The ex-director of Gorgas, ex-secretary of Senacyt and specialist in Public Health talks about the inconsistencies in the Executive's decisions, in the management of the coronavirus pandemic.
Why doesn't the curve of new infections and deaths go down, despite such a severe quarantine?
It is not clear, because they do not give us an explanation. It is probably because the number of tests that is done is insufficient and is only aimed at symptomatics, and we do not know how much follow-up they give to the contacts of the positives.
Let's start with the tests; who should be tested?
As many people as possible. As long as we do not identify the infected asymptomatic, this will continue.
The authorities allege that they can't identify the asymptomatic, because many are negative and the virus has not incubated. Before receiving the result, they continue to expose themselves and others.
Yes, but there are many asymptomatic people who test positive. We can't not do this because there are some false negatives. They need to collect as many positives.
Is there sufficient evidence for that?
There should be. Technology is there and money too. Instead of spending millions on a modular hospital, this is what they should be investing in.
How many tests should be done daily in Panama?
That is the type of information that they can calculate and they should have told us: their goal in tests, not only to say how many they did in the day.
Who should be tested for antibodies?
That should also be massive [scale]. At the individual level, it's easy to detect. And at the authority level, they will realize the actual number of infected. But they should say what test they are using, to see if it is of high quality or has many false negatives. Much information is missing.
How close are we to herd immunity?
Very far. Other information that they should give us, and they don't.
Is there something in the published figures that doesn't add up? What do you need to know?
The distribution of deaths and cases by age. They started giving it and then stopped doing it. It was the only way to see correlations and risks. But above all, I still have the doubt: if the numbers do not drop, what has been the use of quarantine?
Death rate per 100,000 inhabitants. Why are we higher than in the rest of the region?
I have no explanation. I don't think they are manipulating the data in either Costa Rica or Colombia. As long as the number of cases does not drop here, the number of deaths will not drop. And as long as the evidence is not crowded and it is followed until the last contact, the cases will not go down.
Models and projections; why are they so far from reality?
In the end the models end up being either false or very crude estimates, because they start without knowing anything about what will happen with the pandemic. It is very ambiguous.
Things we don't know about the virus yet?
Why it affects older adults more ferociously and why some stay happy at home watching television and others die within five days.
What happened to the theory that heat killed the virus?
Panama is the best proof that it was false. Same as pushing hydroxychloroquine as a treatment. It has not been proven that it is preventive or that it is curative.
Looking at the indices from other countries. With which country do we compare ourselves?
We should compare ourselves with Chile: it does many more tests per million inhabitants and has far fewer cases.
Why?
Better quarantine, more tests and better follow-up to positive contacts.
And what are we doing differently from Costa Rica, which apparently is doing better?
They do less testing, but their case follow-up is much more rigorous. They take care that the positives do not come out of their houses and that they really isolate themselves.
You spoke about the modular hospital.
They should have converted existing spaces. Convention centers have been used for many purposes. That would have cost much less and that itself can meet sanitary specifications. Even Johns Hopkins and the University of Maryland did so at the Baltimore Convention Center.
If people are complying with the rules, as Rosario Turner says, why are we still locked up?
That is arbitrary and justified at first, but no longer. And they don't explain it to us. Why does everyone have the same quarantine? It should be applied to elderly people and those with medical conditions, but opening the measure for others.
And maybe open in places where there are fewer cases?
Yes. It must be by age and by density of cases. How are they going to block the entire country, if the cases are only in two places?
If there are already cases on the other side, what use is a fence?
Good question. You're welcome, if there is already community transmission on the other side ...
What can happen if we are left locked up for longer?
People are losing fear and getting desperate. This will lead us to the economic ruin of the country.
You have to choose between public health and the economy. True or false?
A fallacy. They must develop at the same time. The opening rules here have no clear scientific explanation. And the details of the opening has not been consulted.
What details?
For example, who can think of letting people enter the supermarket and not the hardware stores? What is the difference? Explain to me. Why do collaborators limit, without considering the size of the place? Who did they consult with? We at the clinic were required to have a health committee, but they never said how it should be done, what the functions are, if they will ask us for a report, if they will only ask us or what. Is that going to have the same rules in a clinic as in a hardware store? The rules are neither clear nor consulted.
What will be key to contain the spread?
Maintain clean hands, use of masks and distance.
If you don't touch your face and wash your hands, are you safe?
No, because if you are in front of an infected person you can get particles.
Exercises with face mask, within a kilometer of the house, at the time of the identity card. Does it make sense?
No. It wouldn't do me good to go out at noon, which is when it's my turn. Why not enable from 6:00 am to 9:00 am? Why one day yes and one day no, and not every day? What is the explanation? How are they going to check that it is next to the house? It's ridiculous; it is a police state.
And the mask?
Yes I would use it.
You are a cardiologist. How high has the cost been for heart patients, with high blood pressure and so on, after 60 days without being able to exercise?
We will know that cost when we calculate the excess deaths this year compared to the usual number of deaths. When you see that peak, in there you will not only see the Covid, but also those who could not go to attend. Very few have been able to go to the control appointments. The price we are paying is high.
Being able to go out with a single child a maximum of one kilometer from home. Makes sense?
No. Where does the logic of that come from? Again, the lack of explanation. Where has it been shown that if I take three children there will be more transmission? Who said that if I take them 2 kilometers away there will be more infection than in the kilometer?
Dry Law. Would you have put it?
No. I haven't seen any use for it.
Why didn't they call you to help, being a public health expert?
I dont know. But it doesn't matter.
Do you feel scolded or should you speak to the Panamanian like this?
Scolded. And in these things you should not scold, but convince. Treating people like kids is not the way.
Are the health authorities up to the task?
The first part they did well. In this current part I have questions.
Turner and his conference justifying the purchases. What do you think?
Unjustifiable.
Your thoughts on the ventilators?
Overestimation Not only were they over expensive, but also not needed.
Should the medical supplies be bought by the Presidency or the technical entity that needs them?
The entity that needs them.
What are your thoughts on social security?
The biggest scandal is the lack of transparency in the financial statements.
Your message to anti-vaccine activists?
They are harmful madmen.
Foreign doctors. Was it not necessary or did they not want to hire them?
I am in favor of hiring foreigners, but to tell the truth, it was not needed.
Do you think the Chinese have told the whole truth?
They took too long to report community broadcasting and so countries failed to take action on time.
What are we not going to see this year?
The disappearance of the virus and we will probably not see the vaccine in Panama.
The virus will not go away, but how much will it be mitigated with the vaccine and medicines?
A large part, but it would be a shame, if we abandoned hygiene measures, because there are other infections.
When do you see us all on the streets again without restrictions?
In 2022.
If all countries do not take the same measures on time, would there be a way to avoid regrowth?
There would be no way.
You know well what is happening to us now. Does that give you more or less uncertainty than if you didn't know?
More, because I know that there are other micro-organisms to assault humanity in the future.
Historically, there has been a conflict between Social Security and Minsa. Do you think there will be harmony and unification after this?
With the same figureheads, I doubt it.
Do you think after this the importance of science will be understood, or will the consciousness be temporary?
That is temporary. At the time of the budgets we will continue in the last row of the bus. After this disastrous crash, the bare minimum they should be is to have world-class public health labs. But this awareness is temporary. It's like "I never have a drink again."