The Care Up
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He says he will bet on restoring the trust of Minister of Health, in a strategy that will relieve primary care with powers such as the delivery of medical licenses by Covid-19 and the management of medical residences. How long will the MR quarantine last? At least throughout June, says the Minister Health, who, in addition, opens to advance the curfew and predicts that the methodological change to the death count would add about 600 cases.
Around 4:00 p.m. Friday his phone rang. It was President Piñera. And not to consult him, as other times, on health issues, but to offer to command the Health portfolio. “I said to him: ‘But what does Jaime Mañalich think’, and he replied: ‘He agrees. He just proposed that you be his follower. ‘ So I said yes.
The ceremony was scheduled for today, but the national agreement hastened things. Thus, the toxicologist and twice president of the Medical College debuted yesterday, in a new style: a semicircle with the three representatives, seated and accompanied by two new faces: the head of Epidemiology of the Minsal, Rafael Araos, and the president of the Society of Intensive Medicine, Tomás Regueira.
Paris proposed both names AND more new faces will come. The communicational design includes a daily rotation of representatives of civil society. This, as the first measure of a plan in development to reduce the cases of coronavirus that, according to the new authority, would prolong the quarantine in Santiago for at least this month and will keep classes suspended until August.
In this critical health situation, why did you accept the position?
-Because I think it is a very beautiful, very important challenge. For any doctor and healthcare staff, becoming a minister Health is the culmination of a career.
Do you have the skills?
-I’ve covered practically the entire system. I started in a small hospital, in Achao, with just 30 beds. I went to Calvo Mackenna, I did my scholarship and I went to Belgium. I returned to the Catholic, I was chief of service at the Sótero del Río Hospital, intensive, and after Catholic pediatrics, for many years.
Its style is different from the ex-minister Health Mañalich. Is it what is needed right now?
-Each one has his style and each one has its lights and its shadows. Maybe I have some shadows too, but by the time Chile lived, Jaime Mañalich did very well. And perhaps it was also time for the minister Health to rest.
Now at Minsal, have you managed to identify the weaknesses and strengths of managing the pandemic?
– I think that we are very good in the subject of examinations, although it is necessary to continue increasing. Chile has made almost 70 thousand per million inhabitants. But you need to improve traceability and insulation. It is also necessary to speed up the delivery of the exams, they cannot take that long. Primary care has done well and we must help them to have the necessary elements to continue working as before.
And how will you do that?
-We are doing a job, and the same ministry has a program, similar to that of clinics, to take the exam over the phone and not have to go to the laboratory. We must insist that when the diagnosis is made, the notification is made. I also want to reinforce the IRA rooms (Acute Respiratory Infections of the doctor’s office), where the kinesiologists managed all the children and adults with respiratory failure. At the office level, we can do a lot to prevent the patient from aggravating.
The offices will have a greater role, so …
-It is necessary to find the patient who has the positive test and isolate him. Healthcare residences are not fully occupied, there are people who cannot stay at home and cannot quarantine well. They have to go to the sanitary residence.
This referral is currently made by the Seremi de Salud …
– We are going to try that it is mixed, and that the doctor’s offices can give medical license. But that cannot be promised overnight. I hope that this week we can give this sign, that’s why I have a meeting with Fonasa.
Why do the infections continue?
-The amount of permits requested is gigantic. If people continue to go outside without a justified reason, the virus will continue to spread. Positivity has increased tremendously. More than 40% of the tests are coming out positive. In order to control the disease, the ideal is for it to be 5%.
We are very far from that …
-You have to make people understand that. A sick person infects 2.8 people. And the hyper-contaminants, almost 70 people. Leaving is a huge danger. And going out without protection, or going out in quarantine, is a huge danger to others.
Did you imagine this scenario?
-I figured people were going to be more careful. Maybe we couldn’t convey that idea well. The virus has spread and changed its economic situation. He left for the upper neighborhood, where there is more distance, more space in the houses, people transport themselves by car. It is another world, other social determinants that influence.
You were also surprised by that reality, like the ex-minister Health?
-No. I spoke from the beginning of the social determinants, because I opposed the total quarantine of the beginning, without being prepared. I said, if they call a total quarantine without baskets, without financial support, what happened, what is happening, will happen. It was evident if the virus went down to overcrowded areas, where people have to go out and earn their daily bread. Those people cannot stop working. So when the virus got to those places, there was obviously going to be much more spread.
What to do now, then?
-We must insist on the support given by the media. We are going to try to make short messages in this regard and reinforce the communication plan for the population. Not to cause fear, but to raise awareness of the importance of physical isolation, the use of masks, and hand washing. We have to control more the exit permits, the quarantines, the curfew.
Are they going to limit or prohibit?
-Prohibit no, we will try to find a formula. I always think it’s better to convince first, do it for the reason, and see if that works. There is an idiosyncratic thing about the population, and it also has to do with the economic capacity of families. If the father of the family has no salary, no money, he has to go out to work. So economic measures are needed. That is why I am so glad that an agreement has been reached. It is a good sign for people, the distribution of food boxes has also been well evaluated by the population.
Would it advance the curfew?
-The Minister Health of the Interior must see it, together with Order and Security, but it can be a good measure too, as long as it is carried out because the streets of all of Santiago cannot be controlled either. People have to be aware of first.
You were critical of the style?
– In some things yes, and the President knows it. If a measure does not seem right to me, I will tell you. In that sense I have been sincere. I criticized the call to the new normality, the safe return too, we were at the social table and we were hardly asked.
Do you support the latest methodological change?
-The methodology is used in many developed countries in Europe, where the death certificate of the civil registry is crossed with the positive PCR. Now, thanks to the work of the DEIS (Minsal statistics department) we are going to incorporate patients with negative or doubtful CRP who have a coincident respiratory picture or, so to speak, clinically compatible with coronavirus. That is not going to be before next weekend and that report is going to be done only once a week.
Within hours of taking office, what are you afraid of? What worries you?
-I am concerned that we will not be able to obtain the results that we should: lower the rate of infections, decrease the number of patients that arrive at the hospital, try to contain that sooner, do more prehospital management. We are thinking of establishing a controlled home hospitalization system and reinforcing primary care. And I don’t want people to feel disappointed, I want them to feel supported, and that has been achieved in the communes where the quarantine has been successful. In Temuco they said they had regained confidence in the public system, I want that. I am afraid that people will lose confidence in the health system.
Did the social outbreak influence?
-I get the impression that some people had continued in the “protest mode”, and the “protest mode” does not contribute to containing the spread of the virus, so we have to be aware that at this moment, all the existing differences, especially social and economic, have been exploited more by the coronavirus. We have to work in peace, harmony and unity, and then see who did things wrong or right. And if you have to criticize at that time, let’s criticize, there are the Comptroller and the legal procedures to do the control.
You. appears as someone further removed from the nucleus of government, could you help with that?
-I want to call for dialogue, not from the political point of view, but with all scientific societies, study centres, patient groups. I want to target or focus my efforts on that group. The political side will have to focus its efforts on reaching agreements with the opposition.
How much longer could the MRI be quarantined?
-We are at June 14. All June remains. In June the worst comes, I think. Or very bad. The first 15 days of July I think we are going to keep high figures. I think that only in August, if God wants, we will see the efforts of the quarantine rewarded, if the people comply with them.
