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Source: https://ciperchile.cl/2020/06/03/las...gran-santiago/
YOUR SCIENTIFIC ADVISORS GIVEN YOU REPORTS ON THE ALARMING PROGRESSION OF COVID
The five alerts that the government ignored before tightening the quarantine in Greater Santiago
06/03/2020
By Benjam?n Miranda
At the end of April, when it tried to impose the concept of "safe return" and described the evolution of contagion as a "plateau", the government began to receive worrying reports from its own advisers that showed the aggressive increase in cases in the Metropolitan Region . In total, there were five documents that marked almost all the communes of Greater Santiago in red, but the authority took two weeks to react and apply the total quarantine. The initial plan for partial quarantines failed, confirms one of those in charge of modeling and analyzing this strategy, because mobility in the communes did not decrease: 70% of the trips were maintained and had to drop to 20% or 30% to have results positive.
Between April 30 and May 12, the government had before it at least five technical reports prepared by some of its scientific advisers that reported the aggressive progression of Covid-19 infections that was occurring in the Metropolitan Region. The alarming increase motivated some of these advisers in private to urge the application of a total quarantine for Greater Santiago. But the authorities took two weeks to apply that measure.
Those internal reports were fed with the figures emanating from the Data Table that advises the Government in monitoring the pandemic. What they said collided head-on with the speech of the authorities that in the last two weeks had made efforts to install the concept of "safe return" to work and commercial activities and to describe the behavior of the contagion curve as a "plateau" .
If the government's plan has always been to keep the level of infections as low as possible so that the number of critically ill patients never exceeds the supply of critical beds, it is strange that the authorities have not reacted before to the disturbing information they were receiving from their own scientific advisers.
One of the members of the team working on the modeling of the data handled by the government, Dr. in Biotechnology Tom?s P?rez-Acle, who participated in the preparation of these reports, answered CIPER's queries:
-We said it in his minute, indeed it would have been much better to take the measures sooner. That is undoubtedly the case.
Both the Minister of Health, Jaime Ma?alich, and the Minister of Science, Andr?s Couve, who knew these documents, are not obliged to apply everything that their technical advisers tell him, since they are political authorities who must put other factors on the balance - such as socio-economic indicators, for example - when promoting public policy. The same advisor P?rez Acle explains it:
-We provide indicators that are cold, numbers that must be transformed into some kind of health policy. But there cannot be a direct transformation, because there are many elements at stake.
How much of this delay in applying the total quarantine for Greater Santiago could have been responsible for the difficult situation that the Metropolitan Region is experiencing today? For the Ph.D. in Public Health and Master in Epidemiology and Biostatistics, Mar?a Paz Bertoglia, that is a question that is still open and that the authorities must answer:
-The idea is that people take the weight of the danger of this disease, that (understand that) we do not have an effective treatment and that the only measure to prevent someone from getting sick is not to get it. That should be the message, but when you tell people that you're going to open malls and you're forcing a new normal, these two ideas collide. There is a word that weighs heavily that we do not have it in Spanish: accountability. It means something similar to accountability, but it goes further: you have to take responsibility and mistakes. And here the authority should recognize that it made a serious communicational mistake.
HOW DO WE GET TO THIS POINT?
Official data from the Ministry of Health (Minsal) as of June 3, indicates that the Metropolitan Region has more than 85 thousand cases since the start of the pandemic and that it has the highest cumulative incidence rate (cases diagnosed per 100,000 inhabitants since on March 3) nationwide (1,049.1). Its communes with more active cases are Puente Alto (1,451), Pe?alol?n (1,197), Santiago (1,148) and La Florida (1,082), according to the latest epidemiological report. At the same time, a report by Our World in Data –initiative of the University of Oxford– places Chile as the country with the highest number of daily cases per million inhabitants on the continent.
However, the government continues to show a great achievement: low case fatality of around 1%. And although the hospitals in Santiago have been under constant tension for a possible collapse for two weeks, the management of the Minsal has been effective in adding more critical beds every day and adding mechanical fans.
Another success of the authority is the high and sustained number of PCR tests that are reported every day, which allows us to have a more accurate picture of the spread of the infection. But there have been notorious failures to trace the traceability of positive cases and their contacts (see the CIPER report: "Minsal's internal act reveals serious problems in traceability of cases"). In fact, Minister Ma?alich acknowledged on Wednesday 3 that only 60% of those infected and their contacts are being monitored, when at least 80% are required, so Primary Health Care (medical offices) will join this task municipal). In addition, he informed that the quarantine for the metropolitan communes will be maintained.
How did we get to this point in Greater Santiago?
It was on Thursday, April 30, that the government received the first of five successive reports that showed how the prevalence and rate of contagion were increasing markedly in most metropolitan communes, far exceeding the national average for both indicators. At that time, the failed opening of the Apumanque shopping center in Las Condes took place and days before, President Sebasti?n Pi?era and the Minister of Economy, Lucas Palacios, had held a meeting with leaders of business associations - Juan Sutil (CPC), Patricio Donoso ( Chilean Chamber of Construction) and Bernardo Larra?n (Sofofa) - who delivered protocols so that the reactivation of the economy would not endanger workers.
Just a day before the delivery of that first report that should have triggered the alerts, the Undersecretary of Health, Paula Daza, had mentioned the term "plateau" a second time to describe the contagion curve. But the report showed that both the prevalence (people infected at the same time for every 10,000 inhabitants) and the rate had increased nationwide compared to the data from four days before: from 3.08 and 12.24% to 3 , 90 and 16.75%, respectively.
The data is presented in the reports as a traffic light: if the indicators of a commune are above the national average, they are red, and if they are below that value, green. In that April 30 document, some metropolitan communes not only registered red colors, but showed values that even tripled (as happened with Independencia) the national prevalence average:
[See chart in source linl]
The material that is prepared at the Data Table - and is provided to the Minsal through the Minister of Science, Andr?s Couve - is based on information that the Health portfolio publishes in its epidemiological reports. The reports indicate the daily rate of new cases and the prevalence in each of the country's communes.
What could have caused these sudden and unexpected increases? Tom?s P?rez-Acle answered it in those days on his Twitter account: "increase in active infected, incorporation of asymptomatic people in count and feeling of people that 'this has already happened'."
The following report, dated May 2 (see it here), showed that the prevalence nationwide increased from 3.90 to 4.90 and the country rate average from 16.75% to 34.45%. In the Metropolitan Region, according to this report, much more critical numbers were noted, especially in districts such as Independencia and Recoleta, which registered very significant increases compared to the report two days ago:
[See chart in source link]
A day after this report was issued, on Sunday, May 3, President Pi?era held an emergency meeting with the health authorities in La Moneda. Hours later, the government announced total quarantine for the communes of Recoleta, Quilicura, Cerrillos and Santiago (the latter remained until then partially under this measure). The urgency of the announcement, which shook that Sunday afternoon, was the first public sign that something was wrong. Minister Ma?alich began to talk about the "battle of Santiago" and the "plateau" and the "new normal" were never mentioned again.
The May 5 report –which included for the first time the occupation of ICU beds and the number of mechanical ventilators, according to data from the Chilean Society of Intensive Medicine (Sochimi) - highlighted the national rise in prevalence values (from 4, 09 to 4.14) and rate (from 34.45% to 40.37%). At the metropolitan level, meanwhile, the traffic light showed that ten communes had the four indicators in red (prevalence, rate, ICU beds and ventilators) (see that report here).
A day later, on May 6, Minister Ma?alich announced that 12 communes of Greater Santiago would be quarantined (San Miguel, San Joaqu?n, Renca, Pe?alol?n, Macul, Lo Prado, Lo Espejo, La Granja, La Florida, La Cisterna, Conchal? and Cerro Navia), while the territory under confinement would be expanded to four others (La Pintana, San Ram?n, San Bernardo and Puente Alto):
[See chart on source link]
Data from the May 8 report continued to rise in the Metropolitan Region. And, although nationally the rate decreased from 40.37% to 37.27%, the prevalence increased again from 4.14 to 5.01 (see that report here).
It was with these numbers that the advisor to the Ministry of Science who models quarantines and analyzes their results, Tom?s P?rez-Acle, promoted on Twitter a “strict total quarantine” in those communes whose prevalence was greater than 4, that is, the entire Great Santiago. But this did not happen.
The situation of the epidemiological week number 20, reflected in the report of May 12, showed that the Metropolitan Region continued to increase its indicators in red, and that the national average values had increased: the prevalence from 5.01 to 5, 73 and the rate - which had previously decreased - from 37.27% to 40.78% (see that report here).
It was after this fifth report that, on May 13, Minister Ma?alich decreed total quarantine in Greater Santiago and six other metropolitan communes (San Bernardo, Buin, Puente Alto, Padre Hurtado, Lampa and Colina).
THE FAILURE OF THE DYNAMIC QUARANTINE
The confinement that was decreed in Greater Santiago not only buried the "new normal": it also confirmed that the dynamic or partial quarantines previously applied were unable to encapsulate the virus and flatten the contagion curve. What's more, the five reports cited - prepared between April 30 and May 12 - clearly showed how the disease moved from the eastern districts of the capital to the most populous districts.
Why did this model fail? Tom?s P?rez-Acle, who is also in charge of evaluating the consequences of the restriction measures - such as quarantines or sanitary cords - and has promoted the application of this strategy, told CIPER that they did not work because the mobility of people was not reduced. enough in the first restrictions that were applied in Las Condes, Vitacura, Lo Barnechea, Providencia, Independencia, ?u?oa and Santiago. This means, he explained, that trips to the interior of these communes should be reduced to 20% or 30%, and the same with mobility that comes from other areas of the city. But that did not happen:
"We are facing a completely different situation: mobility within these communes indicates that 70% of the trips were maintained and, worst of all, is that mobility from the communes we call dormitory, such as La Granja, San Joaqu?n o La Pintana -which today are among the most affected-, decreased only between 30% and 40%. Indeed, it was reduced a little more than the mobility within each commune, but even so it is above the theoretical thresholds that anyone who is dedicated to the computational modeling of these systems tells you that it is reasonable, ”he says.
The most notorious expression of this, adds the academic researcher, was that 200,000 safe-conducts were issued per day, many of which were for construction company workers who came from communes that did not present infections and did not have the option to stay. at home.
In any case, a total quarantine with these mobility percentages would not have helped isolate the virus either, says P?rez-Acle.
“For quarantine to really work there has to be a super significant reduction in mobility. If we are not able to do it, we are going to see that the fatality of the disease is going to start to rise, unfortunately, and in an important way ”, concludes P?rez-Acle, one of the scientists who has promoted the dynamic quarantine strategy that has been followed government.
But the news is not good. If mobility needs to be lowered to 20% or 30% for quarantine to work, we are far from that goal. This was confirmed on Wednesday June 3 by Minister Ma?alich in his usual daily report on the evolution of the pandemic. At that press point, he said that the total quarantine in the Metropolitan Region has only reduced mobility to 70%. And he maintained that this percentage should drop, at least, to 35%.
YOUR SCIENTIFIC ADVISORS GIVEN YOU REPORTS ON THE ALARMING PROGRESSION OF COVID
The five alerts that the government ignored before tightening the quarantine in Greater Santiago
06/03/2020
By Benjam?n Miranda
At the end of April, when it tried to impose the concept of "safe return" and described the evolution of contagion as a "plateau", the government began to receive worrying reports from its own advisers that showed the aggressive increase in cases in the Metropolitan Region . In total, there were five documents that marked almost all the communes of Greater Santiago in red, but the authority took two weeks to react and apply the total quarantine. The initial plan for partial quarantines failed, confirms one of those in charge of modeling and analyzing this strategy, because mobility in the communes did not decrease: 70% of the trips were maintained and had to drop to 20% or 30% to have results positive.
Between April 30 and May 12, the government had before it at least five technical reports prepared by some of its scientific advisers that reported the aggressive progression of Covid-19 infections that was occurring in the Metropolitan Region. The alarming increase motivated some of these advisers in private to urge the application of a total quarantine for Greater Santiago. But the authorities took two weeks to apply that measure.
Those internal reports were fed with the figures emanating from the Data Table that advises the Government in monitoring the pandemic. What they said collided head-on with the speech of the authorities that in the last two weeks had made efforts to install the concept of "safe return" to work and commercial activities and to describe the behavior of the contagion curve as a "plateau" .
If the government's plan has always been to keep the level of infections as low as possible so that the number of critically ill patients never exceeds the supply of critical beds, it is strange that the authorities have not reacted before to the disturbing information they were receiving from their own scientific advisers.
One of the members of the team working on the modeling of the data handled by the government, Dr. in Biotechnology Tom?s P?rez-Acle, who participated in the preparation of these reports, answered CIPER's queries:
-We said it in his minute, indeed it would have been much better to take the measures sooner. That is undoubtedly the case.
Both the Minister of Health, Jaime Ma?alich, and the Minister of Science, Andr?s Couve, who knew these documents, are not obliged to apply everything that their technical advisers tell him, since they are political authorities who must put other factors on the balance - such as socio-economic indicators, for example - when promoting public policy. The same advisor P?rez Acle explains it:
-We provide indicators that are cold, numbers that must be transformed into some kind of health policy. But there cannot be a direct transformation, because there are many elements at stake.
How much of this delay in applying the total quarantine for Greater Santiago could have been responsible for the difficult situation that the Metropolitan Region is experiencing today? For the Ph.D. in Public Health and Master in Epidemiology and Biostatistics, Mar?a Paz Bertoglia, that is a question that is still open and that the authorities must answer:
-The idea is that people take the weight of the danger of this disease, that (understand that) we do not have an effective treatment and that the only measure to prevent someone from getting sick is not to get it. That should be the message, but when you tell people that you're going to open malls and you're forcing a new normal, these two ideas collide. There is a word that weighs heavily that we do not have it in Spanish: accountability. It means something similar to accountability, but it goes further: you have to take responsibility and mistakes. And here the authority should recognize that it made a serious communicational mistake.
HOW DO WE GET TO THIS POINT?
Official data from the Ministry of Health (Minsal) as of June 3, indicates that the Metropolitan Region has more than 85 thousand cases since the start of the pandemic and that it has the highest cumulative incidence rate (cases diagnosed per 100,000 inhabitants since on March 3) nationwide (1,049.1). Its communes with more active cases are Puente Alto (1,451), Pe?alol?n (1,197), Santiago (1,148) and La Florida (1,082), according to the latest epidemiological report. At the same time, a report by Our World in Data –initiative of the University of Oxford– places Chile as the country with the highest number of daily cases per million inhabitants on the continent.
However, the government continues to show a great achievement: low case fatality of around 1%. And although the hospitals in Santiago have been under constant tension for a possible collapse for two weeks, the management of the Minsal has been effective in adding more critical beds every day and adding mechanical fans.
Another success of the authority is the high and sustained number of PCR tests that are reported every day, which allows us to have a more accurate picture of the spread of the infection. But there have been notorious failures to trace the traceability of positive cases and their contacts (see the CIPER report: "Minsal's internal act reveals serious problems in traceability of cases"). In fact, Minister Ma?alich acknowledged on Wednesday 3 that only 60% of those infected and their contacts are being monitored, when at least 80% are required, so Primary Health Care (medical offices) will join this task municipal). In addition, he informed that the quarantine for the metropolitan communes will be maintained.
How did we get to this point in Greater Santiago?
It was on Thursday, April 30, that the government received the first of five successive reports that showed how the prevalence and rate of contagion were increasing markedly in most metropolitan communes, far exceeding the national average for both indicators. At that time, the failed opening of the Apumanque shopping center in Las Condes took place and days before, President Sebasti?n Pi?era and the Minister of Economy, Lucas Palacios, had held a meeting with leaders of business associations - Juan Sutil (CPC), Patricio Donoso ( Chilean Chamber of Construction) and Bernardo Larra?n (Sofofa) - who delivered protocols so that the reactivation of the economy would not endanger workers.
Just a day before the delivery of that first report that should have triggered the alerts, the Undersecretary of Health, Paula Daza, had mentioned the term "plateau" a second time to describe the contagion curve. But the report showed that both the prevalence (people infected at the same time for every 10,000 inhabitants) and the rate had increased nationwide compared to the data from four days before: from 3.08 and 12.24% to 3 , 90 and 16.75%, respectively.
The data is presented in the reports as a traffic light: if the indicators of a commune are above the national average, they are red, and if they are below that value, green. In that April 30 document, some metropolitan communes not only registered red colors, but showed values that even tripled (as happened with Independencia) the national prevalence average:
[See chart in source linl]
The material that is prepared at the Data Table - and is provided to the Minsal through the Minister of Science, Andr?s Couve - is based on information that the Health portfolio publishes in its epidemiological reports. The reports indicate the daily rate of new cases and the prevalence in each of the country's communes.
What could have caused these sudden and unexpected increases? Tom?s P?rez-Acle answered it in those days on his Twitter account: "increase in active infected, incorporation of asymptomatic people in count and feeling of people that 'this has already happened'."
The following report, dated May 2 (see it here), showed that the prevalence nationwide increased from 3.90 to 4.90 and the country rate average from 16.75% to 34.45%. In the Metropolitan Region, according to this report, much more critical numbers were noted, especially in districts such as Independencia and Recoleta, which registered very significant increases compared to the report two days ago:
[See chart in source link]
A day after this report was issued, on Sunday, May 3, President Pi?era held an emergency meeting with the health authorities in La Moneda. Hours later, the government announced total quarantine for the communes of Recoleta, Quilicura, Cerrillos and Santiago (the latter remained until then partially under this measure). The urgency of the announcement, which shook that Sunday afternoon, was the first public sign that something was wrong. Minister Ma?alich began to talk about the "battle of Santiago" and the "plateau" and the "new normal" were never mentioned again.
The May 5 report –which included for the first time the occupation of ICU beds and the number of mechanical ventilators, according to data from the Chilean Society of Intensive Medicine (Sochimi) - highlighted the national rise in prevalence values (from 4, 09 to 4.14) and rate (from 34.45% to 40.37%). At the metropolitan level, meanwhile, the traffic light showed that ten communes had the four indicators in red (prevalence, rate, ICU beds and ventilators) (see that report here).
A day later, on May 6, Minister Ma?alich announced that 12 communes of Greater Santiago would be quarantined (San Miguel, San Joaqu?n, Renca, Pe?alol?n, Macul, Lo Prado, Lo Espejo, La Granja, La Florida, La Cisterna, Conchal? and Cerro Navia), while the territory under confinement would be expanded to four others (La Pintana, San Ram?n, San Bernardo and Puente Alto):
[See chart on source link]
Data from the May 8 report continued to rise in the Metropolitan Region. And, although nationally the rate decreased from 40.37% to 37.27%, the prevalence increased again from 4.14 to 5.01 (see that report here).
It was with these numbers that the advisor to the Ministry of Science who models quarantines and analyzes their results, Tom?s P?rez-Acle, promoted on Twitter a “strict total quarantine” in those communes whose prevalence was greater than 4, that is, the entire Great Santiago. But this did not happen.
The situation of the epidemiological week number 20, reflected in the report of May 12, showed that the Metropolitan Region continued to increase its indicators in red, and that the national average values had increased: the prevalence from 5.01 to 5, 73 and the rate - which had previously decreased - from 37.27% to 40.78% (see that report here).
It was after this fifth report that, on May 13, Minister Ma?alich decreed total quarantine in Greater Santiago and six other metropolitan communes (San Bernardo, Buin, Puente Alto, Padre Hurtado, Lampa and Colina).
THE FAILURE OF THE DYNAMIC QUARANTINE
The confinement that was decreed in Greater Santiago not only buried the "new normal": it also confirmed that the dynamic or partial quarantines previously applied were unable to encapsulate the virus and flatten the contagion curve. What's more, the five reports cited - prepared between April 30 and May 12 - clearly showed how the disease moved from the eastern districts of the capital to the most populous districts.
Why did this model fail? Tom?s P?rez-Acle, who is also in charge of evaluating the consequences of the restriction measures - such as quarantines or sanitary cords - and has promoted the application of this strategy, told CIPER that they did not work because the mobility of people was not reduced. enough in the first restrictions that were applied in Las Condes, Vitacura, Lo Barnechea, Providencia, Independencia, ?u?oa and Santiago. This means, he explained, that trips to the interior of these communes should be reduced to 20% or 30%, and the same with mobility that comes from other areas of the city. But that did not happen:
"We are facing a completely different situation: mobility within these communes indicates that 70% of the trips were maintained and, worst of all, is that mobility from the communes we call dormitory, such as La Granja, San Joaqu?n o La Pintana -which today are among the most affected-, decreased only between 30% and 40%. Indeed, it was reduced a little more than the mobility within each commune, but even so it is above the theoretical thresholds that anyone who is dedicated to the computational modeling of these systems tells you that it is reasonable, ”he says.
The most notorious expression of this, adds the academic researcher, was that 200,000 safe-conducts were issued per day, many of which were for construction company workers who came from communes that did not present infections and did not have the option to stay. at home.
In any case, a total quarantine with these mobility percentages would not have helped isolate the virus either, says P?rez-Acle.
“For quarantine to really work there has to be a super significant reduction in mobility. If we are not able to do it, we are going to see that the fatality of the disease is going to start to rise, unfortunately, and in an important way ”, concludes P?rez-Acle, one of the scientists who has promoted the dynamic quarantine strategy that has been followed government.
But the news is not good. If mobility needs to be lowered to 20% or 30% for quarantine to work, we are far from that goal. This was confirmed on Wednesday June 3 by Minister Ma?alich in his usual daily report on the evolution of the pandemic. At that press point, he said that the total quarantine in the Metropolitan Region has only reduced mobility to 70%. And he maintained that this percentage should drop, at least, to 35%.