Fernando García López: "Madrid manipulated the Covid data as it does with the waiting lists"

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BarcelonaUntil his recent retirement, Fernando García López worked for the National Epidemiology Centre and served as spokesperson for the Madrid Public Health Association. He participated in one of the most revealing studies of the consequences of the pandemic in Europe, led by the University of Southampton, and in this interview he reflects on two proven realities: that in Europe and Spain the risks of the pandemic were trivialised and that poor management results in an unacceptable number of deaths.

Was the lack of transparency in the data the main problem in making decisions?

— The public health information system in Spain was very precarious. The proof is that until the end of July the Ministry of Health did not begin to issue reports with the incidence, deaths and hospitalizations of all communities. For more than two months this information was not unified, and without data it cannot operate.

Did regional powers in public health make control more difficult?

— This system has its reason for being and the important thing is that the communities have the resources and the necessary endowment to assume their responsibility. What was evident were the differences in management. The study by the University of Southampton compared three elements between the different territories: the excess of deaths compared to previous years, the decrease in life expectancy and the increase in years of life lost. All the communities were compared and abysmal differences were found. Madrid was the one with the worst indicators: four years of life expectancy lost at birth and an enormous excess of deaths.

Why did this happen?

— 20% of the excess deaths in Spain occurred in Madrid, followed by the Castillas due to the enormous mobility between the territories. But these differences were not due to a natural phenomenon, but to health management, which was worse in Madrid. They did not realise the magnitude of the epidemic until there was already massive community transmission and management was abandoned in the areas with the highest risk, the nursing homes.

State and regional data rarely coincided. Catalonia reported a lot, which made it impossible to compare data.

— Catalonia did what it had to do. What cannot happen is interference by the authorities to disguise the data, as Madrid did with Covid deaths and as it has been doing for a long time with waiting lists. For example, using criteria other than those set by the Interterritorial Health Council. This is unacceptable.

There have always been disagreements between the State and the autonomous regions.

— Yes. When the state of alarm was announced, the policies were uniform for everyone, but ideological reasons soon prevailed. In Madrid, measures were promoted that reduced confinement or limits on social contact under the banner of individual freedom. It went hand in hand with a trend throughout Europe that denied the existence of the virus, said that the PCR was an inadequate diagnostic test and questioned the vaccine.

He says that Madrid was the most affected area, but there was talk of a "Madrid miracle."

— Yes, there were 22,000 excess deaths in Madrid and 42% more deaths than reported. In other words, deaths were counted, but many were not attributed to Covid as the cause. I, who was faithfully following the data to really know the magnitude of the deaths, had to look at the data from funeral homes. So there was no Madrid miracle. The French came here for the freedom to drink beer on terraces. But the fact that life expectancy dropped by four years means that not only older people died, but also younger people.

At the other extreme, Catalonia implemented unpopular measures, such as closing the hospitality industry, but in more advanced waves it did not prevent high death rates either.

— It is difficult to analyse whether the measures worked separately. But, if I remember correctly, it got out of control when the delta variant arrived at Christmas. Although there was a recommendation to meet with the window open or not to celebrate it, people continued to see it as a sacred meeting, let their guard down and there were very high spikes in infections that caused many deaths.

How do you rate the measures taken five years later?

— The lockdown measure, due to the magnitude of the epidemic and massive community transmission, was indispensable. Another second measure that was very important was the vaccines. And as an extra-health measure, the temporary employment regulation files (ERTO) reduced the increase in inequality that was inherently expected from the stoppage of the economy and that, however, occurred.

But we were not prepared to manage the pandemic, but rather to react to it.

— The European Centre for Disease Control and Prevention (ECDC) itself downplayed the risk of what was happening. I think the experience of influenza A in 2009 had an influence, as countries stockpiled a lot of medicines and in the end it had a low impact. The rulers themselves realised that they had exaggerated its severity, which, indirectly, years later, created the false security that Covid would not reach us. In January, hospitals were seeing severe pneumonia, but there was no clinical communication or tests to identify it. In short: we had overconfidence and structural deficits to take measures to control the virus. Only Asian countries, Australia and New Zealand knew how to respond, and economically the damage to Europe and the United States was much greater.

We still don't have a Spanish or European pandemic plan. What do you think is holding us back?

— The World Health Organisation (WHO) has not either, and it has been trying to get it through for three years. Now we have just seen how the United States has stopped funding it. And there are many interests at stake. For example, there are attempts to promote that vaccines do not have patents and can be distributed worldwide, but pharmaceutical companies are lobbying to prevent this.

The visible face of epidemiology in Spain, Fernando Simón, said he was "well prepared" for a new pandemic.

— I have my doubts. The problem is not whether there will be a new pandemic, but when. As a country, I think we are better prepared in terms of information systems and we know that if there is another alarm, it must be taken seriously, but as far as a hypothetical state of alarm is concerned, we will continue to be unprepared legally. The Evaluacovid-19 report reflects the strengths and weaknesses of management, and also mentions important aspects, such as how Europe should have an industry to manufacture masks, respirators and medication and not depend on third parties.