that has been gathered so far on COVID-19. The spread of a virus is measured by a statistic called R0 (pronounced R-naught). This is the number of new people that would be infected by coming into contact with a contagious person. According to a study done by the Imperial College COVID-19 Response Team, the R0 of COVID-19 is estimated between 2.0 and 2.6 In other words, every person with COVID-19 could potentially pass it on to 2.5 other people.

Taking an again optimistic R0 of 2.2, we can model how these 57 contagious people would pass COVID-19 through Tajik society. On the first day in the data, February 8, 2020, there would be 4.5 contagious people. The next day, that number would increase to 4.5*2.2 = 9.9. The next day, 9.9 people would now be considered contagious, so on day two, the equation is 9.9*2.2 = 21.78. This is how exponential growth works, the numbers continue to compound by a factor of 2.2. One caveat: in this model, I also assume that 50% of all newly infected persons are actually contagious. This assumption is built on three possible factors: 1) the person shows symptoms and quarantines; 2) the person is too sick to go out; and/or 3) the person is asymptomatic, which tentative studies suggest make them up to 50% less contagious than those with symptoms.

The press releases from the Tajik Ministry of Health are not consistent, so we do not have daily numbers of new cases. In this model, I take the numbers from the previous day and compound them, unless new numbers have been added. This is a rudimentary way to see the increase over time but is what can be done with the data provided.

Given the model explained above, one could reasonably expect an estimated 12,803 cases of COVID-19 in Tajikistan since the beginning of February 2020. This is considerably higher than the 15 reported by the Ministry of Health.

Discussion

COVID-19 behaves differently in every society. The model is based on limited statistics and assumptions from other countries with different cultural and social factors that would have a major impact on the actual spread of the virus. However, given that the government denied any cases until the end of April, 2020, it is likely that the actual number of cases in Tajikistan is closer to the estimated number than to the government’s claims. While not 100% accurate, this model is based on peer-reviewed data of how the novel coronavirus has spread through other countries. There is little reason to think that Tajikistan, given its economy, migration patterns, and borders, would have such a drastic divergence from global trends.