Doctor and socialist deputy in the Madrid Assembly, José Manuel Freire (Orense, April 28, 1949) never imagined that, in the 21st century, an epidemic could quarantine an entire country, completely paralyzing social and economic life . His generation, he confesses, has never known anything like it. Health Spokesperson since 2011, you think the worst is over of the crisis and he thinks that if, as a society, “we do it collectively well”, we will be able to live with the coronavirus until there is a vaccine or it stops circulating as a threat for public health. Admit, yes, that a new rebound “It is very worrying”.
Professor emeritus of the Department of Health of the National School of Health (ENS) of the Carlos III Health Institute, José Manuel Freire believes that the Government of Spain is managing a “very complex” crisis “well” and points out, in an interview with Vozpópuli, that, as a citizen, “deeply sorry” that for the PP leader, Pablo Casado, this “so devastating” crisis is only a “magnificent opportunity to weaken the rival party.”
About Madrid, the epicenter of the covid-19 crisis in Spain, clarifies that it is good to distinguish health management from the crisis and the political management “very personally” led by President Isabel Díaz Ayuso, who she accuses of using partisanly her institutional position to attack the government.
The attitude of the PSOE towards the regional government in the Assembly has been, he stresses, “of loyal institutional collaboration”, which, in his opinion, “is what it touches in such a crisis.” The socialist deputy assures that Madrid was not ready to go to Phase 1 this Monday, May 18, considers that the reinforcement of personnel in Primary care It is insufficient and it is necessary to do more PCR tests on suspected cases.
How have you lived in recent months and what feelings does the health crisis produce for you?
Fortunately I am very well; if I have passed the covid-19, it has been asymptomatic. I have lived this time confined as any citizen because, although I volunteered through the College of Physicians, after a first call from the Madrid Health Service, they did not call me again. So I have lived the acute phase of the crisis very connected and active, but with a feeling of helplessness for not being able to help directly in anything; also with a feeling of bewilderment and alarm seeing how a new virus threatens everything that seemed so solid and safe in our developed world.
As a doctor, did you ever imagine facing such a situation?
Impossible to imagine that in the 21st century, and in Spain, an epidemic could quarantine the entire country, completely paralyzing social and economic life, with all hospitals overflowing with patients as has happened in Madrid. No, I never thought that this could happen here. And I reproach myself for not having seen the signs that this was possible before, being aware of what was happening in China. My generation has never known anything like it here, although in the poorest countries on earth, situations of total catastrophe due to natural or sanitary crises are not uncommon.
Managing this crisis was and is being, very difficult; with objective criteria and comparing with other countries, there is little doubt that the management of the Spanish Government is being reasonably good
When do you think we are now? Are you worried about a new rebound?
I think that we have passed the worst of the crisis and we are going to a situation in which, if we do it collectively well (and this is a very complex and not easy conditional), we will be able to live with the virus without collapsing the health system and avoiding deaths, until we have a vaccine or the virus stops circulating as a threat to public health. Of course, a new rebound is very worrying. For this reason, it is necessary to be prudent, it is vital to have a good public health surveillance system and provide the necessary resources to the Primary Care health centers, which reach all corners of Spain, to promptly diagnose new cases by PCR all suspects, tracking their contacts and ensuring their isolation if they test positive.
How do you assess the management that is being done by the Government of the health crisis?
The Government of Spain is managing a very complex crisis, unprecedented with which to orient itself. And not only in health, also in the social and economic dimension, so important. Managing this crisis was, and is being, very difficult; with objective criteria and comparing with other countries, there is little doubt that the management of the Spanish Government is being reasonably good. It is comforting to know that we are a serious country, with a government that is more than correct in such difficult circumstances.
I personally have many reasons to criticize multiple aspects of the management carried out (in Madrid), but as a doctor I am clear that the surgeon is not shouted at during the surgical intervention “
Do you think the opposition has lived up to the circumstances? Has there been that political union that you appealed to when the pandemic started?
As a citizen, I deeply regret that for the PP’s national leader, this devastating crisis is only a magnificent opportunity to weaken the rival party, so sectarian and irresponsible shooting against the Government in a situation of national emergency. It is unpatriotic without palliation, and terribly erosive for social cohesion, so necessary to face this great collective threat. Our attitude towards the Government of Madrid in the Madrid Assembly has been very different, of loyal institutional collaboration, which is what it touches in such a crisis. Personally, as a socialist Health spokesperson, I have always told my counselor directly and privately about my criticisms and suggestions regarding the health management of the pandemic. I have not fought a political battle against their decisions, however mistaken they may seem to me. It is also what the Minister of Health does, despite the harsh attacks he receives from the PP. I think it is right and responsible. When everything happens it will be time to analyze and ask for accounts. I trust that citizens will know how to value which politicians we were to contribute and who just to confront.
Regarding Madrid. What opinion deserves the management of the regional government?
In Madrid it is good to distinguish health management from the crisis and political management very personally carried out by the president. It is the epicenter of the covid-19 crisis in Spain. Where there has been a total collapse of hospitals, where more health workers have been infected, where there have been more deaths, where more elderly people have died in residences. Regarding the health management of the crisis, we have had an attitude of loyalty and institutional collaboration. Personally, I have many reasons to criticize multiple aspects of the management carried out, but as a doctor, I am clear that the surgeon is not shouted during the surgical intervention. And I have not. The time will come for judgment and accountability. In fact, for this we have asked for a monographic plenary session, which has been rejected for the moment by the majority of the Assembly Table, made up of PP, Citizens and Vox.
After the acute phase, institutional loyalty also obliges to raise the alarm to see that the government of the Community of Madrid asked, I think irresponsibly, to move to Phase 1 by May 11, without taking into account the required guarantees . The worst of the crisis management by the Government of the Community of Madrid is being the partisan and sectarian use, which the President makes of her institutional position, to attack the Government. In fact, she acts as a battering ram of the PP’s national strategy and not as the president of all Madrid residents, whose responsibility is to solve extremely serious problems, which require institutional cooperation between the central government and that of the autonomous communities.
Madrid has been on the verge of Primary Care for years: it is the Community with the fewest doctors and nurses per inhabitant in Spain “
So, do you subscribe that the community is not ready to change Phase?
No, it was not for Monday, May 11 and it still is not for this Monday, May 18. It was a great irresponsibility to request Phase 1 for day 11. As it has been demonstrated, criteria were not met for that day, as confirmed by the Government itself throughout this week (for the past), because the personnel contract announcements for Primary Care and Public Health (critical issue) are after that date, approved at the Sector Table on Wednesday, May 13. So much so, that in the Assembly I asked the counselor how he did not realize that the more he insisted on what he was doing this past week and what he was going to do, the clearer he left what he had not done before, what was to be done, being therefore irresponsible to ask to go to Phase 1 by Monday 11 without the duties done.
This week (for the past), the preparation of health in Madrid has improved, as recognized by the report of the Ministry of Public Health DG. But not enough in vital aspects of Public Health and Primary Care to guarantee control of the epidemic. No; Madrid is also not ready to move to Phase 1 this Monday, May 18. Fortunately, the Ministry of Health has made a prudent decision for the health of Madrid residents and also our economy. This decision for any health expert should be peaceful and shared, but the Madrid government is installed in the party confrontation with the central government as the “leitmotif” of all its political action.
Is there sufficient reinforcement in Primary Care for this phase change?
Welcome are the 648 new contracts for Primary Care announced by the Counselor. But they are not working yet and, by the way, they are almost 100 fewer than the staff that Valencia is going to hire, Madrid having a much larger population. Madrid has been on the verge of Primary Care for years: it is the Community with the fewest doctors and nurses per inhabitant in Spain. The increase in personnel announced by the counselor for Primary Care is insufficient to meet the needs of the epidemic in Phase 1 of the pandemic and, by no means, covers the historical deficit of personnel in health centers.
About the PCR tests: in the plenary session on Thursday the 14th, I asked the counselor directly, if he could guarantee to his colleagues in government and to the public, that Health was in a position to perform PCR on all suspicious patients treated in Primary Care (more than 9,000 the last week); the counselor could not answer yes. Last Saturday, at a press conference, he said that 6,600 PCRs had been carried out that week in Primary Care; We have improved, but we are still far from being able to make the 9,000 suspected cases that occurred the previous week.
What weaknesses and strengths does the Madrid health system have?
The health of Madrid is very good in the difficult and complex, which fortunately affects very few patients. However, it is deficient in the least specialized but very frequent that affects hundreds of thousands of patients every day, where there are significant delays in receiving care, and where facilities often leave much to be desired. Madrid, which is the richest Community in Spain, under-finances its health (it is the second autonomous community with the least expense / person / year); the difference with the average expenditure per person in Spain is more than 1,000 million euros per year. Almost the expense of all Madrid Primary Care. This lack of resources has de-capitalized hospitals, maintains unsanitary conditions in various health centers, and leads to delays in accessing services. All this pushes the wealthy middle classes to hire private insurance, so that the biggest criticism that can be made of the PP governments in the Community of Madrid is that they have expelled from public health, whose management they are responsible, to more than 30% of the population. And this is very serious as it is very negative for the quality of public health, since it deprives it of its most demanding patients and with the greatest ability to influence that it is well managed and well endowed with resources.
Disagreeing with the decision (to open Ifema) does not prevent me from acknowledging the organizational success of setting it up so quickly, and the generous work of the restrooms, and non-restrooms, who have participated in this effort “
How did you assess the opening of the Ifema field hospital?
The Community Government wants the Ifema hospital to be at the center of its account of the crisis, and to be the most positive image of it remaining on the retina of public opinion. They have made him an icon of political-partisan marketing, calling him on occasion and without it ‘miracle hospital’, ignoring what happened in the other hospitals. So much exhibition, official visits and politics reinforces the hypothesis that the idea of the Ifema hospital has responded more to a political marketing objective, than to a technical analysis of health needs.
Would it not have been faster, more effective, and with less opportunity costs, to build field hospitals or expand beds in the vicinity of the hospitals that needed them urgently, as was the case with the hospital in Alcalá, Leganés and many others? Had this option been chosen, the patients in these facilities would have been attended by hospital staff and more than 1,000 professionals would not have been deprived of primary care, when they were most needed. Nor would staff have been subtracted from hospitals that were at the limit. These are the opportunity costs that I am referring to.
In any case, out of institutional loyalty, when in the midst of the crisis I learned of the idea of raising the hospital, I did not criticize it in public. I only told the counselor in writing in private. Even days later I sent him two folios with suggestions for improving the organization and management that a group of young doctors who worked there had passed on to me. That said, disagreeing with the decision does not prevent me from acknowledging the organizational success of assembling it so quickly, and the generous work of the clinicians, and non-clinicians, who have participated in this effort.
Things cannot continue the same after what has been lived in the residences; the pandemic experience has to change this forever “
What did you think of the start-up of sanitized hotels? And what do you think of the controversy over the reverse award to the chain ‘Room Mate’ where the ‘popular’ president is staying?
I have a positive assessment of the medicalization of hotels, an initiative used in several countries; I think it is a good idea to guarantee the isolation of some patients, and to decongest hospitals for less serious patients, who cannot return to their homes. Another issue is that of the hotel where the president is housed: it is a confusing, contradictory matter and very much in need of explanations in the Assembly and before public opinion. The government must clearly separate the public and the private, without mixing it up. It would have been perfectly understandable for the president to officially hire, not as an individual, a place appropriate to her institutional rank to confine herself knowing that she would have to hold office from there. It is not acceptable to accept as an individual a favorable treatment of a company with which your Government has agreements and contracts.
What do you think of the drama lived in the nursing homes?
What happened in nursing homes throughout Spain during the acute phase of the pandemic is very terrible, due to the large number of deaths and the circumstances in which they have taken place. The most serious situation also in this has occurred in the Community of Madrid with nearly 6,000 deaths. Although what is totally unacceptable because it is inhuman is that instructions have been given in Madrid not to transfer patients from residences to hospitals. He will have to investigate it and ask for responsibilities. Furthermore, the crisis has exposed in a stark way the bad situation of many nursing homes in the Community, a situation denounced countless times in the Assembly by the comrades of the Socialist Parliamentary Group responsible for social services. Things cannot continue the same after what has been lived in the residences; the experience of the pandemic must change this forever; on the one hand, favoring aging at home for those who want it, with good social services and home health care, and on the other hand, thoroughly reforming the current nursing home system.
What do you think of the new hospital for infectious diseases announced by President Ayuso for next fall?
It is obvious that we are dealing with an occurrence of Mrs. Ayuso advised more by her media advisers than health, if she has any. I wonder if there is a report that supports this announcement from a technical-health point of view. I have requested a copy in the Assembly and I have registered a question in plenary session on this matter. In short, with the background of previous Madrid governments, I am very alert that Ayuso says that he even has the plot in mind when there is no record that any decision has been formally taken.
One of the biggest complaints from the toilets has been the lack of protective equipment to face the pandemic. Could it have been avoided?
The lack and insufficiency of PPE material (personal protective equipment) has undoubtedly been the most negative aspect of health crisis management. It has led to the contagion of many, too many, restrooms and staff from residences and other public services. It has been sad to see political leaders, such as the president of the Community of Madrid who, instead of cooperating, has dedicated herself to attributing this disgrace exclusively to the Government in a tricky media campaign, hiding that health is the autonomous competence and includes the purchase and storage of all kinds of sanitary supplies. In short, it is not a consolation, but the lack of PPE has happened in almost all countries, and shows that we were not prepared for a pandemic like this. What has happened will force us to manufacture this material in Spain, to have strategic warehouses. These are part of the changes we must make after the pandemic.
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