Aurora Bueno Professor of Public Health On Second Confinement

201023.- Foto: Fermin Rodriguez. Aurora Bueno, Catedrática de Salud Pública de la Univesidad de Granada

The near horizon drawn by Aurora Bueno Villanueva del Arzobispo Jaén 1960 professor of preventive medicine and public health at the University of Granada is dark

With a slow and didactic tone he explains that he sees politicians who report on the pandemic burned and criticizes their lack of foresight and reforms to stop the second wave

He lives in a city with an exorbitant cumulative incidence on the verge of 1000 cases per 100000 inhabitants which will soon have a curfew if the judges authorize it and from tomorrow it will be confined to the perimeter

Question How do you observe the advance of the coronavirus

Answer It was seen to come but the figures are out of control at all levels which means that hospitals are close to saturation

Primary care is absolutely collapsed The same is happening across Europe so our government cannot be blamed exclusively The president has asked citizens for social responsibility but they are tired they have lost trust in the health authorities that is very important

We are heading for a second confinement it seems that there are no other alternatives but to absolutely limit the mobility of people

Since the confinement ended until now no reform has been made in the health system or steps have been taken to stop a second wave which was totally predictable Not at the hospital level much less in primary care Even so we are much better than in March because we have more diagnostic tools more therapeutic resources and we no longer play blindfolded But prevention continues to fail.

R The figures are very high and hospital resources are saturated The excess mortality and the contagion rate are increasing again there will be no other alternative But everyone who has made forecasts has been wrong due to the unpredictable behavior of the disease It takes the individual collaboration of each and everyone and that requires trust and people no longer trust

Q If in Spain the average cumulative incidence is 348 cases per 100000 inhabitants How do you rate the situation in Granada with 976 cases which almost triples that number and continues to rise

R The situation in Granada is high risk without a doubt But also that of the Basque Country Navarra a large part of Castilla y León Measurements must be taken from 5060 per 100000 inhabitants There has been a very great relaxation throughout the summer We go with a mask but as soon as we can we sit down to take it off

We are asking the population impossible because any person who has been a risk contact is asked to confine himself but the man who has to carry a carriage to eat is silent Between a future risk and an immediate one anyone chooses the future risk

The man who works in a cafeteria and tests positive when he communicates it to his boss he asks him to say that he was on vacation because if he does not close the establishment

Q What can be the alternative

R Either a social support is given along with the health recommendations or we adjust these as much as possible We are asking the population to be more responsible than our politicians and that does not work

Q Is the curfew effective which slightly affects mobility

A The effectiveness of each measure depends on when it is taken Last month we assumed that the increase in infections was due to youth mobility due to their difficulties in maintaining social isolation

There the curfew made a lot of sense because you limited this leisure related to alcohol and private parties but at this moment we have the contagion throughout the community we do not know where the source comes from in the bakery at 1200 you have the same risk of infect you that in a bar at midnight

If everyone is cautious limits their mobility and stays at home except for what is essential there is some possibility of controlling it But we are 47 million people each with their own ideology and many people think that it is best to get infected as soon as possible because that way problems are eliminated Its complicated The ideal would be not to resort to coercive measures but at this time all measures are late

Q Is the governments objective of reducing the incidence to 25 cases per 100000 inhabitants utopian

R We have been below that figure in summer of course it is possible But I dont see it right away We are with very high rates of contagion without health and social resources to isolate cases and contacts

Q What score do you give the Government and the Board in their management of the pandemic

R Governments have done what they could Making decisions in a scenario of uncertainty is always difficult I do not criticize the governments management because I cannot think that I would have done better

My fundamental criticism is that they are burned out they have lost the trust of the people they have given contradictory messages on many occasions so it is necessary to change the faces that give information to the public

Hospital care was reinforced when necessary and that is to be applauded but the response in primary care or in public health has not been strengthened to prevent the second wave from catching us as unprepared as the first

Hospitals are reaching a very important saturation level and other interventions are now being canceled a decision that should have been taken two weeks ago The health professionals are absolutely exhausted they have not had time to recover and we are already asking them to become heroes again

P What has weighed more so that the management of the second wave has been deficient

R I do not know it is very difficult for the political class to put the health of the population before other interests Health is not an imperative need you assume that you will always have it They have considered the problem solved and have not thought that it could return and that it would have to be reinforced there were other priorities

Nor have economic reforms been addressed bearing in mind that the world situation makes it very unlikely that Spain will be able to continue living off tourism in the next five or 10 years The reform of the service sector and the search for other production mechanisms must be a priority

As soon as it was seen that there were black spots in leisure consumption measures had to be taken and a sensible one for this Government which likes to raise taxes so much would be to put a very high rate of social responsibility on alcoholic beverages

Health reform and work on prevention which requires research in vaccines is also essential The vaccine will be the best solution but it has to be effective and very safe because when it is given massively as it has a medium rate of adverse effects it will create a lot of rejection it is to feed the antivaccines

But meanwhile we must put the means so that people respect the prevention instructions and at the same time be able to earn a living and that is very complicated

Q What did you think of the closure of the campus in Granada with the bars open

R A nonsense An unnecessary and unwise measure for not taking into account the adverse aspects Closing classrooms means closing safe places but above all freeing the young sector from any obligation

And we encourage dispersion since they should not go to bed early and can consume that nightlife with greater tranquility When these students return to their families they come into contact with older people

Q What effect does closing the parks have

R It is one of the measures that I have not understood at any time We close the parks and let the children out and then we complain that they are all grouped in the same space Open spaces have to be accessible to everyone they have to be made easier because the risk of transmission is much lower

In Spain we have many hours of sun which is a very important natural disinfection element I prefer children to be touching nondisinfecting surfaces and washing their hands than being in an enclosed space

P The political class asks citizens for responsibility and selfcare but the message of prevention has not penetrated Has little time been invested in educating and raising awareness

A Probably especially when not all messages have been consistent A common mistake is to think that the messages are understood by the entire population in general awareness campaigns have an unequal effect on the different cultural levels of the population

It is necessary to look for a coherent line without fluctuations And when there are changes in trends you have to be humble and not play dumb you have to recognize that you are wrong and identify where you are failing

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