Science has learned a lot, governments have learned something, but have we? Four years ago a virus changed our lives

February 26, 2020. The Generalitat of Catalonia confirms the first case of infection with a virus whose name at that time sounded cumbersome. But today it is said and written easily. And then. SARS-CoV-2. Almost a month earlier, on January 31, the National Center for Microbiology, dependent on the Carlos III Institute of Health, confirmed the first case of the disease in Spain. In particular, in La Gomera. There was so little to foresee as to what might happen. The response had to be quick, and ways to predict and combat a previously unknown virus had to be learned along the way. Trial, error. Four years have passed since then. And during this time, were you able to learn the lessons that pandemic?

The answer depends primarily on the area in which we ask the question. Because there are several fronts. Science, institutions and citizens They had to sooner or later adapt to a completely new situation for which Spain “was not sufficiently prepared.” This was highlighted by independent experts who released their Covid-19 audit last December, a lengthy document of almost 160 pages in which they backed their claim with several reasons.

There were no strategic reserves of materials – there were no masks, gloves, personal protective equipment – there were no information and early warning systems, there were no diagnostic resources. That is why the answer was “contradictions” and “failures of coordination”. Moreover, the legal framework under which some of the measures were defended “was also insufficient.” And they warn that this could happen again. Moreover, they note that we must “learn” that there is a new pandemic of very serious respiratory viruses.”It’s not only possible, but also probablein the short to medium term.”

Researcher at the Higher Center for Scientific Research (VSRC) Margarita del Val, he believes in it too. “The likelihood that there will be outbreaks or epidemics with the potential to cause a pandemic“, he warns. Essentially for two reasons: there is a high concentration of people in certain urban areas and great international mobility. “We come into contact with many different people, and this poses the threat of pandemics,” he explains. He believes that we are “more prepared” than before the arrival of Covid-19, but everything will depend on the virulence with which this new threat manifests itself.

But in what sense are we “more prepared” anyway? Have we learned? Should we have gone further in these four years?

Science in full swing

Let’s do a memory exercise. It’s been months since we heard the names of two other viruses that made numerous headlines in their time. He MPox – perhaps better known as “monkey pox” – and West Nile virus. The latter entered our vocabulary in the summer of 2020; the first, a little later. None of them disappeared. In the latest report on the smallpox situation, published by the Carlos III Institute of Health last December, there were 7,684 cases of infection in just one week. And throughout Spain. In turn, a document published by the Ministry of Health in November last year certifies that “Spain is currently endemic disease situation

» West Nile fever because there are “favorable conditions for the maintenance and circulation of the virus” that causes it.

However, no warnings were received regarding this or that case. And that’s because they didn’t get serious: science worked against them based on what was learned during the Covid pandemic. “Mpox exists all over the world, but thanks to the responsibility and common sense of the most vulnerable, vaccines and antivirals, it has remained something that only exists now,” says Del Val. West Nile virus, in turn, was stopped “through research, analyzing the sequence of the virus and observing how it spread.” “These outbreaks did not become epidemics, so yes, we have made progress in the investigation“, notes the virologist.

Other experts agree with her. This is the case, for example, with the former director of health systems of the WHO and the former minister of health of the Basque government Rafael Bengoa, which highlights, for example, the mission launched by the Coalition for Epidemic Preparedness Innovations (CEPI) and the WHO. “Their project is to prepare us around the world for the worst possible pandemic scenario, and its goal is to create a sense of security,” he explains. In a sense, this allows us to get ahead of the next pandemic, which science says is not only possible, but also probable. “Science has found out a lot because he keeps working,” he says.

Another example in this sense is England. Its risk assessment agency, the expert notes, puts the new pandemic at the same level of threat as a cyber attack. “They note that there is a 5% to 25% chance of experiencing one of these two diseases in the next five years,” says Bengoa.

“From a scientific point of view, This situation allowed us to get an idea about this type of virus“, notes the former Director General of the Ministry of Health. Jose Martinez Olmos. He also notes that all achievements are fertile ground to ensure that the next crisis does not have the same consequences. And here it also points to vaccines. “Technology has advanced significantly to achieve effective immunization,” he says.

And there are also examples from science that apply specifically to the Mpox virus. Or to bronchitis In children. “It was a tremendous success,” says Del Val. “There are many more vaccines on the market now. The health crisis has accelerated the research and production of some of these that were previously being worked on at a very slow pace,” he adds.

Administration, at half speed

In any case, science does not develop without help administration. In an economic sense and in many others. And in this area, according to experts, learning also occurs from mistakes, although not at the desired pace. As Bengoa noted, England is an example. But on the other side of the coin, he laments, Spain does not offer its citizens “a sense of security.” “If Spain could develop a pandemic preparedness plan, it would mean that someone is working and would give the population that sense of security that is being lost,” he says. “Rulers must not forget what happened to us,” he insists.

And it points to a very specific goal: public health. “It’s not the same as public health, it’s worth remembering,” he says. In the same sense, an audit of the impact of Covid was also announced, in which independent experts indicated that some of the errors in the response to the pandemic were associated with pre-existing problems in the healthcare system, including “the distance between the levels of public health and healthcare, deficiencies in epidemiological surveillance systems, structurally insufficient human resources for the day-to-day operations of public health services, as well as the lack of an adequate information system at the national level.

“It has been demonstrated that the NHS has no compensatory ability in a crisis. That is, public health can do more or less what is required on a day-to-day basis, but when a crisis like Covid occurs, it does not have the means to respond,” continues the former director of health systems at WHO. “It was visible and continues to do the same. There has been no progress in this area for four years,” he diagnoses.

Yes, it happened in public health. And the best example of this was the statement on January 30 State Public Health Agency, “which will aim to eliminate risks and threats to the health of citizens and increase equity in this area,” according to Moncloa. This task has been under consideration since 2011, when the Ministry, whose director general at the time was Martínez Olmos, approved the Public Health Law. “At that time we already foresaw the need for such a center, but nothing changed until 2019, and now things are moving very slowly. Having this center is very important,” he says.

And this also points to an audit. “To move in the right direction, many measures need to be developed,” he notes. Which? Experts suggest, for example, that it is “sensible” to apply the precautionary principle to prevent or at least delay the spread of the disease across Spain’s borders. “All in all, The sooner you intervene, the better.“, they emphasize. In this case, they call for early detection of the emergence of cases of the disease to try to control its spread. In addition, they ask that the first decisions be made by a health crisis management committee, advised by a scientific researcher. They also argue, that “it is necessary to foster a climate of mutual understanding that makes transparency compatible with protecting advisory groups from undue social pressure and media attacks.”

And, in addition to the Public Health Agency, they require a Health Emergency Response Plan and Master plan for strategic reserves. For Martinez Olmos, the latter is also true. “It is impossible to be prepared for a pandemic, but you can have the material. Respirators, masks, gloves…” he emphasizes.

Idle population

Covid audit requires inspections and a new living model to avoid another “tragedy”

To learn more

There is a third side to this story: the population. Just as Bengoa pointed out the importance of institutions not forgetting what happened and learning from it, the expert believes that the individual level is the level that has learned the least from it. “It’s almost normal,” he says, however. It was actually called pandemic fatigue. And this was reflected, for example, in vaccination rate since the last autumn-winter season. At the time, all experts noted that the explosion of respiratory viruses was largely due to a decline in immunization rates, mainly among health care workers themselves. “This ultimately affects how citizens perceive the risk and the need for vaccination,” laments Martinez Olmos.

But not only that. Prevention with tools such as medical mask, in his opinion, is also lost. And remember in this sense the criticism that the Ministry of Health received when it decided to make its use mandatory in medical centers again. They came primarily from the PP communities, who spoke, as in the case of Andalusia, of an “imposition”, a measure applied without taking into account the communities. But it was necessary, says the former health secretary-general. And it goes further. “The use of this evidence is proof and this idea should have remained forever.”

Del Val also agrees. “We have not yet realized that you need to use a mask if you have symptoms. And when we are vulnerable. And when we are going to be with vulnerable people,” he says. Moreover, he claims, “the air Most of the interior is airtight“What have cross ventilation measures become? According to the expert, very little. If not at all. “Science has learned that respiratory viruses are transmitted by aerosols, but we have forgotten the importance of air quality,” he laments. So he is celebrating the revival of this idea. establishing a standard that defines the amount of CO2 that can be in the air before it can be considered healthy “It’s voluntary, but it’s a great step to find out how breathable the environment we’re in is,” says the CSIC researcher.