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It happens Interviews

Covid-19, how to avoid further mistakes

Planning, management, partnership, promptness and vision

Interview with Giuseppe Ippolito

Scientific Director National “Lazzaro Spallanzani” Institute for Infectious Diseases (IRCCS)

By December 2020December 21st, 2020No Comments
Photo by Lorenzo De Simone

Covid-19 caught us unprepared. How could this happen?

It did because no one ever believes that bad things can actually happen and because, despite the different warning signs around the possible arrival of a big epidemic, or even a pandemic, nobody prepared or even pretended to. The American virologist Tony Fauci always used to say that sooner or later there was going to be an epidemic, but no one believed him. An infectious disease is like a fire: you don’t know when it might happen but you know that sooner or later it will, and when the country lacks adequate planning it is caught unprepared. Despite some preparedness plans being put in place we lacked a good coordination between those who work with science and those who work with management planning. The result was that no country in the world was ready, not even the United States, which have a federal agency- between the State Department and the Health Department- specifically dedicated to preparedness. Amid this really chaotic situation, Italy responded better than other countries; just looking at what is still happening today in the United States or other countries closer to us- such as England, France and part of Spain- makes you realise that we managed to respond to this emergency with confidence and also with a certain level of efficiency.

Infectious diseases are like a fire. When the country lacks adequate planning it is caught unprepared.

One of the functions of the World Health Organisation (WHO) should be to prepare the countries of the world on how to face circumstances like the Covid-19 pandemic…

The WHO and other bodies of the United Nations have been strongly criticised. The paper value balance, meaning the estimation of what they provide in relation to what they cost, seems to be negative. However, the coordinator role is fundamental. Nevertheless, despite the current director of the ‘The BMJ’, Fiona Godlee, writing for at least thirty years that the WHO required a serious restructuring, this has never happened.

We need to work on a model of efficiency and on creating strong central management.

Going back to Italy, how can the regional fragmentation that was observed during the management of the Covid-19 pandemic be explained?

Some regions were more impacted by Covid-19 and some were better able to provide a public healthcare response. According to the ANAC, the National Anticorruption Authority, the data on the expenditure per treated Covid-19 patient highlighted that the regions that managed to respond better, even among those that were more impacted by the epidemic, had lower expenses. I believe that we should work on a model of efficiency and on creating strong central management. Germany is an example of this- its regions (länder) are extremely powerful but the central role of the Government and of the Ministry of Health is such that during the Covid-19 emergency we only ever saw one single decision maker: Angela Merkel.

According to Richard Horton “there is no ultimate lesson to draw and there is no final meaning that might justify all the lives we lost for no reason, apart from- perhaps- this one consideration: Covid-19 defined the beginning of a new age”. In your opinion is there anything we can learn?

Covid-19 should have taught us that things do happen and that countries cannot plan to just replicate what other states are doing; they should rely on their own resources and capabilities. We cannot delegate the preparation, organisation and provision of services to other countries. Another lesson for us Europeans is that the European Union should also take “care” of healthcare and guide shared decisions. Healthcare should be part of the mandate of the European Union because, without a coordination of the healthcare of Member States, we just limit ourselves to the creation of regulations and the management of activities in time of peace, though it is in time of war that we need to act. This should be a useful example for everyone: France independently decided to reduce the quarantine period due to economic pressure, but if we live in Europe then decisions should be made together. Another lesson to draw is that preparedness also means creating a communication model and establishing what needs to be said and how to say it. If we don’t understand this then we got it all wrong.

Viruses don’t respect borders. We will always find ourselves in situations where all we can do is manage emergencies.

Finally, I would like to conclude by emphasising that, despite being in the middle of an emergency, we still managed to reorganise the healthcare system as though there were no other diseases apart from Covid- however, as we know all too well, other illnesses do still exist and continue to affect people. The Covid-19 pandemic should be the opportunity to reform healthcare globally: if we just think about increasing the number of intensive care unit beds or about investing in local services without a real reorganisation or a bit of coordination between countries- given that viruses don’t respect borders- we will always find ourselves in situations where all we can do is manage emergencies.

 

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