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Covid19 “You criticize but without proposing meaningfull alternative”. Not true for me.

Juan Gervás

Covid19 “You criticize but without proposing meaningfull alternative” or #Covid19 “It is very easy to predict the past”

This is not true in my case

You can follow my activity in Twitter, Facebook and Linkedin with #coronavirus #covid19 from the middle of January with many, many “alternatives”

In Spain, as in Italy, hospitals are probably the main source of contamination
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2764369

In both countries health professionals fall to Covid19 because no protection PPE, even now, more than two months after de first case

Both countries share the same “measures” and the same disaster, there is an “association” (not, of course, casualty…)

Everything is just a “theatre of safety”, as wearing mask now and before controls in airport and cutting travels (did you notice it?)

I have publish a summary of “what no to do” last 25th January

Coronavirus from Wuhan (China). Covid-19. What you need to know to avoid a panic epidemic (January 25)
https://www.actasanitaria.com/coronavirus-from-wuhan-china-2019-ncov-what-you-need-to-know-to-avoid-a-panic-epidemic/

I have published a summary pf “what to do” (March 14th)

Fighting coronavirus (Covid-19) pandemic. First, do not harm (March 14)
https://www.actasanitaria.com/fighting-coronavirus-covid-19-pandemic-first-do-not-harm/

In summary, what can we do just now?

1/ strength primary care (if you have it) and keep running health centers, telecare (phone, video) and home visiting (even at nights and weekends) with the “natural” professinals to incresae longitudinality

2/ strength the universal public health system (if you have it) and provide all health professionals with PPE

3/ implant voluntary isolation at home or hotels (voluntary quarentine) of “people testing positive and their contacts”, and provide money, practical and social support to help families in voluntary isolation

4/ test as much as possible, with or without symptoms, poor and rich, urban and rural

5/ give the control to a “experts group” with a few experts in the field (epidemiologists and so on) and lot of “normal people” as musicians, philosopher, general practitioners, taxi-drivers, workers, students, teachers, homeless, elderly, etc

6/ be transparent about any decision and publish the trade-off, and consider actions about ethics, equity and solidarity

7/ avoid “people concentrations” in any place (hospitals and health centres also, keep patients withot mixing them)

8/ avoid the theatre of safety, so do not recommend the use in general of masks

9/ keep running the country, the focus is not in the hospitals, but in the society

10/ forbid the use of “Molotov cocktails” for treatments (hidroxicloroquine, plus azitromizine, plus paracetamol, plus omeprazol, plus antiviral, plus ceftriasone, plus hydrocortisone, plus furosemide, plus tozulizuma, plus…anything (in fact the pandemia has given doctors licence to kill, without autopsies because the new rules about deaths by Covid, as almost all is Covid)

11/ make clear that many “Covid’ deaths are not “avoidable deaths” just deaths of a “harvesting period”, so avoid distanasia and let people dye at home with their families (be “human”)

12/ take away people from nursing homes, prisions, etc and provide money, practical and social support to help persons and families to live out of these institutions

13/ help epidemiology to be out from the “fog of the pandemy” and produce inmediatly and continually studies for action, so data by person (age, sex, social class, health problems, use of medications, etc) and place (geographic distribution, progress of the pandemic, etc), changes in serology with-without symptoms, “cause of deaths” (autopsies, determination of respiratory virus,…), etc.

You can read this into Spanish:
Coronavirus (Covid-19). El Fin del Mundo no ha llegado (todavía).
[Coronavirus (Covid-19). The End of the World has not come (yet)]
https://www.actasanitaria.com/coronavirus-covid-19-el-fin-del-mundo-no-ha-llegado-todavia/

In doubt follow the sinthesis of the EBM (Evidence Based Medicine)

We have EBM knowledge about total quarantine in this pandemic having no EBM foundation in this pandemic

“Control measures such as quarantine, travel restrictions, and airport screening for travelers have been widely implemented to contain the spread of infections. The effectiveness of these containment measures in controlling the outbreak, however, remains inconclusive While school closure is less effective than workplace distancing or quarantine of exposed individuals, a combined strategy which implements all three measures together was found to be most effective in reducing the spread”.

“A Systematic Review of COVID-19 Epidemiology Based on Current Evidence”
https://www.mdpi.com/2077-0383/9/4/967/htm

We have EBM knowledge about total quarantine in epidemic of respiratory virus having no EBM foundation in general

“Face masks, eye protection and person distancing: systematic review and meta-analysis”
https://www.medrxiv.org/content/10.1101/2020.03.30.20047217v1

“One trial testing person distancing found a reduction in transmission to co-workers when those with infected household members stay home from work.

We were disappointed to find only one trial on person distancing which is currently the core of the global containment strategy.

Juan Gérvas

Médico general jubilado, Equipo CESCA (Madrid, España). [email protected]; [email protected]; www.equipocesca.org; @JuanGrvas

2 Comentarios

  1. Boina says:

    Hello.
    Thank you very much for your opinions, are like a little light in the darkness.
    For the point 7: “people concentrations”, would you include in this category food indoor markets?
    We are trying to get authorization to work in local ecological gardens and their distribution in small consumption groups, currently unsuccessful.