{"id":23503,"date":"2020-12-18T15:04:58","date_gmt":"2020-12-18T14:04:58","guid":{"rendered":"https:\/\/mallorcaglobalmag.es\/?p=23503"},"modified":"2020-12-18T15:57:15","modified_gmt":"2020-12-18T14:57:15","slug":"covid-19-cracks-in-the-worlds-best-health-system","status":"publish","type":"post","link":"https:\/\/mallorcaglobalmag.es\/en\/covid-19-cracks-in-the-worlds-best-health-system\/","title":{"rendered":"COVID-19, cracks in the world\u2019s best health system"},"content":{"rendered":"<p><strong>Despite the fact that Spain has suffered\u00a0the worst incidence of COVID-19\u00a0in Europe at certain times of the pandemic,\u00a0most of the scientists consulted\u00a0by Mallorca Global maintain that the\u00a0Spanish public health system is still\u00a0one of the best in the world and blame the shortcomings highlighted by the\u00a0health crisis mainly on the budget cuts.\u00a0Since 2009, the year of the swine flu\u00a0pandemic, the public health coffers\u00a0have not had any joy, quite the contrary,\u00a0they have suffered an unjustified\u00a0impoverishment that now explains the\u00a0cracks in the health structure.\u00a0<\/strong><\/p>\n<p><em>Text: J. E. Iglesias.<\/em><\/p>\n<div id=\"attachment_23490\" style=\"width: 1994px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" aria-describedby=\"caption-attachment-23490\" class=\"size-full wp-image-23490\" src=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE.jpg\" alt=\"El personal sanitario, en primera l\u00ednea contra la COVID-19. Foto HUSE\" width=\"1984\" height=\"1323\" srcset=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-200x133.jpg 200w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-300x200.jpg 300w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-400x267.jpg 400w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-600x400.jpg 600w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-768x512.jpg 768w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-800x533.jpg 800w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-1024x683.jpg 1024w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE-1200x800.jpg 1200w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/El-personal-sanitario-en-primera-l\u00ednea-contra-la-COVID-19.-Foto-HUSE.jpg 1984w\" sizes=\"(max-width: 1984px) 100vw, 1984px\" \/><p id=\"caption-attachment-23490\" class=\"wp-caption-text\">Health workers, on the front line against COVID-19. Photo: HUSE<\/p><\/div>\n<p>Both <strong>Ildefonso Hern\u00e1ndez<\/strong>, professor\u00a0of Public Health and general\u00a0director of the Ministry of Health\u00a0between 2008 and 2011, from whose\u00a0position he directed the fight against\u00a0swine flu in 2009, along with the\u00a0leading scientist in infectious diseases\u00a0and collaborator of the World Health\u00a0Organization (WHO) <strong>Sebasti\u00e1n Cresp\u00ed<\/strong>\u00a0or the head of Primary Care Research\u00a0in the Balearic Islands,<strong> Joan Llobera<\/strong>,\u00a0ratify the budget stinginess of public\u00a0health in recent years.<\/p>\n<p>Cresp\u00ed adds another handicap that\u00a0has caused strong tensions in the\u00a0system: \u201cThe wild relocation of essential\u00a0health supplies production -from\u00a0masks to ventilators, through testing\u00a0capacity or vaccine production- has\u00a0left us unprotected when we needed\u00a0it most\u201d.<\/p>\n<p>Joan Llobera clarifies that in the first\u00a0wave \u201cit was not acted with the necessary\u00a0speed, although the measures\u00a0were effective. The Balearic Islands\u00a0had good indicators in the months of\u00a0March and April due to movement\u00a0restrictions, an obvious example that\u00a0had the harsh lockdown measures\u00a0been taken earlier, Spain would have\u00a0had better indicators and the public\u00a0health system would not have been as\u00a0collapsed.<\/p>\n<p>Ildefonso Hern\u00e1ndez envisions three\u00a0reasons for the bad data in Spain after\u00a0the de-escalation: the high mortality\u00a0rate in residences, as a fundamental.<\/p>\n\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-1 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-1 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-1' class='gallery galleryid-23503 gallery-columns-2 gallery-size-medium'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<img decoding=\"async\" width=\"300\" height=\"168\" src=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/ildefonso-Hern\u00e1ndez-300x168.png\" class=\"attachment-medium size-medium\" alt=\"\" aria-describedby=\"gallery-1-23491\" srcset=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-200x112.png 200w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-300x168.png 300w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-400x225.png 400w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-600x337.png 600w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-768x431.png 768w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-800x449.png 800w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-1024x575.png 1024w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/\/ildefonso-Hern\u00e1ndez-1200x674.png 1200w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/ildefonso-Hern\u00e1ndez.png 1673w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-23491'>\n\t\t\t\tIldefonso Hern\u00e1ndez\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<img decoding=\"async\" width=\"300\" height=\"200\" src=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-300x200.jpg\" class=\"attachment-medium size-medium\" alt=\"\" aria-describedby=\"gallery-1-23485\" srcset=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-200x134.jpg 200w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-300x200.jpg 300w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-400x267.jpg 400w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-600x401.jpg 600w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-768x513.jpg 768w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-800x534.jpg 800w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-1024x684.jpg 1024w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera-1200x801.jpg 1200w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/Entrevistado-Joan-Llobera.jpg 1920w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-23485'>\n\t\t\t\tJoan Llobera\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n\n<h2>A double circuit\u00a0of patients on the islands<\/h2>\n<p>As head of research at the forefront of\u00a0public health, Llobera unravels the response\u00a0to the pandemic on the islands:\u00a0\u201cTo avoid contagion, a double circuit of\u00a0patients had to be created: those who\u00a0are possibly infectious and patients\u00a0with other health problems, avoiding\u00a0direct attention to the maximum. Due\u00a0to the needs of the centers, the attention\u00a0to the quota patients of each doctor\/nurse was eliminated. The measure, justified at first, has had undesirable\u00a0effects. Telephone assistance from a\u00a0professional who is not your reference\u00a0implies a loss of continuity in care,\u00a0hinders clinical decision-making and\u00a0poses a greater risk to patient safety.\u00a0The stress that primary care professionals\u00a0endure is enormous and the fatigue\u00a0and weariness they suffer is logical\u201d.<\/p>\n<p>\u201cSince this year we are doubling the\u00a0number of doctors and nurses in specialized\u00a0training in family and community\u00a0care in the Balearic Islands, but we\u00a0will not notice their impact for another\u00a0four years\u201d, he adds.<\/p>\n<p><iframe id=\"ep-chart-81d9b17a-6b10-40de-a592-981cc548c6f2-302\" style=\"width: 100%; min-height: 450px; overflow: hidden;\" src=\"https:\/\/www.epdata.es\/embed\/81d9b17a-6b10-40de-a592-981cc548c6f2-302\/450\" height=\"450\" frameborder=\"0\" scrolling=\"no\"><\/iframe><\/p>\n<p><iframe id=\"ep-chart-3dab4179-c99d-46c1-93a2-7e62873d3d5f-302\" style=\"width: 100%; min-height: 450px; overflow: hidden;\" src=\"https:\/\/www.epdata.es\/embed\/3dab4179-c99d-46c1-93a2-7e62873d3d5f-302\/450\" height=\"450\" frameborder=\"0\" scrolling=\"no\"><\/iframe><\/p>\n<p><iframe id=\"ep-chart-aa4e8cf3-7182-44d5-9ae5-a8fecd311240-106\" style=\"width: 100%; min-height: 450px; overflow: hidden;\" src=\"https:\/\/www.epdata.es\/embed\/aa4e8cf3-7182-44d5-9ae5-a8fecd311240-106\/450\" height=\"450\" frameborder=\"0\" scrolling=\"no\"><\/iframe><\/p>\n<h2>Consequences on regular health activity<\/h2>\n<p>This frenetic activity that health\u00a0professionals have had in these\u00a0months with COVID emergencies\u00a0has displaced the usual activity of\u00a0health centers, outpatient clinics and\u00a0hospitals. If not collapsed, the system\u00a0has faced an unusual work volume\u00a0that is noticeable in the day-to-day\u00a0agenda. \u201cThe effects of delays in\u00a0care are beginning to show,\u201d Llobera\u00a0continues, \u201cbecause the patient did\u00a0not attend or it was not easier for him\u00a0to go to health services. The consequences\u00a0and excess mortality caused\u00a0by the COVID-19 crisis and especially\u00a0the psychological consequences\u00a0derived from the pandemic have yet\u00a0to be assessed\u201d.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-23496 alignright\" src=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/cronograma-coronavirus.jpg\" alt=\"cronograma coronavirus\" width=\"273\" height=\"846\" srcset=\"https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/cronograma-coronavirus-97x300.jpg 97w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/cronograma-coronavirus-200x620.jpg 200w, https:\/\/mallorcaglobalmag.es\/wp-content\/uploads\/cronograma-coronavirus.jpg 273w\" sizes=\"(max-width: 273px) 100vw, 273px\" \/><\/p>\n<p>Sebasti\u00e1n Cresp\u00ed adds that \u201cthe\u00a0health crisis is of enormous magnitude\u00a0and it is logical that a good part\u00a0of the resources are destined right\u00a0now to this emergency situation.\u00a0Coronavirus infections may have\u00a0overshadowed other pathologies\u00a0attention. We will have to be very\u00a0careful so that this does not happen\u00a0in the future. Paradoxically, it is also\u00a0probable that the pandemic has\u00a0brought some unexpected benefit,\u00a0such as the reduction of other respiratory\u00a0infections\u201d.<\/p>\n<h2>Caught off guard<\/h2>\n<p>\u201cBefore the pandemic, we tried to\u00a0orient the health system towards\u00a0attention to chronic problems, which\u00a0was the dominant pattern of population\u00a0aging\u201d, explains Joan Llobera.\u00a0\u201cThe infectious diseases and epidemiology services were dimensioned\u00a0to monitor hospital infections or small\u00a0outbreaks such as food. It is obvious\u00a0that the epidemiological surveillance\u00a0and public health systems in general\u00a0must improve and have a structure\u00a0adaptable to sudden changes without\u00a0the rigidities of civil service regimes.<\/p>\n<p>Had the Public Health Agency, which\u00a0is advertised in law, developed, perhaps\u00a0we would have dealt better with\u00a0the pandemic. It caught us off guard\u201d.\u00a0Hern\u00e1ndez agrees on the urgency\u00a0of the creation of the Public Health\u00a0Agency and calls for another \u201chealth\u00a0technology evaluation that tells us\u00a0which health and non-health technologies\u00a0are the most efficient. Both\u00a0agencies must be separated, because\u00a0whenever they mix, public health is\u00a0diluted. We would end up as usual,\u00a0making thousands of cats scans that\u00a0are useless\u201d.<\/p>\n<h2>The hum of the pandemic<\/h2>\n<p>\u201cIt is curious what has happened\u201d,\u00a0continues the Public Health professor,\u00a0because all the experts spoke of\u00a0the possibilities that we would have\u00a0a pandemic, but that it would be a\u00a0mutation, in fact in 2009 we had that\u00a0experience [swine flu] that fortunately was not so important. That puts\u00a0us facing the failures of entrusting\u00a0everything to science and not providing\u00a0resources. We have been slow\u00a0in research responses and in fact we\u00a0still are. In the epidemiological part,\u00a0we have not dedicated enough resources\u00a0to investigating transmission\u00a0chains and now we are not even able\u00a0to say which part of the transmission\u00a0is attributable to what type of activity.\u00a0As this research does not produce\u00a0anything to patent, but only knowledge\u00a0to act, it does not have a private\u00a0company behind it to do it. And it\u00a0has to be a response from the public\u00a0administrations&#8230; That should make\u00a0us think about how much to invest\u00a0and how much taxes to pay in order\u00a0to have security from state structures\u201d.<\/p>\n<p>Hern\u00e1ndez rejects that the central\u00a0government\u2019s coordination of the\u00a0COVID-19 response has been erratic.\u00a0\u201cAt the beginning of the pandemic,\u00a0only coordination and general\u00a0containment measures were centralized,\u00a0but not health decisions. The\u00a0ones who decided to hire or not, or\u00a0modifying their autonomous policy,\u00a0were still the autonomous governments.\u00a0I mean to prepare for the\u00a0de-escalation, to dedicate the money that came from the State to health or\u00a0other things. What has been done is\u00a0for each community to contextualize\u00a0the measures with their environment\u201d.<\/p>\n<p>The expert criticizes the attitude of\u00a0the Community of Madrid in its confrontation\u00a0with the Government: \u201cThe\u00a0forms of federal government are not\u00a0made for political irresponsibility, but\u00a0for politics that try to solve problems.\u00a0This is a chronic issue in our country,\u00a0the continuous institutional disloyalty\u00a0of both some governments and\u00a0some parties make it difficult to do\u00a0well executed federal work.\u00a0Sebasti\u00e1n Cresp\u00ed stresses on the\u00a0same, but in a different way: \u201cI hope\u00a0that, as a society, we will be able to\u00a0overcome partisan obstacles and\u00a0we will all row in the same direction\u00a0to achieve it\u201d.<\/p>\n<h2>Response plans for any eventuality<\/h2>\n<p>For future crises, the former Health\u00a0General Director calls for investment\u00a0in health security, because \u201cwe\u00a0need to have response plans for any\u00a0eventuality or crisis, plans in which all\u00a0administrations are involved because\u00a0there may be problems of a nuclear,\u00a0chemical, and infectious nature or\u00a0related to climate change\u201d.\u00a0In addition, it is committed to a\u00a0change in public health services.<\/p>\n<p>\u201cUntil today we have not had a health\u00a0policy worthy of the name. The rescue\u00a0of sick people has been prioritized,\u00a0that it is good to have a system\u00a0that heals people, but it would be\u00a0foolish to think that people do not\u00a0get sick, which implies having to\u00a0prevent people from having cancer,\u00a0vascular or chronic cardiorespiratory\u00a0diseases. And for that, there are public\u00a0health policies\u201d.<\/p>\n<p>\u201cIt\u2019s not so much about \u2018how much\u2019\u00a0but about \u2018what\u2019. For example, there\u00a0are situations in which the population\u00a0is unnecessarily medicalized. The health service does not provide benefits in an area such as mental\u00a0health, which must provide them, and\u00a0it does not provide benefits in the\u00a0area of community reinforcement for\u00a0people with problems. The debate\u00a0that needs to be done is what kind of responses to health problems Spanish\u00a0society wants to give\u201d.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Despite the fact that Spain has suffered\u00a0the worst incidence of <a href=\"https:\/\/mallorcaglobalmag.es\/en\/covid-19-cracks-in-the-worlds-best-health-system\/\"> [&#8230;]<\/a><\/p>\n","protected":false},"author":4,"featured_media":23488,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[136],"tags":[],"class_list":["post-23503","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog-en"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>COVID-19, cracks in the world\u2019s best health system<\/title>\n<meta name=\"description\" content=\"Most of the scientists consulted\u00a0by 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