Closed parks and open bars.
This image - which the Community of Madrid fostered when it confined the first neighborhoods to the perimeter and could also be seen in some moments of the de-escalation - illustrates very well the constant examples that the covid epidemic is leaving behind decisions made by politicians without scientific endorsement.
The rulers have the last word in the difficult balance involved in caring for the health of the population while maintaining the economy as much as possible while a contagious virus circulates around the world.
But the technical criteria for imposing measures dictated more by partisan tactics and populist calculations than by available evidence have often been forgotten.
A total of 55 scientific societies have once again hit the table this Sunday to claim that it is the best available knowledge, and not the heads of the cabinets, which dictates the course to fight the coronavirus.
In health, you are in charge but you do not know
, is the title of the manifesto signed by the main scientific-medical societies of the country, which bring together 170,000 health professionals.
"Accept, once and for all, that in order to face this pandemic, dominant decisions must be based on the best available scientific evidence, completely detached from the continuous political confrontation", reads the first point of a decalogue in which they offer their advice to make the better decisions to stop the virus.
Surely, the trigger for this writing is the scuffle that the Spanish have attended almost directly between the central government and the Community of Madrid to establish minimum thresholds with which to confine the most affected municipalities and restrict more capacity and social relations.
According to the details of the disagreement, which EL PAÍS has published this Sunday, thresholds such as cities with 100,000 inhabitants being affected or ICUs exceeding 35% occupancy with covid patients were the result of political negotiations (Health initially proposed localities more than 20,000 and critical beds were above 20%).
More information
The president of the Madrid doctors sees the new restrictions in the Community as "absurd"
New restrictions in Madrid: what can and cannot be done
"I understand certain haggling if it comes to reaching agreements, because we are not talking about an exact science, but provided they end up reaching those agreements.
Otherwise, it is a disaster that hurts everyone and undermines the confidence of the public, ”says Ignacio Rosell, professor of public health at the University of Valladolid.
He defends not to put all politicians in the same bag;
In his opinion, in many places scientific criteria have been followed, although those that have not made more noise.
“The problem is that a prudent community in isolation does not avoid the impact of all the others.
It gives the impression that this has already become a fight of not being the confined one and others.
The political sense is taking precedence over public health ”, he adds.
The
political versus science
debate
is not black and white.
Pedro Gullón, member of the Spanish Epidemiology Society - who does not subscribe to the manifesto - and co-author of the book
Epidemiocracy,
emphasizes, on the one hand, that there is a struggle for evidence: “The field of economics seeks results that are different from those of from the field of health and there may be a contradiction.
Politicians have to take care of finding the balance that best fits.
On the other hand, remember that the evidence on what to do against the coronavirus is not always very solid: “We often base ourselves on previous experiences, on what we see more sensible, but for years there will be no studies that show what works. better at every moment ”.
Rafael M. Ortí Lucas, president of the Spanish Society of Preventive Medicine, Public Health and Hygiene (Sempsph), one of the signatories of the manifesto, believes that although there are no mathematically infallible thresholds to decide actions, and despite the fact that the evidence is “ complex ”, the measures“ can be based on scientific criteria ”.
"When in the de-escalation we had an incidence of 40 cases per 100,000 inhabitants, we considered whether or not we would open it and we said that we would evaluate it every two weeks," he now points out when the average in Spain is 269.49 cases and in Madrid 647, 91.
“We cannot be since July waiting to see what happens and discussing what if this or what if the other.
We may have doubts, but let's analyze, let's see what measure we can have and let's evaluate ”, he claims.
In fact, one of the main negligence against the evidence, as 17 experts have stated in
The Lancet
magazine
,
has been not evaluating results.
José Miguel Cisneros, head of Infectious diseases at the Virgen del Rocío Hospital in Seville and former president of the Spanish Society for Infectious Diseases and Clinical Microbiology, also a signatory of the manifesto, reflects: “Spain has been the first in the first wave and first in the second.
We have not learned due to lack of evaluation, self-criticism has not been made nor the available evidence has been used and this is what we demand ”.
Decisions without evidence
From the beginning of the health crisis, for some reasons or others, decisions have been made apart from the scientific evidence, although this is not immobile either, but rather changes as new discoveries are made.
An example is that of masks, of whose effectiveness there was no solid evidence in the early stages, but which are already out of the question.
At least in part, because countries like Spain force them to be carried anywhere open, even without other people around.
"This doesn't make sense," says Ortí Lucas.
"If it is to be fulfilled more where it is needed, which is mainly indoors or in very crowded areas, it may be a good measure, but this will have to be explained, and it is not being done," he says.
Here are other points where non-science decisions have been made in recent months:
The case definition
Defining who is suspected of being infected is the first key step in tackling the disease, since only they are searched.
The lack of evidence meant that at first there was a very restrictive definition.
Cisneros recalls that the first days only those who had been to China were tested.
The infectologists asked that all unknown pneumonias be performed.
"If it had been done from the beginning, we would have found before the virus was already in Spain and lives could have been saved," he says.
Quick tests
With the quick tests there were bad decisions from the beginning.
“In the first place they were bought without demonstrating efficacy and had to be returned.
Then they were used to screen the population, among health workers, when this is not useful, ”says Cisneros.
The same thing happens with the new antigen tests.
They have been shown to be very useful for detecting the virus among people with symptoms, but not so much for the general population, as they are being used in the Community of Madrid.
Cities with less than 100,000 inhabitants
The fact that confinement thresholds are valid for cities with more than 100,000 inhabitants and not for smaller ones is an “arbitrary” bar, all those consulted agree.
“What you have to see is whether the transmission chains are known.
It is true that in a small town you can have a very high incidence and that no restrictions are necessary because it is easier to know where the outbreak comes from than in a large city, but you have to analyze it depending on the case, ”says Ortí Lucas.
Parks closed, bars open
The closure of parks has been one of the solutions proposed by some cities and autonomous communities, despite knowing that the risk of contagion is up to 20 times lower outdoors.
"If you close the parks, you are promoting indoor activities, which is counterproductive," says Gullón, who believes that it does not make sense that the capacity of the hospitality establishments is equally limited (50% in places that meet the thresholds of confinement indicated in the BOE) indoors than on the terrace.
“Maybe the ratio should be 75% outside, 25% inside.
Or completely close the service inside ”, he adds.
Furthermore, as Rosell points out, there is a contradiction: "It is obliged to respect the distance between tables, but not to do so between chairs at the same table."
Information about the coronavirus
- Here you can follow the last hour on the evolution of the pandemic
- This is how the coronavirus curve evolves in Spain and in each autonomy
- Download the tracking application for Spain
- Search engine: The new normal by municipalities
- Guide to action against the disease