Wednesday, June 3, 2020

The collapse that was not

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The collapse of the Spanish health system due to exhaustion of beds in the ucis, predicted for the March 25th in a manifesto signed by a group of scientists, still has not occurred.

Those 69 investigators requested on March 21 a immediate total confinement Y close seven autonomous communities to avoid saturation of intensive care units in hospitals. Since then, however, the ICU beds have been expanding at full speed and have not been exhausted, although no community was closed and the reinforced confinement still took a week to apply, from March 28.

Graph without collapse

The same researchers rectified their predictions. six days later of the publication of the manifesto. They did so in a letter published on March 27 in the prestigious’The Lancet the most important medical journal. The first author of that letter is the expert in tropical diseases Oriol Mitjà, who has just been released as an adviser to the Govern.

The graph that supports the omen of collapse in the manifesto is very different from the one that appears in the scientific journal. In the second no collapse is seen: UCI earnings are kept below the total number of beds available.

In addition, the saturation date remains undefined. The manifesto read: “current measures will lead to a collapse of the health system around March 25 “On the contrary, the letter sent later to ‘The Lancet’ warns of a”very high risk of saturation“, which establishes between March 26 and April 24.

The difference between the two predictions is because mobility during partial confinement was much less than the researchers initially thought. In the first manifesto, scientists assumed that movements of people and trafficking had been reduced by a fifty%. However, in the letter they updated this estimate to a 70%.

Nor did the manifesto take into account the ucis extension. The authors assume that there are some 5,000 beds of this type in Spain. In other words, 3% of the total, according to the typical proportion that occurs in hospitals. However, the actual number could be much higher. For example, the Govern estimated last Monday that ICU beds are currently in operation in Catalonia triple those that were before the crisis and are 85% occupied.

Call for attention

Àlex Arenas, a researcher at the Universitat Rovira i Virgili (URV) and principal author of the mathematical model that supported the manifesto, believes that there was a collapse. “On the 24th the ucis were indeed full. Another issue is that we have some first class toilets they have made an incredible effort, “he says when asked by this newspaper.

“The letter to ‘The Lancet’ was intended to be a call to attention. It was seen that the government was in an immovable position and it had to be revealed that things could go very wrong“explains Arenas.

“The model correctly indicated that there was a serious problem with the ucis, but like any model it is not perfect and therefore it must be taken with great care. There were people who got a little carried away by passion“he replies Miguel Hernán, Professor of Epidemiology at Harvard University and member of the scientific council that advises the Government.

The manifesto, the letter sent to ‘The Lancet’ and two draft articles detailing the mathematical model have raised blisters in the Spanish epidemiological community. “You have to be much more cautious. Given the degree of uncertainty we have, making such strong statements is not possible: making predictions with the precision of days is not the usual thing,” he says. Francisco Bolúmar, Professor of Epidemiology at the University of Alcalá de Henares.

“Things are being done very quickly and without sufficient rigor, in order to leave a mark. The most veteran epidemiologists are amazed by colleagues who have no doubts: I see it as quite dangerous, “he says. Clara Menendez, a malaria researcher at the Institut de Salut Global de Barcelona (ISGlobal). Menéndez believes that the authors of the letter should be explicit on the change of scenarios that they handled regarding the collapse of the system.

Same requests

Bolúmar does not explain how, after update your diagnosis From the situation, the researchers of the manifesto did not renounce the measure that they proposed: the total confinement and closure of regions. “I do not see that what the letter says is based on what is seen in the graph,” he says.

Arenas replies that even with mobility reduced by 70%, household permeability (Outings for shopping and other activities) can have a major effect on infections. However, it distances itself from the request for the closure of regions, which specifies that it was not part of the model and is overtaken by the current situation.

“Things have been done well. The government has reduced the pressure on the ucis with stricter confinement and the autonomous communities have increased their capacity. Things work, I am satisfied with how the situation has been handled, “says Hernán.

“The model [empleado en el manifiesto] is conceptually rich, but it takes years of experience to make predictions, “says an international benchmark in mathematical modeling of epidemics, who prefers to remain anonymous.” Right now, many want to help, but before making predictions and suggesting measures, there are have to talk a lot with politicians and with authentic epidemiologists“he concludes.

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