In the midst of the debate over the attempt by the Government of Gustavo Petro to perform surgery on the health system, this weekend the country reaches the third anniversary of the harsh quarantine that was decreed to face the covid-19 pandemic and that, step, remember how this sector that now wants to intervene demonstrated the strength of which it is coated. The reason is that, in the midst of the problems that had to be resolved, it faced the contingency and served almost the entire population; today, for example, only those who did not get immunized by will are not vaccinated.
The virus, without a doubt, left indelible marks in Colombia. At the end of 2020 and much of 2021, it became the leading cause of death while strict confinements, curfews and mobility restrictions generated an unprecedented economic impact that raised the poverty figure to 21.2 million people. .
Even so, the medical contingency on behalf of the sick and seriously ill due to the virus caused Colombia to go through four waves of massive infections between July-August 2020, January 2021, April-July 2021 and January-February 2022. In this framework, although the health services were at the top, the system withstood the impact of the demand for care on behalf of patients with covid and those who had to be treated in intensive care units (ICU).
How did you transform the system?
The number of ICU beds was one of the biggest gains for the system in the midst of the health emergency. In the months of greatest suffocation for medical services, in Colombia there were between 10,000 (October 2020) and 11,000 (January 2022) ICUs available to care for seriously ill patients with covid.
As of March of this year, the Integrated Social Protection Information System (SISPRO) reports that there are 8,353 intensive care beds. Of these, 38.20% (3,191) are intended for the care of patients with this virus.
In fact, the Health Situation Analysis (ASIS) that the Ministry of Health has presented in the last two years show how the system has equipped itself with more care in intensive care.
The 2019 ASIS shows that there were 8,131 ICU beds for a population of 50.3 million inhabitants, which represented 1.6 beds for every 10,000 inhabitants; Meanwhile, the 2021 ASIS reports 9,313 for a population of 51.6 million inhabitants, which is equivalent to 1.8 beds per 10,000 inhabitants.
Despite this progress, the figure continues to be in the last places of the member countries of the Organization for Economic Cooperation and Development (OECD), where the last place is occupied by Mexico, with 1 bed per thousand inhabitants; followed by Costa Rica, with 1.2 beds per thousand inhabitants; then Colombia, with 1.7, and Chile with 1.9.
Given this, the medical researcher and professor at the Javeriana University, Camilo Prieto Valderrama, told EL COLOMBIANO that this shows that the country came out “strengthened in terms of the installed capacity of intermediate and intensive care, especially in remote areas of the country”, although he warned that “there is a risk that this cannot be maintained over time, since this equipment requires maintenance and personnel to be operated”.
For his part, the senior researcher at the Department of Global Health at Harvard University, Johnattan García, added that with this equipment the health system was able to care for “everyone who had any symptoms of covid-19. The system did not collapse and that is why there was never a situation in which there was a lack of care space in intensive care”.
To this approach was added the doctor and master in infections and integral medicine, Leonard Maiguel, who stated that the sector “responded well above expectations and the bad publicity that is constantly given to it, since the intensive care units, the emergencies and medical services responded by treating the most serious cases.”
Colombia: the worst qualified?
In his eagerness to present numbers that support his health reform, the president presented on his favorite balcony –Twitter– a ranking carried out by Bloomberg that showed that Colombia is one of the worst qualified countries in the management of the covid (see trill).
And he added the legend: “This is why a health reform must be carried out. The absence of a preventive and primary care system leaves us much more vulnerable to pandemics than most countries in the world.”
However, this premise went wrong and, instead of criticizing, what he ended up doing, unintentionally, was a compliment to the health system. It turns out that the news that he shared on March 11 with that ranking was from June 2021. In fact, the same Bloomberg ranking from a year later (June 2022) placed Colombia in 12th place, above Chile, Singapore, Belgium, Israel and France. The Chilean cartoon says: Plop!
The explanation for this good qualification, explains García, is due in part to the fact that “it was a response adjusted to the conditions we have in the country, which is based on a health system that allows citizens to have support and financial protection which was spectacular, because there were no cases of people who could not enter an ICU or who had to face extraordinary costs to be able to access this type of services”.
Likewise, he added, the role of the National Institute of Health (INS) was crucial to have “follow-up on the cases, have almost integrated information from many sources to have information on available beds, test results, infections and deceased people ”.
Such was the level of guaranteed care that the health promoting entities (EPS) of the subsidized regime maintained in 2020 the average number of people served and care in procedures per year, according to SISPRO data. In 2019, they treated 32.3 million people and performed 434.2 million procedures; in 2020, they did the same with 27.7 million people and in 384.2 million procedures; and in 2021, the figure was 30.5 million people and 423.9 million procedures.
In 2022, these insurers served 25.9 million people and guaranteed 355.4 million health care.
Precisely because of this success and because of the trust that many sectors still place in the EPS, the reform of the Petro government has not managed to penetrate enough in Congress. The document was presented on March 13 and there has not been a single presentation on the subject to date. Added to that, parties such as the U, the Liberal and the Conservative have been distancing themselves from the articles proposed by the Government.
Even so, President Petro assured this Saturday from the Dominican Republic that his cabinet has held “intense meetings” with all sectors to “reach a maximum consensus without the Government losing the fundamental axes of the reform” for which, according to him , there is already “95% of that project agreed”.
Does it leave lessons for reform?
Three years after the toughest contingency that health in Colombia -and in any country in the world- has experienced, its response in those years is at the hand of the national Government to evaluate the strengths of the system, in the midst of the debate about that in Congress rakes in how it should be reformed.
Given this, Dr. Prieto points out that the reform that President Petro and the minister of the sector, Carolina Corcho, want to carry out, “cannot see the past as an enemy to be destroyed, with a clean slate perspective, but rather as an ally that allows to generate a better service to the citizens”. Therefore, a lesson that the pandemic left for him is that “Colombia does not have a perfect system, like no country does, but it does have the capacity to respond to contingent events and expand its service capacity.”
For his part, researcher García noted that the health system must always be improving and that the reform “takes half a step forward in the information system that they want to remove, but it is more thought about cost issues than clinical infrastructure. It is necessary to think not only about money, but also about the public health infrastructure”.
“The challenge is to take the lessons learned from the pandemic to better prepare for the future, as well as to encourage the national production of vaccines and not depend on foreigners to produce them, as well as having agreements with those who develop the vaccines to produce them in the country”, added Leonard Maiguel.
This is how vaccination moved
Mass immunization, which began on February 17, 2021, has resulted in the application of more than 90 million doses to the population. Of these, more than 36 million have been for first doses, more than 30 million for second doses, more than 14 million for booster doses and more than 2 million for second booster doses, for a total of 36.9 million regimens. complete immunization
This mass immunization process had its peak between May 2021 and March 2022, dates on which up to 2.5 million doses were applied per day.
“Vaccination was massive, the distribution of the vaccines was adequate and people found the vaccines in the care centers and, although they did not arrive in the first months, as they did they were applied relatively quickly and this was the key factor for to be able to stop the number of deaths and serious cases in the pandemic”, said the doctor Leonard Maiguel in this regard.
However, these two factors behaved, at least, atypically last year. Although the number of infections had a high peak of infections between January and February, the number of deaths was below 300 per day: half of those that occurred between April and July 2021, where the daily deaths reached up to 693.
Likewise, vaccination performed well in the first two months of 2022, in which more than 1 million doses were applied per day.
Without going any further, given the apparent test overcome after almost three years, what remains is to appropriate what has been learned, take care of what has been gained in terms of hospital system equipment, and hold accountable those who in the past have asked for the broadest for them, in the opposition, and the narrow for the others, in the Government.
5.346
they were the ICU beds that the country had in February 2020, before the pandemic.
