The last two weeks of the pandemic do not give truce to Chile, which has become the third country with more cases of Covid-19 infections in Latin America, after Brazil and Peru, exceeding 100,0000 positive cases and more than 1,000 deceased, at the date of publication of this interview. In the latest report from the Ministry of Health, last Monday, 5,471 new cases were added, bringing the total figure to 105,159, since the start of the pandemic.

As if that were not enough, the socio-economic effects of the crisis are beginning to hit the South American country strongly, that after more than two months of confinement – for some obligatory communes – many people from the marginalized neighborhoods have demonstrated on the streets asking for “food” and “Work”, despite the fact that the Government promised the delivery of 2.5 million food baskets, which apparently arrive very late. Meanwhile, under the controversial slogan of “The new normal” or the “Safe Return” plan, the country’s president, Sebastián Piñera, is committed to resuming economic and school activity at the height of the pandemic.

The first case in Chile was registered on March 3. Then, Piñera assured that the country’s Public Health System, one of the best in the region and the first in Latin America, was prepared for the health crisis. Today the beds are at 95% occupancy in the metropolis, where the focus of the pandemic is concentrated, and people’s discontent is felt. What happened then? Why has Chile become the third epicenter of the pandemic in Latin America today?

To answer these questions, we spoke with Dr. Gonzalo Navarrete, who is a pediatrician at the University of Chile and a Master in Public Management. He was mayor of the commune (municipality) of Lo Prado for three periods between 2004 and 2016. He has served as medical deputy director of the South Metropolitan Health Service, director of the Institute of Public Health and undersecretary of Health in the government of President Ricardo Lagos, head of the Institute of Public Health in the first Government of Michelle Bachelet. In addition, he led the Health Commission and later the Education Commission of the Chilean Association of Municipalities. He chaired the leadership of the Party for Democracy between 2016 and 2018. He is currently head of the Neonatology Service of the El Pino de San Bernardo Hospital, where his plant has been set up to treat infected adults, due to the shortage of critical beds and beds. the Intensive Care Units (UCIS).

Q. What did you think the first time you heard about Covd-19 as an epidemic happening in China?

A. To be honest, I saw it as something far away, something similar to the H1N1 epidemic, or something similar to what bird flu can be, things that are careful, but do not have a planetary extension, and that if it came Our country was going to be relatively manageable, like the influenza epidemic. In Chile, every winter we have full Emergency Care Units, especially in pediatrics due to the respiratory virus, influenza, adenovirus … etc. Therefore, we thought we were going to have a similar crisis, only slightly more than normal. We were used to health crises rather as children. I think that a good part of us did not suspect that this would have a planetary dimension, mainly in adults, with the high degree of mortality and lethality that it has.

Q. At what precise moment did you become aware of the dimension of what was coming globally?

A. Two moments: One, when the Chinese build a thousand-bed hospital, one intuits that something different is happening because an epidemic like H1N1 had not previously required that level of deployment; and later, when the topic begins in Europe, where one appreciates quite worrying mortality and fatality data. I would say that in Chile, only at the end of February, a certain awareness began to be seen that this (the Covid-19) was much more important than what we were initially perceiving.

Q. As of today (date of publication of this interview) Chile is the third country in Latin America in infections by the new pathogen. What are the main mistakes that have been made to reach the current state?

R. I would say that the main error is that the Government understood the strategy as an intensive care strategy and the use of ventilators. All that was prepared at the start was to increase ICU beds and increase the ability to ventilate critically ill patients. The pandemic was seen as what was going to cause deaths. We had to prepare the health system, which is true that it was completely collapsed and that it had the possibility of critical adult care at that time, but it was neglected. Today we are paying for the expansion of the pandemic because the role of primary care, the role of mass testing, and the role of supporting people to stay home was completely undervalued.

The second dimension of the problem is that the pandemic has a health component, but it also has an economic-social component that must be addressed at the same time. Chile has a high culture of public health; We have had many epidemics, from cholera onwards, and we have controlled them in time, but that has been achieved because people understood that they had to stay home and had the resources or help to do so.

P. However, mortality in Chile is very low compared to the level of contagion and the rest of the countries that lead the pandemic curve.

A. That has two possibilities of explanation: the first is that, at the moment, only about 27% to 28% of those hospitalized in the UCIS are people over 65 to 70 years old. We are talking about the rest of the infected population having a little more defense; and the second that, probably, there is a certain under-registration because in order to be able to place the diagnosis of the death certificate with Covid-19, it had to have a positive PCR. Just a week ago the registry system was changed and now with a clinic, a suggestive scanner and / or a history of respiratory disease, you can place the diagnosis of Covid-19 as a cause of death.

Q. You speak of the lack of testing, but I understand that Chile is one of the countries that has tested the population of the region the most.

A. Yes, what happens is that we started much later than the pandemic required, which is part of the debate; Because if you had started from the beginning with a massive-wide test, and apart from the test you applied a device so that the one who was positive would effectively stay at home, and also the contacts would have been tracked… but that was not done. After much discussion we managed to expand the testing capacity. There, the main reason is that this lack of gaze of primary care, not community, not public health, out-of-hospital, was the one that somehow failed, and when an attempt was made to increase it is because we had the difficulty of the laboratory network.

This action has a very specific reason, and that is that public health in Chile, for a long time, has been with little investment and the truth is that at the beginning the network of private laboratories that allowed testing to be expanded was not integrated. We also had a transitory difficulty regarding the issue of testing supplies, because the laboratory that provided them ran out of stock. The last thing is that there has been a problem of mismanagement because the health management system is extraordinarily centralized, social actors only a few weeks ago began to have the ability to be heard. We have a Government and a Minister of Health (Jaime Mañalich) with a very autocratic culture. In fact, before the peak began, the Government transmitted a speech of some certainty. Those in power today are pure people from the private hospital world, so what they understand is the concept of the profitable healthcare business.

P. The protests have returned to the Chilean streets in the midst of the pandemic. What are the differences between the protests of October 2019, which placed your country in the international gaze, compared to the current protests?

A. These protests today do not have the political character of the previous ones, which required the great structural reforms; rather, they are focused on poor neighborhoods, fundamentally motivated by despair over the near future. The previous protests were with a political outlook and were held in the city center. People today are mobilizing for the most basic thing, which is the possibility of eating and being able to have an income, and that is quite dangerous and makes a very complex difference.

If the Government continues to make the same mistake regarding money transfers so that people can buy and do not repair it; and therefore, continuing to bet on the distribution of boxes of merchandise, the situation may become a very dangerous cocktail in the coming weeks. The truth is that they have made very complex mistakes by not knowing the population reality. Here the government is making a design similar to that of “the new normal” and what they are doing is making political profit from the pandemic.

P. What risks does your country run with the announced slowdown in isolation?

A. We are not clear on what will happen. I think that we do not have the possibility of leaving the quarantine within two weeks, because here the behavior has not been what one saw in European countries, where there was nobody on the street. I don’t think the curve will go down until the end of June and I hope that the mortality issue can be controlled. Today the public health network is saturated. The private network is making an effort to increase its capacity because fortunately the Government has understood that the public network and the private network, at this time, have to go hand in hand. But if this continues between 4,500 to 5,000 infections, five percent of them would have to be admitted, which implies between 120 to 130 daily patients in the ICU. We do not have the capacity to do this and in another seven or ten days, if we do not tackle it in time, we will have a crisis like the one experienced by Italy or the United States, which did not have the capacity to treat critically ill patients.

Q. The Chilean health system is made up of a mixed system of care made up of public insurance, which is called FONASA, which is the National Health Fund, and a private one called ISAPRE, Social Security Institutions. What role is the private sector playing in the pandemic right now?

R. The Government made a good decision a month ago in which the command of the public and private sector is left to the former, and therefore, the beds are available online for the entire population. I think this is a very important change because the separation in the public and private sectors was brutal in everything: in resources, in wages and in people. The public sector serves 82% of the population and has 50% of the resources, while the private sector serves 18% to 20% and manages the other 50% of the resources, which is brutal inequality. The issue of payments was another problem because with the insufficiency of the public sector, benefits were bought from the private sector, but the public sector was paid one and the private sector was paid 1.3 or 1.4, therefore, it was business. The reasoning is, “I do not expand the public sector so that it pays the private sector,” which are ultimately the promoters of the health business.

Q. I understand that right now the capacity of beds in Chile is 90% of its capacity.

A. Yes. In other words, in the Metropolitan region we are currently at 95% and nationally at 90%. We are transferring patients from the metropolitan region to nearby regions, more or less between 100 to 150 km, or when there has been a need, a patient has been transferred up to 500 km away. The complex thing is how the crisis that is coming from

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