When the information does not conform to reality
What happen? Where does it happen? When it happens? How? Who transmits and who does it affect? The control and management of a pandemic has a direct influence on what data is collected, how, and in what way this data is processed, analyzed and published. The ability to do it quickly, reliably and with homogeneous criteria in all areas is related to the response that administrations can give. No administration was prepared for the volume of information that they were going to have to handle, but, within this generalized inability, not all of them gave the same degree, nor did they all give the same answer. In Madrid, the regional Executive did not publish its own data, daily, until April 22. And like the rest of the autonomies but in a more acute way, the delays and the difference with the publications both at the state level and those that could be found through the hospitals themselves offered very different realities. Nor did this area have and does not have the best possible training to face the epidemiological challenge that covid entails.
Sindemia, the missed opportunity in the response to covid-19 in Madrid
Madrid, the territory with the most infections that imposed the most lax measures
On October 28, the professionals of the General Directorate of Public Health sent a letter to its director, Elena Andradas [puedes consultar el documento completo aquí debajo]. In it they alluded to multiple difficulties that had dragged on since the beginning of the pandemic and that had not been solved. They exposed their “discomfort at not being consulted” or feeling “participants in technical decisions” and made a breakdown of problems in the organization, coordination, human resources and the epidemiological surveillance system.
In this last section, they insisted on the need to “modernize” the systems “to have information on the pandemic in real time and to be able to act in a timely manner”; they alluded to the fact that “we need an agile Information and Surveillance System capable of managing the enormous amount of data that is being generated every day, essential for making decisions and managing this crisis”; also that “it is necessary to integrate the different information systems [e incluían como ejemplos la historia clínica del paciente y la web de colegios, entre otros]”, Because it is” totally inefficient to continue entering the same information in each of these registration systems. “
The Community of Madrid disclosed inaccurate data on primary care, tracking and PCR
Finally, they requested “support and modern and integrated technological development that allows the continuous capture of information and automatic loading of data”: “To stop being” minced “and dedicate ourselves to the search for contacts, investigation of outbreaks and control of the transmission chains ”.
The inefficient use of technology also contributed to those never entirely optimal results to which the Public Health technicians refer in the letter. For months, these professionals, such as those in primary and hospital care, exposed the absence of an integrated model that would allow them to do their work fluently. Quentin Leclerc, researcher in the Department of Epidemiology and Infectious Diseases and the Center for Mathematical Models for Infectious Diseases at the London School of Hygiene & Tropical Medicine, synthesizes that “effective contact tracing requires two things that must be done well and quickly.” .
The first, detect and register contacts. The second is to notify people of these contacts if there has been a potential transmission potential. “In both cases, technology makes these processes much more feasible,” he says. The expert also says that it is “more convenient” to trust technology “than in people’s memory to remember who they had contact with, since they probably do not remember contacts with strangers”, for example.
Speed is “essential,” insists Leclerc: “We are trying to” catch up “with the virus and stop it before it spreads any further. The longer we wait to identify and warn, the greater the risk that some of these contacts that have been infected will also infect more people. ” He believes that, in general, administrations “have well understood the importance of technology” and that new systems such as apps —Which “had to be developed and tested first, so there was an inevitable initial delay in their implementation” – “are well integrated into the public health response in the case of many countries”.
Radar Covid, after six months, has only registered 50,503 positives, just 1.8% of diagnoses in the same period
Not in Spain, where the Radar Covid application, after six months, only has registered 50,503 positives, only 1.8% of diagnoses in the same period (2,783,104 infections, until epidemiological week 6, February 14, the last with data). Madrid, where it entered on October 8, is one of the seven autonomies that contributes a significant number of positives with respect to the cases it reports – along with Galicia, the Basque Country, Asturias, Castilla y León and Castilla-La Mancha -, even so , the application does not operate as it should.
The epidemiologist Miguel Hernán reflected a few days ago that one “of the most surprising aspects of the management of the pandemic is that Spain has a app leading digital tracking system in technological development, privacy protection and European interoperability “, and yet it has not been well implemented in all the autonomous regions:” It is as if they put a luxury car at the door but decide not to put fuel in The deposit. Obviously, it doesn’t work ”. For Joan Carles March this has also been the problem: “Seven million people have downloaded it [apenas un 14,8% de la población española], but how it has been implemented by the communities, how this process has been developed and how the population has been informed has not been the most appropriate way ”.
The data source of the impact of the virus
When the first wave devastated the hospitals and the population was kept in their homes, confined, access to reliable and daily data on what was happening in the centers was practically impossible. In Madrid, an information blackout by the Ministry of Health almost total covered the first month and a half of the pandemic. Then, infectologists from 42 public and private hospitals in the community organized themselves through a WhatsApp group created previously to share information on clinical cases. “Given the lack of data and the inaccuracies that we saw, it was expanded [ese chat] to all the hospitals in Madrid and we agreed to share the data of our hospitals ”.
In spring, this information was not made public except for some of those sheets to which this newspaper had access periodically, and these sheets were the most reliable document to know the situation of the hospitals. “We prefer that the first communication was a scientific publication,” says the infectologist. And so it was, at Elsevier [puedes consultar ese documento haciendo click en este enlace]. In addition, he recalls, that group “served to share other experiences and other anxieties, the pressure was terrible on the ICUs and much was shared to try to improve the treatment of our patients.”
Already in the second wave, created a Twitter account: expanded to 62 members. This information continues to be the most adjusted to reality, together with the daily data provided, also since the second wave, by the Madrid Society of Intensive Medicine in its account of that social network. “They are data known to the management and there is no problem in sharing them, it serves to have a real reference and by the doctors themselves, without political bias, of how the covid impacts on the system.” This information “helps people understand the difference between individual risk, which is small due to covid, because mortality from infection is around 1%, with the capacity to destroy the hospital system, which is impressive.”
The avalanche that suffocated hospitals
Would an official channel be interesting to do it? The specialist assures that “it works well like this”, they have “independence” and it is “more precise”. “Especially in the second and third wave [sus datos] they coincide more with those of the Ministry ”, he adds. “The only discrepancy is the medical ICUs.” That is to say, the structural capacity of these intensive care units, whose occupation leads to the total or partial stoppage of care for other pathologies. “It is critical that the information that is transmitted adjusts to reality. Listening to the first wave “on the verge of collapse” is mitigating language, and if you are at the door of an ICU with a relative who cannot enter because there is no gap and what you hear is “on the brink” it is not totally collapsed “, He says. “Have we come to the image of people dying at the door of the hospital? No, but the collapse in Madrid, in Spain, in Western Europe is this, lowering the quality of care a lot ”.
Information about the coronavirus
– Here you can follow the last hour on the evolution of the pandemic
– Restrictions search engine: What can I do in my municipality?
– This is how the coronavirus curve evolves in the world
– Download the tracking application for Spain
– Guide to action against the disease