Webinar ‘Coronavirus: Lessons of a pandemic’, organised by the University of the Americas, Chile on 7^th of April 2020

On 7^th April 2020 the University of the Americas, Chile organised a Webinar on ‘Coronavirus: Lessons of a pandemic’ chaired by Prof Osvaldo Artaza in which fifteen panellists, experts in public health from the Americas, contributed to a discussion on the lessons learnt so far in the region. The following is a transcript of my contribution.

Firstly I would like to acknowledge the debt we owe to those working on the front line for their amazing work, particularly the professionals – doctors, nurses, technicians, receptionists – but also to all those who make it possible for services to continue operating under such pressure.

These people include cleaners, ambulance drivers, carers, shop assistants, fire fighters, public security services, delivery drivers, volunteers and all those who offer a service to society with the risk that it poses to themselves and their families.

What stands out is the commitment and professionalism of professionals and workers from different sectors. Dedication and solidarity are common denominators in all countries, regardless of differences in culture, religion, and origin of birth.  But the shortcomings in many countries, in assessing which and how many health professionals are needed, have also been highlighted.

Despite the seriousness of the current situation, there are signs that point to hope for humanity.  People and their communities are reinventing themselves.  Even so, troubling questions arise, among them, why is it that no country, nor alliance of countries, had no strategies in place, nor were they prepared for a large biological incident, let alone a pandemic.

This pandemic will eventually end, one day a vaccine will be available and we will develop herd immunity: it is just a question of time. But sadly, not without an unprecedented cost to individuals, families and to society.

There is no time to delay reforms, so we must rethink how health and social systems are planned and explore the possibility for collaboration between sectors in order to be prepared for potential new episodes in the future.  There is an urgent need to introduce changes immediately, focusing on improved coordination and integration of care and health services.

This is illustrated by the way in which we have scaled and designed current infrastructures, which together with classic hospital-centrist models, have made it difficult to give an efficient response at this time.  One possible way forward is to introduce the concept of flexible and adaptable structures, bearing their territorial distribution in mind.  This would maximise the existing infrastructures and improve care pathways of the most vulnerable and needy patients.  In other words, I am talking here of equity.

However, the issue goes beyond bricks and mortar.  The lesson of these months is, without a doubt, that there is a need to change the way we provide services, especially in times of crisis.  Global, local and contextual measures are required as we have already seen with regional lockdowns and the WHO’s declaration of a pandemic which represents an advance in the awareness that this crisis affects humanity as a whole.

Behind the decisions made by governments, there is a constant that stands out: who is delivering the message, how and when is it communicated? Guidelines and messages aimed at the general public, be it confinement, risk segmentation or preventative measures, have run a different course, depending on the country and its political leaders. The evidence so far shows there has been no consensus among scientists and messages have been inconsistent even within the same states, despite recommendations by supranational organisations.

What have we learnt these days? That reliability of information is questionable at a time when there is no proven evidence not even if face masks protect or prevent transmission, if tests are reliable, let alone how cases are reported, including the representation of the number of deaths.

It can be concluded that in addition to clarity of message, a change in the leadership model is needed. Along with this, social media and new technologies are serving as a new way of providing some services.

We are probably all familiar now with the concept of herd immunity, but even those who advocated it have had to change their discourse and now promote confinement as a better alternative.

So, as the days go by and the graphs show curves, peaks and plateaus, new COVID-19 cases and subsequent deaths, and evidence of the pressure, including in Intensive Care Units, that health services are facing, there is an ethical question: How do we prioritise, and who?

Patients with multiple health conditions, with rare diseases, in treatment or on the waiting list for cancer treatment, patients with mental health problems, pregnant women or people in long-term centres such as nursing homes, may have been relegated to low priority status.

It is here, from the vision of Integrated Care that we can offer some hope. These vulnerable and fragile people should be able to follow their treatment and therapeutic paths as far as possible. The redesign of these care pathways between levels of care, is an opportunity to review current models.

Our services have adapted from responding to infectious diseases to treating multiple chronic conditions. However, we find that not only are our services unable to provide a coordinated response to chronicity, but neither do they have the tools to respond to a crisis caused by an infectious outbreak. It is the paradox of the 21st century.

We have within our reach the opportunity to develop new models of relationship between levels of healthcare and social care, incorporating the support of community networks and volunteering, as has been shown these days. Together, now more than ever, we must reflect and work on the values of society and the future vision of the services required in times of stability, but also preparing for critical episodes.

For future generations, we cannot afford not to move forward. We have endless opportunities to incorporate innovation. Who would have imagined that a car factory would be dedicated to manufacturing oxygen ventilators?

Rethinking will involve planning and reorienting production and logistics systems and incorporating them as key sectors in health and care systems, whether that means support in the purchase of food and basic items, or the provision of advanced technology. The way in which health services are financed must be changed, no longer calculated on volume, but by other variables. All ministers in all ministries must become ministers of health. There should be a move from health policies to health in all policies. And actions should follow words.

To conclude, I would like to paraphrase a few words by Yuval Harari taken from an interview in the Spanish press: Humanity is facing a world crisis; perhaps the greatest crisis of our generation. The decisions that citizens and governments make in the coming weeks will shape the world for decades to come.

Not only will health systems be shaped, but so will the economy, politics, and culture. We must act quickly and with resolution. We must also consider the long-term consequences of our actions. When choosing between alternatives, we must ask ourselves not only how to overcome the immediate threat, but also what kind of world we want to inhabit once the storm has passed. I want to end these words with the memory of the people who have left us and who have not even been able to say goodbye to their loved ones.