With the sixth wave entering its final phase but still with the coronavirus leaving deaths on the table, the Government has already opened the doors to end the pandemic, albeit technically. The withdrawal of indoor masks is getting closer every day and there is already a plan to “flu” covid.
They are the steps prior to a return to normality in which nothing is going to be the same as before, something that for experts in Preventive Medicine and Public Health does not necessarily have to be bad. At least they hope that many habits and prevention measures adopted in these two years (as well as new ways of working) will remain or, at least, have penetrated sufficiently. These are some of the issues that Public Health experts such as the professor at the UMH in Elx, Ildefonso Hernández, or the epidemiologist and researcher at Fisabio, Salvador Peiró, would include in their particular letter to the Magi “for the post-pandemic era”.
The normalization of its use when someone has any respiratory infection (as Asian citizens have already been doing) would be one of the great post-pandemic improvements. “It will not make sense for someone to cough into a health center now. It should be part of the prescription package for doctors in patients with respiratory infections with symptoms”, Peiró points out. “I think that the population has integrated this quite well, putting on the mask if they have symptoms and doing it on their own because they already know that even if it is a mild condition for them, it can harm others,” says Hernández, who bets that citizens will apply common sense.
It is not that people did not wash their hands frequently before, but the paranoia of contagion of the coronavirus through contact (which is now known to have a limited role) has made many people aware of the number of germs that accumulate when day in hands “The WHO recognized it as one of the most direct ways to save lives,” recalls Professor Ildefonso Hernández.
“In respiratory diseases, contagion by hands plays a discreet role but is very important in other infections or in health settings. You have to maintain proper hand hygiene but you don’t have to fall into germophobia, “adds Peiró, also warning of the dangers of abusing hydroalcoholic gel.
For the Fisabio researcher, Salvador Peiró, it is going to be one of the great changes after the pandemic, perhaps not the fastest, but “work should be done on a new regulation of CO2 maximums and make changes in the air equipment to guarantee a sufficient renovation in sanitary spaces, but also schools, discos, cinemas, theaters and other institutions”, he points out. As happened with legionella and the change in the legislation on cooling towers, SARS-CoV-2 “should mark a before and after in monitoring the biological quality of air in indoor spaces and CO2.” As long as ventilation equipment and HEPA biological filters are improved, the adopted custom of “ventilating spaces” should be maintained.
A point on which all preventivists agree and on which the Government has already started to work: improve and give more care (in human resources and economic investment) to epidemiological surveillance systems. “They are fine, but it is time to take the leap and make them more efficient, fast and agile, also integrating information on social conditions, for example,” explains Hernández. For Peiró it is also essential that the two years of the pandemic serve to improve this instrument “by integrating several systems at the same time, such as laboratories or sentinel systems without forgetting sequencing and also maintaining the information that wastewater has been giving us and that they gave us clues two weeks before,” he explains.
Both agree that now is the time to strengthen these systems “for whatever may come.”
Within the chapter on lessons learned and at the same level as the improvement of surveillance systems, the epidemiologist Salvador Peiró points out that it would be appropriate to have “a certain stock of equipment” ready, after having learned the hard way how hard it is to obtain material when markets have crashed. “It would be nice to have intermediate warehouses with material and our own logistics to gradually replenish and that do not expire and also, although it is more difficult, a national or European production capacity. Do not depend so much on China.
Along with the investment in Public Health, the experts do not forget the holes in Primary Care that the pandemic has exposed and the need to cover them, with money and human resources. “The fracture line in Primary Care has been very evident,” summarizes Peiró. The collapse of health centers has left a mark on chronic care, for example, still to be evaluated. The two agree that a good way to “invest” in the Primary will also be to adopt “ways of working and things that have worked” in the pandemic, according to Hernández, such as telemedicine or “coordination with residences.”
Beyond the purely epidemiological or healthcare issue, the Professor of Preventive Medicine Ildefonso Hernández adds to his particular letter to the Three Kings other issues that are just as important for him to maintain, for example, that there is a technical and authorized voice to transfer messages in pandemic. “Having an authoritative voice communicating is something that works well, also someone who is not the political decision maker but a scientific voice that responds to public health issues,” especially in times of “fake news and hoaxes,” he points out.
Finally, and among these parallel issues to the purely health ones, Hernández adds one last one: «Maintain and defend the collective heritage that the public health system supposes». For the professor of Public Health, achieving the levels of vaccination that have been reached has been thanks to “many years of work and the trust of the people. We need to take care of the Valencian health system. It has flaws but it is a heritage to maintain. In this sense, Hernández advocates maintaining the social protection cushion deployed by the government beyond the critical moment of the pandemic. “It is good that policies are maintained over time so that no one is left behind.”
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