Monday, May 16

What happened to the applause?: Colombia reopens with more than 600 deaths a day and the health system oversaturated


The Government of Colombia has begun to lift restrictions to stop the spread of the coronavirus in the midst of the sharpest peak / plateau of the pandemic and with a vaccination rate that is just beginning to take cruising speed. 648 deaths were recorded on Monday and the country already exceeds 105,000 deaths registered. In a public statement, 140 medical and scientific organizations asked Conservative President Iván Duque to postpone the measure to ease the hospital collapse.

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During a meeting earlier this month with Vice President Martha Lucía Ramírez, the director of the World Health Organization, Tedros Ghebreyesus, and epidemiologist Michael Ryan, who is responsible for managing health emergencies at the same organization, they expressed their apprehension about the hasty lifting of restrictions. Judging by hitherto modest vaccination rates, they said, loosening the rules could result in a disproportionate cost of lives.

“I believe that the decision to reopen the economy at this time has to do with other realities of life,” says former Health Minister Alejandro Gaviria, “but I find few reasonable explanations from an epidemiological point of view.” The Government, however, considers that the field is paved to restart the engine of normality under a new model of differential monitoring by cities that has been baptized as the Municipal Resilience Index (IREM).

The Ministry of Health, Fernando Ruíz, released the new decree on June 3, just as the country was emerging from a 40-day national strike and one of the most bitter social outbreaks in recent times. That is why the epidemiologist Claudia Vacca underlines the political ingredient in the latest decisions: “It was inconsistent for the Government to keep the economy closed in the face of pressure from the business community, at the same time that giant citizen mobilizations were taking place in the street.”

Blame the mobilizations

But faced with the nightmare scenario in hospitals, with an ICU occupancy above 90% in Bogotá, Cali and Medellín, the three main cities, President Duque chose to point towards mobilizations as the main cause of the crisis, instead to show solidarity with a medical staff at the limit or the families of the more than 100,000 deceased (as did, for example, the British Prime Minister Boris Johnson when his country reached the same record).

“More than 10,000 deaths could have been prevented if we had not had agglomerations in the last six or seven weeks,” said the Colombian president last Tuesday from the presidential palace. For epidemiologist Diego Rosselli, “that figure is taken from the hat. An exaggeration.” And Alejandro Gaviria, today rector of the Universidad de los Andes, adds that the statements are an attempt by the Executive to impose his story in a situation of “collective exhaustion.”

In the same way, Dr. Rosselli recognizes that, despite the fact that crowds are an obvious contagion factor, to rigorously quantify the impact of the marches on the trajectory of the pandemic requires more solid evidence. Other underlying symptoms outweigh more, in his opinion.

For example, the frustration of a country where labor informality has reached 47.8%, according to data from the National Administrative Department of Statistics; or a State incapable of guaranteeing in a sustained way an economic lifeline for the most vulnerable; or the inefficiency of the health system “to carry out good genomic surveillance.” “In Colombia we have no idea which variants are killing us!” He says.

There have been blurred signals from the government. The Minister of Health recognized on June 16 that Bogotá was going through a phenomenon of “hypercontagion”, where 40% of the tests carried out in the capital yielded positive results for COVID-19. “At this time, any measure that is made will really have very little effect, because the contagion is already there,” said Ruíz, 62, a doctor in public health.

Hernán Bayona, president of the Bogotá Medical College, disagrees: “It is not true that nothing can be done from an epidemiological point of view. With these statements, the minister fails to fulfill his constitutional function of caring for the public health of Colombians.”

Of vaccinations and votes

The vaccination process in Colombia has been late due to the always cumbersome negotiations with pharmaceutical companies. Other countries such as Mexico or Chile took off more quickly. The first Colombian to be vaccinated received the dose on February 17, but only a few days ago the campaign exceeded the 200,000 daily doses that the Government set as a target.

Political scientist Diego Fuerte estimates that the country finally has the supply of sufficient vaccines and the pace will be sustained. So far there are about six million people immunized with the two doses. This represents around 11.8% of the population. In any case, the parallel rate of infections and daily deaths still poses an obvious risk to bring forward the total reopening, they point out from various medical circles, but also those responsible for the WHO.

To appease the deep uncertainties, Minister Fernando Ruíz has repeated in statements to the press that the process will be “gradual, progressive and responsible.” And that cities will only be able to recover the cultural, social and economic activities announced based on the occupation of the UCI, which must be, according to the resolution, below 85%. A reality that today is nothing more than a longing.

Meanwhile, the clock is ticking. The echo of the delta variant resonates with force and the daily confirmed cases oscillate between 25,000 and 30,000. Simulations suggest that the third wave has become a tsunami and could extend into mid-July.

Live with 60 euros a month

The debate revolves around the moment. The most cautious maintain that the margin of error is minimal and to manage the new measures requires the pulse of a surgeon.

The chemist from the University of Antioquia David Bautista, however, is in favor of the immediate reopening: “At this point in the pandemic, restrictive measures are no longer tolerable due to the economic and social problems that the country is experiencing.”

And the first months of hibernation were drastic. Alejandro Gaviria refers that collective exhaustion is evident; and epidemiologist María José Bustamante explains that staying at home is no longer an option for most. That is why he asks himself: “What else can citizens do when half the country lives on 300,000 pesos (about 66 euros) a month?”

For Bautista, many of the problems arise from the unsuccessful pedagogical dissemination of official measures. The absence of adequate communication, he says, has resulted in the need to resort to coercive measures such as “quarantines, curfews, and other police attitudes.” “There is too much misinformation and the national government is unable to communicate well or do good pedagogy,” he says.

All of the above in the middle of a pre-election year where, according to the immunologist Gabriela Delgado, “what matters the least is life.” Delgado warns that these are fertile times for experts and arguments of all kinds whose only goal is to disqualify and question the measures in public health according to their political leanings.

Therefore in his speech he prefers to leave room for nuances. And he affirms that the only thing clear is that, if after a year and a half, Colombians think that the masks “should be used on the chin, or that it is time for parties and social life in places without ventilation”, a deep reflection should be opened on the “lack of leadership in society and the ignorance of the value of science”.

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The initial applause and gratitude are over.

Abandonment, disappointment, disappointment and helplessness are some of the words that are repeated among health personnel to portray their state of mind in recent months. Half a dozen sources consulted agree that there is a general feeling that the burden-sharing by the Government on their shoulders has been disproportionate. Also that in the last peak he has left them alone.

The neurologist Diego Rosselli affirms that more than one colleague has called him crying. He confesses that he does not know “how to comfort them.” And Cecilia Vargas, president of the College of Nursing Organization, says that these days there are nurses doing marathon shifts of up to 36 hours: “The occupation in the units is no longer relaxed because the patients are healing, but because the people it’s dying”.

But it is not only a matter of state oblivion. Gabriela Delgado, an academic at the Academy of Exact Sciences, believes that it is an innate attitude to the human condition. “We are ungrateful,” he laments, “from the initial recognition, which includes some government bonuses, we now see how people mistreat vaccinators. The thread always breaks on the most fragile side.”

Surgeon Hernán Bayona, for his part, lists some of the difficulties underlying the feeling of shipwreck among doctors and nurses: delays in the payment of salaries in public hospitals, due in part to the administrative inefficiency of a system full of twists and turns; low salaries; and fragile hiring conditions, mostly temporary, are the order of the day.

But, in addition, the impact of the hospital collapse is leaving collateral damage and fractures that will mark the post-pandemic. Bayona indicates, for example, that it has “regressed more than a decade in maternal and child mortality rates, which went from 40 to 65%”.

Alejandro Gaviria confirms that the relationship between the Government and certain medical associations has blurred. “There is a fact that calls me the tension,” he maintains, “and that is that the letter from 140 associations asking that the opening measures be postponed has not had any repercussions on public opinion. In another context it would have been devastating. Today it is not. it is because people have entered a kind of resignation “.

The young pharmaceutical chemist David Bautista says: “But I don’t think there is much to do either. This is a pandemic in a third world country and I don’t think the social and health determinants in Colombia have been able to change in a year.”



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