by Lleonard Barrios 07/04/2020
Image: Doctors Benito Almirante, Fernando Simón, Antoni Trilla and Oriol Mitjà
Lleonard Barrios Sanromà is a former professor, retired last September, of Cell Biology at the Autonomous University of Barcelona
Epidemiologists often say that projections to predict the course of an epidemic have many uncertainties, as there are many influencing factors. This view indicates that there is great caution in communicating future estimates, and more so in the case of a new pandemic like SARS-2 better known as Covid-19.
The health authorities delegate the treatment of the data to teams of experts and from this collective work some conclusions emerge that a spokesperson usually communicates. The important thing is teamwork following scientific criteria. This is how one works at the Imperial College or the Carlos III Institute. Does this mean that the forecasts (hypotheses) are accurate? No, scientific hypotheses, to be so, must be experimentally disposable and, in the case of epidemiology, this is seen over time, when new data shows whether the forecasts have been fulfilled or not.
This principle of prudence is observed in many epidemiologists, such as those who communicate the new data almost daily to us or those who explain in plain language what measures we should take and reason with us. In this sense, the tone usually shown by Drs. Fernando Simón, Antoni Trilla or Benito Almirante, among others, stands out as very adequate, and I quote for their media role. All of them play a very prudent professional role, of incalculable value in times as difficult as we are living them.
On the other hand, the role of Dr. Oriol Mitjà, who in my opinion does not find the right tone, is surprising. In the Catalan public media and as an advisor to the regional Ministry of Health, Dr. Mitjà has acquired a very prominent role that, unfortunately, does not correspond to that of an advisor. Despite the fact that at the start of the SARS-2 pandemic,
Dr. Oriol Mitjà declared in February that the epidemic might not come here and that it was more or less like a flu, a month later he declared the incompetence of those responsible for the committee Spanish emergency to deal with the crisis and demanded his resignation two days after the entry into force of the state of alarm.
Mr. Mitjà obviated that the powers in health in Catalonia were entirely transferred to the autonomous Government of the Generalitat until the alarm decree and that now it still has all the capacity to buy the material that is needed in many hospitals. The lack of adequate material has been a way of contagion for Catalan toilets in a higher proportion than anywhere else. Mr. Mitjà said nothing when 160,000 families with the right to canteen help were forced to break their home isolation to go to the municipalities to collect the accreditations when in other parts of the state this was done via mobile phone.
Mr. Mitjà has every right to make political statements, but then he is exposed to political criticism about his positions and his opinion as a scientific adviser is devalued for lack of objectivity. You can’t be at mass and ringing
Mr. Mitjà has not said anything about the drastic change of position of the Generalitat on the status of the Conca d’Òdena, which has spent a week demanding more drastic measures (for all of Catalonia) to ask for the opening of the confinement in the area , a measure totally against Mr. Mitjà’s postulates. He rightly claims that tests must be carried out to identify asymptomatic infections and break the route of infection, but he has not proposed in public that all the devices for doing RT-PCR of Universities and research centers be made available to the regional Ministry of Health. The incompetence in organizing this task has been from the Catalan health authorities.
In relation to two of the documents presented by Mr. Mitjà, some observations should be made. The Generalitat, to demand more drastic measures from the Spanish Government, presented a Health document on March 24 using estimates made by Dr. Mitjà, using the SIR model, according to which, in the most favorable case, the peak of new cases will occur on April 12 and the final number of cases and deaths would be very high.
Based on the data now, it could be that the peak occurred either on March 31 or April 2, we will know later. As I have mentioned, it does not seem appropriate to use a single modeling and it is necessary to contrast with other modeling, in the same way that, from the strictly health point of view, it is not very useful to use the opinion of a single epidemiologist as it is usually more consistent to contrast different opinions.
From a strictly health point of view, it is not very useful to use the opinion of a single epidemiologist, as it is usually more consistent to contrast different opinions.
The second document I wanted to comment on is the one presented on April 3, called Coordinated Exit from confinement. This is a working document, adapted from an Andorran plan, in which the measures to be adopted and the techniques to be used to control both possible outbreaks and to know the immunization of the population are mentioned.
Two things surprise the document, the first is that the document says Reviews by panel of epidemiologists Experts in Communicable Diseases, but only two authors sign it. Again a collegial vision of the measures to be taken is lacking. The other surprising thing about the document is that there are no bibliographic references, essential in a working document that must be reviewed by experts.
Even in the document it is stated that there is a low proportion of the immunized population (15%). This data is an average extracted from a report from Imperial College on Monday, March 30, and would be equivalent to about 7 million immunized, with a range ranging from 1.5 million to 15 million. This report is not mentioned in Dr. Mitjà’s document, nor is the wide hairpin.
A pandemic like this ends up putting everyone in their place and it will be necessary, when we overcome it, to make a thorough analysis of the mistakes made to learn from them. This includes all of us as a society, epidemiologists who must make an exclusively scientific analysis and institutions that must make a political analysis of crisis management and the adequacy of the health system after a decade of spending cuts in public health.