Irene Hartmann
08/07/2020 - 17:57
- Clarín.com
- Society
In the brief but dense account of the coronavirus in Argentina, many came questioning the official health strategy: beyond the early quarantine, they point out the low number of swabs , in relation to other countries and to the advice of the WHO. As the Government does not deny the matter, we accommodate ourselves to the fact that " what can be done is done " with the available resources. But, why will fewer swabs be made from now on, that is, why was it enabled to consider patients infected without PCR?
Can you read a certain resignation in the face of a snowball that is already unapproachable? And, furthermore, how will the positivity rate be calculated from now on, especially taking into account that several jurisdictions (the city of Buenos Aires, Mendoza, Córdoba, and Chaco ) lowered their thumb to the “ease” of ignoring swabs in those cases?
"Ease", because for the Health system it is obviously simpler, cheaper and more expeditious to say "you have coronavirus" who "fits" with the new and broader definition (having symptoms and being a family member of an already confirmed case of Covid ), to receive the patient in a guard, swab it, send the sample to be analyzed, and have it processed and certified by a laboratory worker ... In the words of Eduardo López, an infectologist at the Gutiérrez Hospital and one of the Government's advisers on the pandemic, “ the new measure aims to consider as positive those who obviously are, without wasting resources ”.
But several jurisdictions are giving their thumbs down to the Nation's recommendation. And many others will join the proposal. In some places they fear "having too many cases", taking the words of the Chaco Health authorities. In that province, as in the city of Buenos Aires, Córdoba and Mendoza, they assure that they have " sufficient testing capacity ." In Río Negro and Neuquén they are “looking at the issue” and could continue with the PCR in some cities, but they will suspend them in Bariloche and General Roca. The province of Buenos Aires, for its part, will suspend swabs in the cases defined by the new protocol.
Carla Vizzotti, Secretary of Access to Health, reported the new criteria on Thursday.
This fear of "having many cases" is confusing. Perhaps it should be read online with a certain fear from the authorities of a “ shot ” of positives . Because, just as testing more people makes more cases of Covid-19 visible, the same effect produces broadening the confirmation criteria, in this case, by clinical criteria and epidemiological link .
These jurisdictions, apparently "rebellious" in the face of the descent of the national line, will actually make use of a power authorized by the Ministry of Health itself. Each jurisdiction is free to choose, depending on its epidemiological situation, whether to continue testing everyone or not. The recommendation aims to lower the tests where there is community transmission, “just as other countries did at the time of frank growth of the curve, such as Italy and Spain. And also Argentina, in the 2009 influenza A epidemic, ”López explained.
Guillermo Durán, Conicet Principal Investigator, director of the Calculus Institute of the Faculty of Exact and Natural Sciences of the UBA and one of the “non-medical” heads who has been focusing on the analysis of the pandemic, also spoke of “taking advantage of the resources”. Durán reiterated something that he had already told Clarín : the urgency of testing, but "not necessarily more but more intelligently ."
Health workers from the DetecAr plan, in Palermo. Photo: Guillermo Rodríguez Adami
“First we had a positivity ratebetween 10% and 20%. Now it is very high, which means that it is not tested intelligently . You have to look for asymptomatic patients and Argentina does not do it because it uses its tests where everything is exploded ", he clarified, adding:" We have been pointing out the determination that was made ... it seems good to us, but it should be even broader. " This means, "not only stop doing PCR to the cohabitants of positive cases: that everyone who is positive for a doctor, is positive, period". And, of course, be isolated.
Argentina has already carried out more than 812,000 tests. On Thursday alone, 18,000 swabs were made, but that is little by what the WHO recommends, since the local positivity rate exceeds 40% . However, Durán believes that the question is not in making massive tests but in doing them strategically. In other words, “how many” does not matter so much as “where”.
“I am surprised that there are districts that do not accept the option that was given now, for example the City, which is also doing little testing. If you test little and they give you the possibility of releasing tests to patients who you already know are Covid, the logical thing is that you use them where they can be best used, "he said.
Graphically, it would be like this: “There are places where positivity reaches 80%. If you do tests there, you are throwing them away. Use them in places where you could detect asymptomatic, in the lowest links of the contagion chain , and not where the proliferation is explosive. That is why the positivity is so high ”.
What is Coronavirus? How is it spread and what are its symptoms?
Watch the specialHow the positivity rate of Argentina will be calculated with these changes is something that Clarín still could not clarify. This variable considers the portion of "positives" out of the total tests performed. But if there are new positives without PCR , should they be counted in the calculation or not?
While awaiting clarification from the Ministry of Health on this point, López and Durán agreed on their vision: the "new positives" (without CRP) should be added to the total confirmed, from now on, but they should not get "in the same bag ”When calculating the positivity rate , a variable that for the“ non-specialized ”begins to become quite confusing.
According to López, "the logical thing would be to leave these cases in a separate column." And Durán concluded: “You have to consult the Nation. My recommendation is to consider these cases separately. Just as 'discarded by PCR' and 'discarded by clinical analysis' are counted as separate things, in this case they would be different types of 'confirmed'. With and without PCR ”.
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