Helena Legido-Quigley: “Austerity saps the ability of a health system to respond to COVID-19”

Interview on COVID-19 with Helena Legido-Quigley, Associate Professor of Global Health at the London School of Hygiene and Tropical Medicine and at the National University of Singapore.


What role has Spain played in the COVID-19 pandemic?

ESMH Scientist Helena Legido-QuigleySpain has been slow, but as equally slow as the rest of Europe. The continent lost a month that could have been used to get ready. Some Asian countries reacted much faster, for instance Singapore was taking actions already in January. I went from there to Spain and I could not believe my own eyes. Spain should have cut flights from Italy and cancelled football matches and street demonstrations. Defending the celebration of the Mobile World Congress [scheduled in late February in Barcelona and then cancelled by the organizers] was a mistake. However, I support the confinement measures the Spanish government took starting from 15 March. They were among the earliest and strictest in Europe.


Why did Europe fail to see what was coming?

Everybody was taken by surprise. Even eminent epidemiologists failed. The Spanish COVID-19 technical committee gave a press conference every day and I liked that transparency. But it felt strange that they did not take action. A student of mine [in Singapore] told me: “talk with your government, tell them to act”. There were alarming signals from Italy. A key difference between Europe and some Asian countries is that the latter had gone through SARS in 2003 and were more prepared.


Why are certain countries so relaxed? Sweden, for example.

There is a lot of uncertainty and not even scientists agree. Countries have adopted different measures and we will see which ones are better later on. But I think Sweden is not taking the right decisions. Some countries rely mainly on models, but they should complement that with the experience of those places that have been struck by the pandemic earlier. This suggests that confinement is better than betting on ‘herd immunity’ and on saving the economy.


What works against the pandemic?

There are three strategies. First, confinement. Second, testing. Third, preparing your health system. In Spain, confinement came late but it has been strong. Also tests came late, but they are being ramped up. The organization of the health system is the most chaotic part. Intensive Care Units (ICUs) had to be prepared in advance. There should be Noah’s Arks [infrastructures aimed at quarantining infected people with mild symptoms away from their homes, where they could infect other people]. On the contrary, there are suggestions that the Spanish health system may be on the verge of collapse.


What could be improved in the Spanish health system?

The austerity measures applied in the last eight years. [Before the crisis,] Spain had one of the best health systems in the world, with one of the lower levels of expense in Europe. Then, all parties and all regions applied budget cuts. When I interviewed doctors, they were shattered. Austerity saps the ability of a health system to live up to these circumstances. Nowadays, the percentages of doctors and of Intensive Care Unit beds in Spain are much lower than in Germany. Health workers have not had access to protection measures: for this reason, thousands of them are infected.


So, how is the health system coping?

Professionals have improvised very quickly. They have transformed restaurants into ICUs. An NGO has promised to set up field hospitals. Now it’s time to take creative measures. The government’s idea to move patients to less collapsed regions is a good idea. We should also hire doctors and nurses from abroad, to compensate for those infected. We don’t have enough experts and we need help.


What can we learn from successful countries?

It’s too late to copy them, but they are lessons to be learnt. Singapore had a stock of all the necessary material for two months. They have deployed massive testing. And they track all the people that has been in contact with an infected person for 14 days. This is how they have managed to avoid the extension of the epidemic. In South Korea, the epidemic did spread, but they were able to handle it with massive testing, tracking, and confinement. An important lesson is that they produce PCRs [the test used to diagnose COVID-19]: it’s useful not to depend on China for that.


What can the European Union do to help?

The European Union has been late, too. They should provide countries with tests, respirators, and material to protect health workers. I don’t mention economic measures because it’s not my expertise.


What should we do once the crisis is finished?

One important thing is the transparent sharing of evidence, so that scholars can assess what worked and what did not.


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