Daniel Gollan he is unmoved when he receives criticism that portrays him as a spokesperson for the worst scenarios. They call him an alarmist. The harshest definition was expressed by Mauricio Macri’s former running mate in the elections. “It is the death doctor, who anticipates the collapse,” said Miguel Pichetto. The Minister of Health of the province of Buenos Aires answered him. It was as forceful as the former senator: “Pichetto knows absolutely nothing about medicine, he should speak less.”
In an interview with Infobae, the Buenosairean government official analyzed the situation that the conurbano lives with the coronavirus, the new stage of the quarantine, the possible vaccine and the non-compliance of the people. He emphasized a specific idea. Axel Kicillof government thinks of intermittent quarantine. Open and close according to the situation. Until the vaccine appears or, in a better scenario, until the contagion levels drop to a level where they can be controlled.
The quarantine lasted until August 16. The challenge is to lower the infections. If they will increase, Kicillof has already decided to harden the insulation. Once again.
Health, politics, coronavirus in a video conference talk.
“Minister, what is the situation today?” Finally they were able to reach an agreement with the government of the city of Buenos Aires.
– Yes, the last meeting was very good, as practically all the ones we had in this time of pandemic have been. We review the numbers and are in important tune about what the current reality is. We are convinced to continue to maintain all health strategies, considering AMBA as a single health jurisdiction.
“What analysis did they do?”
—We were analyzing numbers, perspectives, projections. I think we are in a very similar diagnosis of what is happening. We have agreed, as we have been doing so far, on the recommendations to find a common formula.
—What have you been seeing in the Buenos Aires government in recent weeks?
—We see that the best thing is not to continue enabling mobility that implies the possibility of contagion. Based on the numbers we have it was not convenient to increase circulation. That is what we discussed with the City. Also to follow closely the evolution of the occupation of beds, which is being very tense, especially in the private sector and in the big companies of prepaid medicine.
“How tense is the situation in that sector?”
—The situation is very tense regarding the occupation of intensive care beds and general intermediate care beds. You have to be very finite with the pencil day after day. There is a general consensus to respect and take into account that if the saturation of the system is put at risk, special measures must be taken with a margin of maneuver. This is what the Governor defined as intermittent quarantine.
It irritates that Macri travels abroad, it is a bad example
“That implies moving forward, slowing down, backing up.”
—As the President said, as the infectologists and specialists have said, we are far from solving the problem. We are, on the contrary, entering the eye of the storm. It is time to crown all that effort that has been made in all these months with the central objective of not saturating the system at any time.
– As of today, what is the capacity of the health system in terms of intensive care units?
—We have in the AMBA, on the Buenos Aires side, we have an average occupation of 61%. We have integrated private service providers and hospitals. An integrated dashboard. But that 61% is not homogeneous. In other words, it does not mean that in all hospitals I have almost 40% availability of beds. I have hospitals that are very crowded and others that have less people. That explains the average occupancy of close to 60%.
“And that happens at the AMBA?” That is, patients from one district who are admitted to another.
—I give an example. The PAMI patient absorption system was saturated in the City of Buenos Aires. Today in Esteban Echeverría there are 11 patients derived from the City. Obviously, you are looking for the solution of the bed where it is. Therefore you cannot think that one place is going to be overcome and then the other is not. If one is saturated, people start looking for their bed and end up occupying anyone in any area of the metropolitan area.
“Where’s the main concern?”
—The concern is because in the last 19 days we have seen an average growth in the demand for intensive care beds. An average of 10-11 per day. We have had a remarkable acceleration in these last four days, with two days of more than 30 new beds. That is where the alarm appears.
– To what do you attribute the acceleration in the rate of contagion in recent days, which has also generated greater occupancy in intensive care beds?
—To the acceleration that we are seeing of the confirmed cases and, therefore, of all those that cannot be confirmed because they are asymptomatic. We see that the numbers are growing a lot. A smaller percentage of that number, much less, needs an intensive care bed. I want to clarify one thing. From the measurements taken on July 1, the growth curve slowed down significantly. Not that it stopped growing. After the opening on July 16, the quarantine was quite relaxed. Today we are receiving the impact on the beds of that quarantine and what happened after July 16.
—I ask you two questions about this last stage. In these three weeks where it was decided to try to return to phase 1, did you see that there was an effective compliance similar to that of the last week of March? And the other: how can we explain that after three weeks of quarantine we have higher numbers today than we did a month ago?
“The matter is as follows. It had a quite significant impact and we can see it in the main districts of the first and second cordon of the conurbano. The curve lowered his acceleration quite a bit. It did not stop growing. The objective of lowering the curve was not achieved because the disease is still in full expansion. We always said that epidemiologically this disease radiated from the Autonomous City of Buenos Aires because it was the place where the highest concentration of cases that came from outside arrived. Then it dispersed throughout the province of Buenos Aires and other provinces of the country. But the highest concentration came from there and therefore it was expected that the highest concentration of cases would begin there.
Pichetto is a person who does not understand anything about health. I shouldn’t talk so much
—It expanded and then the cases multiply. And the quarantine?
–Hardening the quarantine is not what one would like, but it is not that one is actually going to make the disease stop. As we always said, we are modulating the growth rate so that the entire system does not block us. That’s what this quarantine adjustment did for. Obviously, it had nothing to do with the one of the first week, which was practically absolute, where the essentials moved exclusively. But even so, it allowed the growth rate to slow down.
– In the Buenosairean government they are conscious that the people are not fulfilling the quarantine as before?
-Yes, totally. One notices that there is relaxation in many activities that are allowed. But there are also many people who continue to gather. We said it clearly. A patient arrives at that meeting, perhaps an asymptomatic, and of 10 or 15, 4 or 5 patients leave. We ask people again, especially young people, who out there think that they have a low chance of having a bad time with this disease, to think about their direct affections, their family, their neighbors, their peers. work, that they do have these comorbidities, that they are of high age and that they do have a high risk.
—The point where it all ends is social consciousness. Which is what they usually ask from the Government.
We have to appeal to the question of social conscience. We insist. If at any time we see that the situation can get away from us and we will not be able to respond from the health system, which is at that moment where the number of deaths increases, if we see that moment come, we have to do a stand back and try to moderate the growth of the curve.
—During the week you announced that at this rate of contagion that we are experiencing, the health system may become saturated in the second half of August. If people now comply with this new quarantine, is the system guaranteed not to crash this month?
–Guarantees, with this virus, we have almost none. It is a virus that has, and the disease itself, so many angles still unknown to science, worldwide, that we have many variables that we do not manage. And it’s the worst thing that can happen to someone who plans: have few certainties. And there, what one calculates, which is an acceleration that is going to happen one way, occurs another. And what we plan according to the days of stay and the replacement of the therapy beds, the calculation that one makes, must be corrected after two or three days.
—It may be that the number of infections increases further and the plan of action changes again.
—At the rate of growth this week, let’s stay in our homes, let’s not add more activities. Then we will see very finely what happens. If it really goes off and the traffic light turns red with the therapy beds, we are in general agreement that this will have to be communicated very well to society so that it is understood that, out there, a new special effort will have to be made in a new stage.
“Are you concerned about compliance from now on?” We have been in quarantine for more than 130 days and you accepted that in the last time there was a relaxation.
-Yes. It always worries. Anyway, we We see that there is a large number of the population, I would say majority, that is doing very well. Not only those who stay at home, but those who go out to do jobs that are allowed. They comply with the distancing, in the use of chinstrap, soap, alcohol gel. There is a majority consciousness. The problem with this type of disease is that if 25% of people relax, they generate contacts and those who took care of themselves suffer the same consequences.
I am convinced that next year there is a vaccine for coronavirus, it will be a manageable disease
“Does that percentage concern you?”
—I am concerned with that percentage of people and I am concerned with some kind of strong discourse from people who deny this problem or others who, even knowing that it is a problem and that many people may die, say: “It doesn’t really matter that the that they have to die, as long as the economy does not fall ”. Those speeches are not good. The second quarter of the United States economy, a country with an absolute anti-quarantine president, fell 33%, the biggest drop in 1940. Clearly the economy falls due to the pandemic, not quarantine.
—He referred to the speeches that question the quarantine. Miguel Pichetto is one of those who expresses that idea. This week defined you as “Doctor Death, who anticipates collapse.”
—I know Pichetto. He is a person who does not understand anything about health. He understands absolutely nothing. You can comment like any other. With a common sense that, in my opinion, is macabre. He admires what countries like the United States or (Jair) Bolsonaro, or (Donald) Trump, do in terms of this global pandemic. They are different visions. We do not agree. As long as we can save lives, we are going to save them. Pichetto says: “Well, let the virus do what it has to do, let’s take care of the economy.” But we’re not even saying that. The economy falls due to the pandemic, not the quarantine. It seems that he does not want to understand it, it seems that he is in a speech that has more to do with some political interest.
—The opposition authorities that govern have a completely different attitude. We are working closely with the mayors of the opposition. We may have differences, but we are working well. They have responsibility and don’t want to carry a problem. I would tell Pichetto to read a little the code of ethics of the Auditor General of the Nation. I don’t think I should have to talk that much. It would have to be a little bit more neutral, impartial. He is in a public function that deserves it.
“Does it bother you that there is a sector of politics that accuses you of being an alarmist?”
“A few days ago with my vice minister Nicolás Kreplak we were remembering when he made an assertion saying if he would sign the quarantine to end in September. They criticized him. We would all sign. But the truth is that it is not. Even when the cases can start to drop, until the vaccine is available, what we are seeing all over the world are permanent outbreaks. So it will take a long time to go with that new normality.
“And about what they say about you, about your gaze?”
-It does not worry me. What I would be concerned about is not having done everything possible to prevent people from dying. That would be unforgivable to me. You make as much effort as you can. Everything. If later it did not reach, it will not be because we did not. That is my concern.
—Is the health system still not collapsing is a double-edged sword for quarantine enforcement? In other words, if people do not see that hospitals are collapsed, the idea that the pandemic did not hit so hard will continue to fly over society.
-What if. Axel Kicillof always makes this comment. That the success we have had in preventing this from happening, that these tremendous images happen in Argentina, sometimes becomes a double-edged sword, because there are people who say “well, in the end the beds are there” and that contributes a little for people to relax. It would be very sad, and it will never be our position, that by the rigor of seeing these images people learn. If that happens, then we have a month with the system saturated and with people who do not enter. It is not corrected overnight. And that is what we want to avoid.
“There is a question we all ask ourselves.” When will the vaccine be? This year? The next? What precision can you give?
—There are fifteen or more vaccines, which are already in clinical trial stages, out of more than a hundred that have begun to be developed worldwide. There are some that are very advanced, the one from Oxford with AstraZeneca, the one from Pfizer, the Cansino from China. There are several vaccines. One from Russia was announced on Wednesday and we don’t know it. I am convinced that next year there will be a vaccine for coronavirus. The coronavirus is not going to be the same next year as this. It is going to be a manageable disease in another way, because we are going to have the vaccine.
“That changes the picture.”
—I also bet on hyperimmune serum that we began these days to test in hospitals in the province of Buenos Aires, in clinical trials. That would lower the profile of seriously ill patients a lot and we could better manage therapy beds, which is what we are achieving but in a limited way. We are saving and improving lives with plasma. But it is limited. If we achieve hyperimmune serum, this can reach produce hundreds of thousands of treatments in a short period. We would also change the profile of the disease. Science is going to give us an answer. One more effort must be made.
The objective of lowering the curve was not achieved because the disease is still in full expansion
—And until then how do we live? How do we live until the vaccine appears? Are we going to live in an eternal quarantine? Are we going to live in a quarantine that is relaxed according to the circumstances?
—We are going through a stage, a global crisis, which is to be swimming underwater. We are not comfortable because we begin to feel that we are short of breath, so the idea is to get out, breathe. We breathe two weeks, three weeks. We can open businesses. We can improve some economic situations a little. Over there we go back to making an extra effort during a period. So on. Now we do not imagine a country, as it happens in the rest of the world, in which we can go back to classes, bowling alleys, soccer fields. There are sectors that are still going to be relegated for a time.
“What are you seeing happening in the rest of the world?”
—There is an observation with what happens in many cities, urban conglomerates, very large in the world. It is observed that at some point the curve begins to go down. It is not that the disease disappears. There are far fewer cases per day. Sometimes there are sprouts, but they do not reach the explosive magnitude of the first time. We are trying to understand why it happens. Scientifically there is still no explanation. But that would also give us perspective. If this is verified, there will not be the same number of cases in this period of the next month and a half, two months, as we would have later.
“What do you mean?”
—You have to hold on a little longer, try to preserve yourself and wait for the cases to drop. Then we can enable more activities. We will have to take great care of the cities of the interior of the province and the country that have not yet had cases, or that had very few. It is a virus that in a month and a half, two months, came out of China and was worldwide. It has a phenomenal capacity for expansion.
“Then the logic would be to try to flatten the curve, then start living with the virus and, based on what happens every week or fortnight, open or close the quarantine.” It would be like this?
—It is the logic of intermittent quarantine. Loosen a little, see how it goes, close a little if necessary. We have a lot of municipalities in the province where that is not necessary. They are all with much more standardized activities. The measure that is needed one closes, but then releases, releases as far as possible. If we see that the system is not going to saturate us, we take another clean jerk again. Modulate the curve with inputs and outputs. Already. There is boredom. It’s not easy being locked up that long. But it is better to do this out of conscience and not to do it because we see those terrible images. We want to avoid these images for Argentina, because that does not go away after the retina or the memory of the people.
—I ask you two basic questions that are often asked by many people. Does the virus change anything when the temperature rises? Can the virus weaken over time once it is circulating?
—What this virus has shown is that the temperature, which many of us initially thought that if it behaved the same as others would affect it, did not affect it too much. Because in Florida or Manaus, in cities that are really hot, he behaved in an aggressive way. Experts say that viruses of this type, in general, tend to have an increased behavior of cases during winter periods and a decrease after the peak. After a certain number of cases, there tends to be a decrease.
“There is no concrete scientific explanation then.
“It isn’t very explained.” One of the explanations is because people are more outdoors, they are less closed, something that although it influences, we see that this virus has a contagion capacity that on a beach, if we are very crowded, we also get it. There are no hard explanations. And that is another problem we have. We read dozens of publications in scientific journals and world publications. One week one thing is said and the other is questioned or the opposite is said. This uncertainty is very difficult for those who have to plan.
–Former President Mauricio Macri traveled to France with his family. He had already traveled to Paraguay to have a meeting with the former president of that country. What is your reflection on this last trip? Taking into account that we are going through a period of strict quarantine and that Macri has a preponderant role in Argentine politics.
—I give you a reflection from the health point of view. For me it is a bad example. I said it when he went to Paraguay back and forth. If all Argentines are banned from doing a lot of things, who are representative figures at the national, even international level, it is not a good example to say: “I’m leaving, I’ll be back.” The truth is that it irritates a little. People who have been presidents or have been in important institutional positions have more responsibility. Personally, it irritates. It is a very bad example.
I kept reading
Mauricio Macri arrived in France: “Here you live in freedom and with responsibility”
Are we all going to get coronavirus? The reflections of an expert from Yale University