With more than one million 200 thousand patients, exceeding 60 thousand dead and rising, the pandemic of coronavirus advances and dyed territories. Ten countries concentrate 80% of the detected cases and some nations take weeks and months to face the Covid-19. Four medical experts, who have analyzed the complicated situations of Iran, Spain and China, and the success in the containment of the autonomous region of Hong Kong, explained to EL UNIVERSAL in which you get it right and failed.
“Don’t let the politics get in the medical issues. That is the message here. Happened in Iran and is happening in the united States,” says Kamiar Alaei, an expert of iran in health policy and co-chair of the Institute for International Health and Education in Albany. “From the iranian government, there was weeks of denial in front of the coronavirus, for political reasons, and acted afternoon, which led to expanded for the country”.
At the end of 2019 in Iran witnessed a series of protests by a rising strong in the price of fuels, which is joined with the anniversary of the Revolution and the Parliament elections in February 2020. In this context, Alaei ensures that the people had lost confidence in the authorities.
“When the epidemic began, the government thought that if they admitted that it had coronavirus in Iran, the people would have no excuse not to participate in the anniversary and the elections, so I ignored the problem despite the fact that there were a few cases in cities such as Tehran, Qum and other”. Finally on the 19th of February, in the city of Qum, reported the first two deaths, and with them, the first mention of the coronavirus on the part of Iran.
According to the Johns Hopkins center, the first case of Covid-19 was reported in Iran on the 18th of February, a day before the first two deaths. Now, according to recent data, exceeded 55 thousand infected and 3 thousand 400 deaths. It is the fifth largest country in the world with absolute numbers of deaths. By comparison, in Spain and Italy, the first deaths were reported more than 15 days after the authorities to report the first cases.
“Never start by dead, there are always cases before, and the question is if they could know that there were cases in the country. After the deaths, began between the political authorities and the health to discuss whether to put or not the city of Qum in quarantinebut then there was a big delay to the time to take action and when the took were warm,” explains Alaei.
“For example, millions of people have traveled by the end of the year [el calendario persa lo marca en el equinoccio de primavera, el 20 de marzo] from big cities to small towns, aggravating the problem,” he adds. The closing of colleges and schools arrived on the 5th of march, with 107 dead accumulated.
“It all depends on the attitude of the government. Also Italy, the united States and Spain did not take seriously; for weeks passed to the topic, did not see the spread of community and looks at how they are”, he regrets.
Spain is one of the nations most affected by the Covid-19. In total numbers it is the third, with more than 124 thousand cases and 11 thousand dead. Though some days we have come to count to almost a thousand deaths a day, after three weeks of alarm Status and confinement, the growth curve is flattening.
“It started with a containment strategy, identifying and diagnosing cases and providing medium isolation of suspects, they soon had to move to a mitigation strategy, basically treat that the intensity of the transmission does not generate enough cases that desbordasen health services”, explains Ildefonso Hernández, professor of public health and former director-General of Public Health of the Ministry of Health and Social Policy (2008-2011) when it was the pandemic influenza (AH1N1).
“Given the lethality of the disease and its ability to spread, the non-adoption of measures a little more strict than those initially envisaged in each country could lead to the overflow of their health services.” Then he continues: “Yes you could have done better things in preparedness and response”.
Hernandez reflects that, until you know what’s going to happen with the pandemic, it is difficult to analyze which sequences of actions have been correct. “The countries that got an excellent containment, confining the cases of small groups of population, they will have to face at some point whether to return to routine, the potential for new cases to appear,” he concludes.
Lessons from the source
In China, the city of Wuhan and Hubei province were the source of the pandemic. At the university of Oxford, a multidisciplinary team carried out the article The Effect of Human Mobility and Control Measures on the Covid-19 Epidemic in China (The effect of human mobility and control measures before the epidemic of Covid-19 in China). Published on march 25 in the journal Science, one of its authors, Moritz Kraemer explains that “in China, the outbreak appeared after that there are probably thousands of introductions that they fired the local transmission in other provinces.”
“In our study, we found that in China they have implemented the restrictions to travel three weeks after that would have [positivos], which was too late to contain the outbreak in Wuhan,” she argues. “We now know that in order for closures to be effective, these have to be done a lot before. Once there is local transmission on several points, the important thing is to keep the physical distance and social, to do testing and tracking the cases.”
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In their study they used data of geolocation of cell phones Baidu Inc, the search engine par excellence in China, and combined with the data bases of the Open Covid-19 Data Working Group. With this they saw that the local transmission between people was given long before the outbreak and could only be mitigated by control measures, drastic, taking into account the incubation periods of five to 14 days, they did not show results until after a week of being implemented.
For Kraemer, the greater part of the governments adopted an attitude of “wait and see what happens”, which can be fatal, as was seen in the case of several States. As an example of good practice, only highlights three nations, Singapore, South Korea, and the former colony of the Uk now Special Administrative Region of China: Hong Kong.
At the university of Hong Kong Ben Cowling is head of the Department of Epidemiology. “Our first cases were detected due to arriving visitors from China in the second half of January, but we have had a very small amount of local transmission, with no evidence, almost, of that is taking place”. The same 25 of that month, with five patients identified, schools were closed down and decreed a halt almost total. Of time, the total number of deaths in Hong Kong is four people.
Under your point of view, Hong Kong managed to suppress the spread for two reasons. “We identify almost all cases by tests, up to the light, followed by isolation for the positive, and quarantine of their close contacts; then we moderate the social distance, with people working from home, closing schools, improving hygiene and making the whole world wear mask”.
As a recommendation to the mexican authorities, says that to build field hospitals to treat the cases would help to keep those patients from the hospitals normal.
But now, as I said the Spanish Hernandez, the return to normality in Hong Kong has led to a resurgence of cases. In mid-march, after almost two months of closure almost complete, the city returned to their daily lives. Since that time cases have multiplied, going from 149 on the 15th of march to more than 800 at the beginning of April.
Several of the experts questioned compare this coronavirus with the pandemic flu 1918 Spanish and ask to look in that mirror historic to see what impact it might have finally this pandemic.
This caused 25 to 50 million deaths throughout the world and lasted from January 1918 to December of 1920, with three waves of infection. When he finished, the life expectancy in the united States had dropped to 12 years.