2020 represented, without a doubt, the year when the Dominican health system underwent its greatest litmus test. The Covid-19 pandemic shouted to the wind each of its accumulated weaknesses for years, but it also went out to reduce strengths that will last, commitments, alliances, solidarity and integrity.
Since the beginning of the year, the system has been put to the test in its capacity to prepare and respond to the imminent arrival of an enemy, about which very little was known and for which the health sector was not adequately prepared.
This led him to stagger and put himself on the verge of collapse, in moments of greater stress, in the face of the overflow of the response capacity of diagnostic tests, the exhaustion of medical personnel and over-demand for hospital beds with occupancy that exceeded 100% in the main demarcations, with saturation of the Dr. Defilló National Laboratory and private laboratories whose appointments took days.
In the midst of the pandemic, the system had to face not only the attention and prevention of citizens, but also the effervescence of political campaigns, municipal, congressional and presidential elections, the transition process of transfer of command, and the change of authorities before the arrival on August 16 of a new Government, which implied changes of faces in the key axes of command.
The first case
The greatest nervousness among the population and decision makers occurred on March 1, with the diagnosis made public of the first imported case of Covid-19, the Italian Claudio Pascualini, who remained for 54 days admitted to the Ramón de Lara Military Hospital in the Dominican Air Force, the first center converted into a Covid hospital.
Subsequently, the controversial case of Mrs. Oraida Herrera Díaz, the Dominican resident in Italy, came to the country to her home in Villa Riva, Duarte province. Following her positive diagnosis, authorities initially accused her of escaping from the hospital, which she denied.
She was ordered to remain in home isolation, but when she did not respect it, she was later taken against her will to hospital isolation.
Then came community transmission, starting in five of the most populous provinces, and then spread throughout the country.
The first big outbreak
San Francisco de Macorís, the main municipality of the Duarte province, was the first major outbreak, with the collapse of the health system and dramatic narratives of deaths of people in their homes or on the streets without a response to medical attention.
That was the first demonstration the country had that this coronavirus was not a game. The province to date registers a cumulative 125 deaths.
The biggest peak
July was the month of greatest tension, almost reaching the collapse of the system, with occupancy of beds that exceeded 100% in districts such as Santo Domingo and Santiago. At the end of that month, the country registered an accumulated of 69,649 confirmed cases, 1,160 deaths and a positivity of 33.68%.
The hospitals
To avoid contagion and in view of the high demand for patients, the Public Health Network separated the care, dividing the health centers into Covid and non-Covid hospitals.
The private sector, which initially showed some resistance to receiving patients suspected of the virus, including cases of “rebounds”, was forced to set up rooms that in some centers were being expanded to reach 70% of their bed capacity.
Isolation centers were set up, which in the beginning were the cause of great conflicts and protests on the part of the communities that opposed the taking of infected people there.
Front line staff
While many disobeyed confinement orders and defied luck by exposing themselves to the virus (and still do), health personnel, including doctors, nurses, bioanalysts, among others, have waged a tireless battle against disease and death in the health centers.
Tired, exhausted, emotionally shocked, but steadfast, hospital servants have been on the front lines throughout the year fighting an enemy that still has many unknown answers. However, it should be noted that many outpatient medical services were closed and a large part of doctors stopped attending patients for fear of contagion. One of them adopted the teleconsultation modality, which is still in force today.
Disinformation and press conference
The pandemic found the country without a clear education or communication strategy for the population, without trained personnel, without special ambulances, without sufficient diagnostic and biosafety supplies, so that the acquisition, in the midst of a global demand, was not in progress. the same speed of local requirements.
This gave way to the emergence of a wave of rumors, false news and misinformation, and it was in this context that the Ministry of Public Health, led by then-Minister Rafael Sánchez Cárdenas, implemented the expected daily virtual press conference, where it gave information and answered questions.
Little was known about the virus and the treatments to be applied, so practically everything so far is experimental. Many of the drugs that began to be applied with the consent of the World Health Organization (WHO) were later removed from the treatment scheme.
Chronic diseases: a challenge
Life in the pandemic during these nine months brought deterioration in the health of patients with chronic conditions and mental health due to the fact that many patients stopped going to their routine check-ups, due to the fear of contagion, the call to stay at home and the protection of a large part of medical specialists. Patients with these and other added conditions began to return to health services in the last two months, but with their conditions aggravated, posing another challenge to the health system.
Mental health, already with weak care responses in the country, also worsened and specialists are currently treating part of its consequences.
Alliances and agreements
The Social Security system made alliances and agreements that covered Health Risk Administrators (ARS) and Health Service Providers (PSS) and issued resolutions guaranteeing coverage of diagnostic tests and medical care, which have been extended every month to not leave without medical protection workers who are still suspended from the companies.
National epidemic
In June, faced with difficulties in approving requests for extension of the National State of Emergency, the Ministry of Health announced the declaration of the State of National Epidemic due to the health crisis of the Covid-19 coronavirus, with the purpose of adopting extraordinary measures aimed at the control of the epidemic.
Public Health also issued resolutions aimed at the mandatory use of masks, among other measures, and established protocols, including the general care and treatment of Covid, to go to the polls during the election process, for companies, schools and the tourism sector among others.
This pandemic year left lessons and strengths for the health system, among them the strengthening of the services of the Intensive Care Units (ICU), whose lack of beds was a weakness carried over by years and greater awareness about hand washing and hygiene.
MEASURES
DATA
Little by little.
To date, 447 ICU beds and 385 ventilators are available just for patients with the virus, in addition to others installed for regular services.
Although imposed by resolution, a large part of the population became accustomed, little by little, to wearing a mask as protection, standing in lines at supermarkets and banks, walking around with soap and alcohol disinfectants, washing their hands more frequently and, for the first few months To maintain a real distance, which with the passage of time was lost, to the point that arrests are being recorded by crowds at clandestine parties.
THE ORIGIN
The deadly invading virus
An extended family.
Covid-19 is the most recently discovered infectious disease caused by the coronavirus. Both this new virus and the disease it causes were unknown before the outbreak broke out in Wuhan, China, in November 2019. Currently, Covid-19 is a pandemic that affects many countries around the world. Coronaviruses are an extensive family of viruses that can cause disease in both animals and humans.
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