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How is it possible that Spain, one of the countries with the best healthcare system in the world, is also among the most affected by Covid, with more than 300,000 official infections, 28,599 deaths and more than 50,000 infected healthcare providers? What has failed? That is the question asked by 20 specialists in Epidemiology and Public Health who today publish a joint letter in the scientific journal The Lancet in which they demand "an independent evaluation" of the response to the epidemic in the country.

The document, signed by top-level experts, underscores the need for an external commission, made up of Spanish and international professionals, to carry out an "independent and impartial" analysis of the management that the Government has carried out in recent months. central as that of the different Autonomous Communities. That assessment, they continue, is essential to "prepare the country" not only for new waves of Covid-19, but also for other possible future pandemics.

"We have to learn from what happened," says the Spanish Helena Legido-Quigley , specialist in health systems and health policies at the London School of Hygiene and Tropical Medicine in London and the Saw Swee Hock School of Public Health at the National University of Singapore and promoter of the initiative, together with Alberto García-Basteir o, doctor of the Hospital Clínic, researcher at the Barcelona Institute of Global Health and coordinator of the SEROCOV1 study.

Along with his, the letter includes prominent firms in the field of national and international Public Health, such as Rafael Bengoa , an expert in Public Health and health management, who was a health adviser to the Basque Government and former Obama adviser; Ildefonso Hernández , Professor of Public Health at the Miguel Hernández University of Alicante and former General Director of Public Health (between 2008 and 2011); Margarita del Val , virologist at the Severo Ochoa Center for Molecular Biology and coordinator of the CSIC's Interdisciplinary Thematic Platform on Global Health, or Beatriz González López-Valcárcel , expert in Health Economics, PhD in Economics, Professor of Quantitative Methods in Economics and Management from the University of Las Palmas de Gran Canaria and member of the Interdisciplinary Working Group that advises the Ministry of Science on Covid matters, among others.

The objective of this joint claim, stresses Legido-Quigley, is to identify errors and locate those factors that need to be improved for the future. "We do not want to blame or that the evaluation is used as an opportunity for the political scourge. It must serve to improve the health response, "she remarks.

"There is no desire for revenge," agrees Beatriz López-Valcárcel. “But it is necessary to evaluate what has happened to us as a country, why we have the numbers we have and how we can better prepare ourselves. It is actually an exercise that should be done not only now, but systematically in the area of ​​public policy. What has happened has been a failure and it is necessary to learn from mistakes ».

Causes

Among the reasons that explain the high number of infections and the high mortality from Covid registered in Spain, several causes have been pointed out, says Legido-Quigley. Lack of preparation, delayed decision-making, coordination problems between the Government and the Autonomous Communities, or lack of resources and provision in nursing homes are some of them. The influence of factors such as the aging of the population, social inequality or the effects of a decade of austerity that has reduced the capacities of the health system has also been pointed out.

“It is important that we can identify everything that we can modify and separate it from what we cannot act on. It is not possible to change the age of the population or how relationships are, but there are many factors that we can change. The system has very high capacities that are not well used, "says Ildefonso Hernández, who recalls that the intention of the letter is" totally constructive "and that, although it is not usual in Spain, other countries such as Sweden and New Zealand or institutions such as the WHO itself has already launched similar evaluations.

The analysis, points out Hernández, should be carried out by a committee made up of independent professionals of recognized prestige, it should be both quantitative and qualitative and, in short, it would have to study aspects such as the human and financial resources used, how the different decision-making processes were, which they are the capacities of information systems, the available infrastructure or the role of research in the response to the crisis.

In addition, it must also take into account economic circumstances and the impact of growing inequalities on the country's vulnerability, the document added.

"We ask the different governments to see this evaluation as an opportunity to be better prepared , prevent premature deaths and build a system based on scientific evidence," agree Legido-Quigley and Hernández.

"If Spain has been able to carry out the best seroprevalence study in Europe [the one carried out by the Carlos III Health Institute], it is also important that it stand out as a country that draws really useful lessons from what happened," he concludes. Hernández.

In addition to the experts cited, they also sign the letter published in The Lancet , Carlos Álvarez-Dardet, Alex Arenas, Carme Borrell, Manuel Franco, Montse Gea-Sánchez, Juan Jesús Gestal Otero, Joan Carles March, José María Martin-Moreno, Clara Menéndez, Sergio Minué, Carles Muntaner, Miquel Porta, Daniel Prieto-Alhambra and Carme Vives Cases .

According to the criteria of The Trust Project

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