mr burke yellow says or pneumonia or are. an immunocompromised fungal disease or viral disease that was an h i b hiv as in the thing that was going to be killing who was going to allow all these other pathogens to come in turn immunocompromised and kill you a similar thing is happening here with coronaviruses that people are dying of pneumonia people are dying of heart complications or other organ failures and that's what's being written down as the cause of death well professor hamer 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 they're spread very rapidly in a population of people who are very susceptible to dying in my state kristen sites think now 70 so it would 150 and 60 percent. of the deaths are among people who contract the disease while in nursing homes yes that was ease does affect the elderly more than younger people you know in the elderly category myself so i'm very worried i have the luxury of staying at home a lot of other people don't even if we account for that and. if we strictly compare

large metropolitan areas like moscow to large metropolitan areas like new york a 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 isn't there still even if you take that into account there still and massive difference i don't 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 don't think where there are far enough into the kind of epidemic.

epidemiological investigations yet to draw any conclusions in any any final level as you say it's not done that it's 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 that's why i'm asking those questions and i don't i don't know where this is they did in one of those where you did not made that accusation per se but the general tone was that russia has an institutional interest in under reporting those cases what i'm trying to. ask you about here is whether russia could indeed be performing batterer objectively. i think this becomes a very silly argument about who is killing more people and not reporting it i think that's not a particularly useful way to think about 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 how laws caissons. turn out to kill people and how those cases turn out to be reported as cold related deaths or are any irrelevant sideshow what i'm 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 forty's there are a lot of old people around but i think where we're at now is that. what we're

seeing in russia is a delayed epidemic compared to western europe. a delayed epidemic compared to the united states and it's too early to predict where it's going to go and i certainly don't 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 in-depth reporting honest on the counting this is a long standing question in scientific debate the so-called waste off wrong problem whether everyone known to have a particular if action should be recorded as having dies on that infection even though that person happened to have let's say stage 4 cancer or i believe the condition of the russian doctor is not the bureaucrats but the russian doctors they have insist that you have to distinguish between the primary cause and the catalyst

in eighty's that goals are recorded in the death report what is the problem with a surprise. i'm not saying there's 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 don't 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 you know appropriate but nevertheless does raise. suspicions among people who want to score political points about 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 that's why i'm i actually asking you the

scientific question because the russian doctors do not take those diagnosis on the top of their hat in order to make that conclusion they have to conduct an autopsy it's written into the law russia has cost more to make salmon nations also all dad's reach is a different story of for example for many countries in western europe it's also a different story for the united states because from what i know you know the avril ability of post-mortem examination differs from state to state don't you think that russian doctors have a reason to feel it's not superior adenike least considine the data and isn't that actually good from a scientific point of view that they're coming to the global community of scientists with the day that establishing was was the main cause of the disease and what was the air pump and 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 that's that's 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 decision making today to trace 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 deal in a 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 epidemiological conditions would also be very different on the ground why should put in a trial for that matter be involved in making decisions about some tiny town be it in primordial or i'll ask our new haven 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 a 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 that you. yet it isn't both federal governments. were catastrophic will misaligned to the size and the consequences of ignoring the pandemic in its earliest stage professor primer told governments rather it's in russia or in the united states are on deriding the magical expenses goals of making the necessary resources available to unite all down. and i don't know i don't know what russian is but certainly the united states barrel 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 can't speak for russia because i really don't know the situation you know the people i've talked to

my colleagues in russia even though many of them are infectious disease doctors and people who are infectious disease public health people don't seem to have the answers to the questions i have been asking them but. i am. and i'm not going to you know. speak beyond what i'm 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 they in their eyes and none the less even though russia made it made a concerted efforts you build designated call that 19 hospitals for the resources into the region compensated doctors all across the country you say that you don't have enough information about russia and yet you make merry you know broad ranging

statements that respond the response of the 2 governments is pretty much the same i i don't i don't see. based on the numbers that. russia's response has been particularly affected. yes and yet you cannot you cannot argue with the continued increase of 10000 new diagnoses a day and suggest rush is there when ever a russian has done as proven effect well press a hammer we have to take a very short break now but people be back in just a few moments. the world is driven by shaped by one person.

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welcome back to all the parts that drugs are the primary professor of health and to give me elegy all microbial disease this at the alice school of public health professor hamer what matters is not the diagnosis what matters it is the motel it's a rate speaking of which i think this is actually a very important question because i'm sure you would agree that neighbor has a higher than this is very which pandemic with we spend i make a fax 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 a nation it's not called 19 per se that's so scary it's 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 can't put that exclusively on trial now you're just if you're just going to

talk about death rates in the united states is in the middle of the pack in terms of death rates death rate of about 5 percent you know countries in europe that have far greater death rates so and i don't 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 through that was true for h. i.v. and i don't see any reason to think why it's any different now for covert it's not i don't think it's malicious i think it's systemic and i think it's a it's a failure to recognize that a precipitating of end 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 world's richest countries a count and for more than 90 percent of all report they called it 900 deaths whereas countries in south asia in africa with far poorer health infrastructure and very dense populations they have witnessed so far lower my talents and despite being pretty advanced in terms of testing maybe it's not so much about how good your health infrastructure is maybe it's indeed the creek's this thing they don't know about like how with differences about age is tribulation. very simple if

you're straight in outside of europe and united states in other developed countries it 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 age is not the only variable maybe of the complications are seen in middle aged people why 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 i'm not trying to blame the united states is actually i don't think the increase. you know take to 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 it's pretty common in in in the more developing countries in many parts of the world the only reason you're 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 you're going to see a higher prevalence of those underlying americans are registering time to time using children already come on the. internet the type one diabetes in children is a relatively rare condition relative creasing you can use it in older. well professor hammer i think ribéry 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 i mean anyone can i you disregarding the soccer at all i am not i know i am not i am not disagreeing with you of all i'm saying is in many other parts of the world once you account for the difference in age you're seeing an increase in the ada relative age of the population you're seeing increases in the same kinds of metabolic diseases universally. yes but not to the same extent the rates are very narrow your question can't be the same extent the west has a as a 100 year head start on on an india and china. but they're 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 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 in italy i want to bring you back to you know that interaction between infectious and simple and diseases because if that's the case isn't it and beat misleading to be thinking about public 9000 as streatley of virus rather than this hybrid in taxes math the ball is patent and that's rather like a virus but who's brutality is primarily driven by mutable exact areas or mit's and all of this regulation and whether that in fact at fact how we think about preventing goldman sachs amicable and diseases well in the short run you

can't change people's 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 can't really think in the short run about changing people's 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 what's going on and when 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 we're somewhere siva to 10 days behind knowing where things really are and that that's pretty much clear and that they did the same situation with any virus but i mean i'm sure you're with a remedy that these coronavirus is not the 1st and not the last to you know strike humanity so we feel we have to think about. the way that policy has to change and wouldn't. it 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. i'm not all that optimistic. that death's going to happen but that doesn't mean i'm going to stop working towards that. we take these 3 existing state of public health as an important variable wouldn't 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 indian and average pakistani an average nationalist pretty much any country is mitten bollock least how 3 are than an 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 it's not. well when it comes to women it's growing rebel and when it comes to math it's a different story well i so you know dogma 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 the last there tearing down 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. that's also a possibility doesn't mean you know that's all and that's 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 it's not no it's not a joke it was a cruel joke. well 7 maybe they didn't because the russian women are indeed i mean then you can look at many studies 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 pro-social behaviors but 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 to think about 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 as well after it is sure that sugar will be a line of goods after his dad but anyway we have to leave it there thank you very much for your insight you're 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.

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this is the fans that is a comforting. thought . i. filled the streets of new security. as a response sanctions. muslim community celebrating the end of the month long ramadan fast while some countries or. other nations seem unwilling to change. the faces decades behind bars for corruption. sitting prime minister to go on trial.