“The restrictions are the product of an ineffective health policy”, says Roberto Debbag

“In June, daily mortality will start to drop. Signs of control of the pandemic will appear by the end of the year. If we get vaccinated, the coronavirus is going to be a different story for us ”. Roberto Debbag He is not one of those who doubt: either he is silent or he affirms. He has years of experience at Garrahan Hospital and in the booming pharmaceutical industry. He is president-elect of the Latin American Society of Pediatric Infectology, as well as advisor to Mario Fiad, president of the Senate Committee on Health. Bugle She interviewed him because he is a respected physician who is distinguished by his solid observations and critical outlook on managing the pandemic.

-The government plans to complete the vaccination of the first major risk group (over 60 and people aged 18 to 59 with co-morbidities) by early June. What do you think of this expectation?

-May be a real wait. I would say that by the end of June, as long as the vaccine delivery schedules are respected; in particular, the 4 million doses of AstraZeneca. If they do not arrive, it is not filled. If they arrive, of all the communications the state has made about the vaccination campaign, that would be the first promise that would be kept. We are talking about single-dose diets, for 13 to 14 million people.

-The Covid strikes without distinguishing between the first world and developing countries. To what extent has this intense wave been inevitable and to what extent is it a consequence of the decision-making (and lack of decision) of the authorities?

-There are reports of (Economic Commission for Latin America and the Caribbean) ECLAC which show that Latin America is one of the regions most affected by its inherent social inequalities, notably the lack of access to health systems and decades of corruption in the region. Argentina is not exempt. During the first six to eight months, the dynamics of the virus were unknown. There wasn’t much to avoid. But since the end of last year and the start of it, without a doubt, some of the impact of the pandemic could be avoided.

-What was done wrong?

-Things would have been different if the three legs that support the pandemic control table had been strengthened. The first is citizen communication. In the United States, infectologists, epidemiologists and scientific societies have been analyzed according to their level of credibility. The most credible person turned out to be Anthony Fauci, an independent doctor from the American political division. Here, it would have been good to find one or more personalities far from the political divide, who could be “spokespersons”, carrying citizen communication.

-The return match?

-The testing policy. Not only the number of tests per day, which is very important, but the strategy of finding people with and without symptoms. This has not been done. Testing is not the only thing, but if there had been an effective strategy, such an increase in infections and deaths would have been avoided.

– But even the health authorities who took office after the VIP vaccination scandal downplay positivity, a variable based on the number of tests. Why is this happening?

-It is a mistake. Testing is not the only tool, but it is an essential tool that decreases transmissibility.

-But why is this happening?

-The testing strategy is ineffective. Millions of rapid tests have been purchased, but they are unnecessary for people with little or no symptoms. I’m not going to talk about politics, only medicine, but in Ezeiza they do antigen tests and not PCR. It is a mistake. The authorities are advised by a group of experts, long-time colleagues whom I respect, but they summon them to a meeting at Olivos or Casa Rosada and in an hour and a half they have to resolve some central issues. They should work several hours a day and generate a consensus that is reflected daily in public documents. It is not an individual problem but a problem of functioning. The work must be daily, intense and in a group.

-How should these working groups be?

-I would organize four large groups with leadership and responsibility. They wouldn’t come to a meeting for a few hours. It would take hours of these advisers to work day and night to generate citizen communication that gives a halo of credibility on measures and prevention against the virus. The second group would focus on testing, including finding asymptomatic patients. And that would produce a new consensus on testing … strategies designed months ago need to be revised. The third group, with skill in economics and medicine, it would focus on access to vaccines. They would make all the calls necessary to generate new deals. The fourth would measure the effectiveness of the measures. All independent political professionals.

– But the Ministry of Health does not do all this?

-In this way? If I say “I want to know the details of these four control lines daily», As a citizen, I do not have this information. Even conversations from the National Immunization Commission are not communicated quickly. In countries like the United States, commissions like this operate with very clear rules, which include the representation of citizens, who can listen and make their voices heard.

-Before you spoke of three “free legs” in the management of the pandemic. The third is missing.

-It is precisely access to vaccines. Since January, the number of people who have died and the suffering of many families could have been reduced. Deaths in the final hours, with a dose administered around April 15, could have been reduced. There is a part of the story of the pandemic in Argentina that could have been avoided. I say this without taking into account the impact of prolonged quarantines in terms of poverty, access to healthy food and physical and emotional dimensions on children due to the closure of schools.

-You have always supported school attendance, but we are the fifth country with the most active cases of Covid in the world. What do you think of New measures?

-We have to look at the indicators by jurisdiction: intensive therapy and access -or not- to adequate tests and vaccines. At the end of the history of restrictions and with a high level of transmission, it makes sense to close schools. Sooner or later, that’s what ends up happening. It is necessary to adopt more profound restrictions, but they are the product of the ineffective health policy of the pandemic in terms of communicational credibility, in the screening strategy and in access to vaccines.

Speaking of vaccines, what could have been done better?

-When I hear that vaccines are not accessible … Let’s see, there was no efficiency neither in the consolidation of adequate agreements nor in the diplomatic strategies.

-What do you think of the frustrated deal with Pfizer?

-It should be analyzed from righteousness, not science. We could have been one of the top rated countries for a business like this. A very large study was done here, with 6,500 volunteers. It was a great approach. And there are three Argentines linked to the company who could have produced a facilitating effect: the doctors who work at Pfizer Alejandro Cané and Alejandra Gurtman, and Fernando Polack, who led the trial here. They could have been involved to speed up the transaction. An opportunity was missed.

– Coming back to the schools, is it acceptable to close them in this case?

-It wouldn’t be very academic to say whether they should shut down or not, just by looking at the data on daily infections, without access to the rest of the variables: who gets sick, how, how they were detected. Many experts do not access deep data. They should at least be able to access advisers and then publish them.

-Why are you not part of the group of government advisers?

-I was in the United States when the pandemic started. When I managed to get on a plane, I already saw the consolidated photo of the advisory group. They are all friends. There are no cracks in there. Seeing it from afar, luckily I did not participate. I could take a different action, be a citizen voice, so called peaceful lawyer (patient advocate), who communicates his mistakes and successes to society. I am convinced that a lot of advisers think the same as I do, but they are unable to say it because they have to abide by a series of rules.

-Where are we in the wave and what will happen in the next few weeks?

-We are in the most difficult, the most painful moment since the arrival of the first case of Covid from abroad. It might get worse in the next few weeks. But by the end of June, daily mortality will decrease. Signs of control of the pandemic will appear by the end of the year. If we get vaccinated, we’ll have a different story. We’re going to have a better vacation. With the infection, yes, but not with the current intensity. It all depends on the state.

– So not to mention the winter tourist vacation?

-No, I do not think so.

From telemedicine to running

Roberto Debbag He is an infectologist at UBA specializing in pediatrics. “After the residency at the San Justo Children’s Hospital, I trained with who is our teacher: Daniel Stamboulian. René Favaloro led the cardiovascular team. It was the golden age of Sanatorio Güemes, ”he recalls.

At the end of the 1980s, he promoted the creation of the infectology department at Garrahan Hospital, where he worked for 20 years. In 2004, already in the private sector, he was director for Latin America of the Sanofi-Pasteur laboratory. And ten years later, back in Garrahan, he promoted the national pediatric telemedicine program.

Debbag is 65 years old. It is precise and detailed. Without a doubt, calculator. His life outside of medicine stands out as a runner. Marathon runner, in fact. At the end of 2020, he began advising the president of the Senate National Health Commission, Mario Fiad. And he is vice-president of the Latin American Society of Pediatric Infectology. But from October, he will chair this body.

PS