translated from Spanish: Sotero internist warns Chile entered «war situation» and warns it could exceed «10 thousand deceased»

«Today we are in a situation that is the most dramatic in which we could be, we already outperformed Italy in total cases, it is a very dramatic figure, not only are we talking about beating Italy per million inhabitants, but in the total number of cases even though they are 60 million inhabitants and they take twice as many exams. Even though we take fewer exams, we have more and we are not far from having the cases of Spain,» warned the internist of the Hospital Sótero del Río and magister in Public Health of Imperial College UK, Juan Carlos Said, about the situation reached by the pandemic in Chile that places the country as the eighth nation with the highest number of infected , with 242,355 cases.
«Unfortunately this increase in cases is accompanied by the number of deaths. (…) today, in fact, I think it’s getting more and more likely that even in terms of the dead we will end up with the same number of deaths per million inhabitants as Italy, which is very dramatic. Today only counting deceased with confirmed PCR, that is 4500, (when) we have not passed half the pandemic and the dead are distributed symmetrically, that is, the percentage of deaths that occur when the curve ascends may be more or less similar to the number of contagions when the contagion curve descends, then we could perfectly reach 10 thousand deceased and with 10,500 we already have the same number of deaths per million inhabitants that Italy and I insist » only considering positive PCR patients,» he said in Radio Universo.
Said – who tested positive and is quarantined on Friday – was one of the first voices to point out that more important than concentrating on the number of fans was to test, detect and isolate contagions and their contacts, a policy that the Government has already admitted was late. «We’re not going to beat this pandemic with mechanical fans, that’s not the strategy,» he said at the end of May, then warning what was happening in the weak traceability management that the Minsal showed at the time. Then came the announcements of hiring larger plotters and enabling health shelters.
«If we consider probable patients, we are already in 7 thousand deceased, which would turn this tragedy, and I give you the tip, into a tragedy that has cost more deaths than the Chillan Earthquake and the 1957 flu together, that severity of crisis we are talking about. Changes have been made effectively but not sufficient, number of plotters have been increased but not in the proportion required. We talked about it here, for example, in Wuhan for 11 million inhabitants there were 9 thousand people charting and in Santiago we are 5.7 million inhabitants and initially we had 80 people plotting. Today it’s 500, but the number we need is likely to be at least 4,000 people making calls,» he added.
«It’s important because it’s the only way to shorten the time that one person infects others, quickly locating contacts and isolating them and it’s not Nasa technology, it’s accessible that the state can finance, it’s not a luxury, it’s not very expensive technology, it’s phone calls. There have been progress but very slow.» Added.
«Similarly, in the situation of isolating the sick there has been progress in creating sanitary residences, but it has not been the same in the occupation that are still empty today. There were talk of 12 thousand residences and no more than half are occupied and striking, considering that 6 thousand or 5,500 people are infected every day and probably a fifth of these people live in conditions of poverty in terms of habitability and are people cannot quarantine their home without infecting the rest of the family.»
War situation

«That has been one of the most positive things about government management, which has effectively increased the number of beds and fans and that’s very positive. But the bed system is not infinite and today the occupation (of the system) is total. Let’s be honest. That idea that there are beds somewhere or hidden fans, it’s not real that, with all the colleagues I’ve talked about the public or private sector, they all convey to me a situation of collapse, that everyone has tripled the beds and they all deal, the wards, pediatric beds, emergency box, is being hospitalized where you can,» he said.
«And the most delicate sign is that we are hospitalizing at the Health Reference Center (CRS) or in offices. In La Granja there are patients hospitalized for 8 days in an office. That we have patients hospitalized in offices and CRS, that’s something that nunsca had happened. This is serious. It’s not normal. It’s okay to be done because otherwise patients wouldn’t have hospitalization but it’s not like to say ‘quiet means we’ve got enough beds, that’s not the reality.’ When they tell me ‘a patient was hospitalized in a CRS’, I say look that’s not a bed in valid terms, it’s a desperate measure, it’s a war situation, dramatic, it’s not normal in any scenario,» he warned.
«You have to understand that and pass on the risk of that to patients. A patient who is cared for by specialists who are dedicated to this issue, in beds that are originally intended for that, is a patient that his health will obviously take greater risks,» said Said. «All of this is a deterioration in the quality of care that inevitably leads to greater lethality, a greater risk in the care of these patients and that has been seen in other countries (…) they are at increased risk of death. That’s what you have to pass on to patients and say ‘look, the system is collapsed, there are no more beds.'»
«The last bed is something rather theoretical, no patient is going to tell you that you’re going to take care of one and another you’re not going to take care of it, but what’s going to happen, is that resources are started to be prioritized, it’s going to say ‘look, this patient’s going to be intubated’, ‘to this other, because maybe he’s older , more diseases, worse prognosis, look we’re going to try to hold on with non-invasive ventilation or we’re going to support it with a high-flow nasal cannula.’ What’s going on is that these treatment prioritizations are being done that aren’t common in everyday life in a normal winter campaign. That prioritization is the dilemma of the last bed,» he explained.
«It’s not that someone is left out of the hospital, all patients are admitted thanks to the efforts of the professionals who are working, but the situation is collapse, so we don’t have to push more that or believe in that naivety that there’s going to be a fan for every Chilean, that’s a utopia. Just as there can’t be a carabinieri in every house for us to comply with quarantine, there’s also no fan for every person who gets sick if the epidemic continues to reproduce without any control. That is a reality that must be transmitted to people, there is no infinite resource and we can continue to add beds and fans indefinitely if we do not reduce the number of those infected.»
«That’s where Minister Paris has to put all his chips. What failed the most, independent of the quarantine model we can say, what was never done well and was the center of failure in this strategy was ‘diagnosing, tracing and isolating’. To this day the exams are delivered in nine days in arrears, 45% of patients receive their exam after 14 days of symptoms, until the end of May 11 thousand contacts were not located, that is where we began to lose the battle and we continue to lose it. We’re not telling people that they’re sick, we’re not locating contacts in time, we’re not isolating them, that’s where the minister should put all his chips to beat the coronavirus that we’re clearly losing on all fronts.»

Original source in Spanish

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