Modern times

By : Alberto Palacios
Jefe del Departamento de Inmunología y Reumatología del Hospital de los Angeles Pedregal en CDMX

26 November, 2020

"The poor, the old and the chronically ill are dying without need. I ask myself with you: is it not the duty of the State to avoid it, to return our credulity in concrete measures of assistance and health rather than to take over as accountants for the damage? "

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Over one hundred thousand deaths (and counting); this does not let up. These are not graphics or slides. I have seen the face of death in marginalized, diabetic patients whose rarefied lungs no longer serve them. They are these martyrs who have joined so many others without a voice in a neighborhood near my hospital. Dozens of more deaths which, because of their irrelevance, do not contaminate the brand-new official figures. Their families and I are fed up with the vanity and triumphalism displayed by governmental spokesmen. Here the only thing that has been defeated is the truth.

As I look out my window, having recovered a few coronavirus patients, I can feel the dawn and this slightly cleaner atmosphere that allows me to distinguish the margins of my city. I listen to Sarah McLachlan singing "Angel" from her home and think with measured optimism that perhaps, a more contemplative, even more supportive, future awaits us.

I believe, by the force of renewed fervor, that we will take to the streets with prudence, that the bars will see us provide fearless toasts, kiss each other again, lift our souls and rewrite our silences. We will be less, and we will have that regret of not having launched the lifeboats in time when the hurricane was coming. But we will also discover ourselves as children, usurping the air, the squares, and the once forbidden corners.

Think for a moment about all the mistakes we have made as a species. We destroyed our environment, we imposed asphalt and concrete where once were natural gardens. We cut down the lushest forests to lay out roads and make furniture or floors taken away by pride and contempt for other species.

Meditate with me on the recent mistakes: to think that we could contain the progression of SARS-CoV-2 with flimsy isolation measures. That we could cure it with antivirals that have not worked for other similar diseases. That we could lessen its destruction because we are invincible or that it occurs to us (like Didier Raoult or like his front man Donald Trump) that a drug can be used by imposition without having been properly studied. Or even worse, to think that herd immunity is achieved without major setbacks, because a ruler or pseudo-preachers of science can dispose of many human beings from the comfort of their sanctuaries.

I do not. For me, as a physician and observer of souls, any life has an endearing value. Regardless of their race, their religion, their socioeconomic status and their achievements or merits. When I receive a patient, I accept that a quality has been bestowed upon me - not without effort and dedication - that forces me to protect and restore his or her health to the best of my ability. At the beginning of this pandemic, I had little idea of what to offer COVID-19 patients to avoid a fatal outcome; but I have studied hard and have been able to discern that when the virus attacks the vascular endothelium, it becomes imperative to protect the blood flow, avoid clots and attenuate the storm of cytokines that characterizes its onslaught. Despite my small clinical triumphs, I do not boast of any heroic position. On the contrary,  the release of mobility that we adopted a week ago seems premature to me, as well as to pretend that we have defeated such an aggressive enemy. Contagions continue to rise and to speak of a "new normal" at the height of the pandemic is an exercise in foolishness, to say the least.

Data from other countries (Spain, Italy and France) that suffered serious losses show that they decided to reduce confinement controls when they were sure that contagions were bordering on the minimum. Here we have rushed to give an impulse to the economy without guaranteeing adequate protection conditions for a mostly poor and obese population. I hope that we will not have to complain to our rulers about their lack of judgment, because the price of losing lives unnecessarily will be very high.

Now that the streets of my city are not very busy and its inhabitants are masked and fearful, I recreate in my fantasy those urban corners where I grew up, when time rode with candor and we thought we owned the planet. We forged Olympics and Soccer Championships in stadiums that defied the architectural majesty of other latitudes. Despite the fact that our governments, in a fit of rage, had cut off the voice of students and other rebels who fought for more democracy and less autarchy. 

But we could go out and take the sky by storm. The violence came from an archaic and repressive state that wanted to maintain its privileges at the cost of suppressing the voice of the needy and of the forgotten. Robberies were scarce and an almost innocent solidarity prevailed in the midst of so much injustice. Although there were "güeritos" and "caifanes" who contrasted socially, and who undoubtedly confronted each other in many ways, the collective feeling was that there was room for everyone.

It seems to me that three historical phenomena occurred which exacerbated social destabilization and created a general climate of distrust. One was the destruction of the countryside and the rural population in exchange for a disproportionate concentration in the cities. They grew until they became uninhabitable and, very peculiarly, the marginal strips were filled with outcasts and exiles coming from the increasingly deserted plains of this country. That in turn favored migration to the north, further despoiling the destitute communities. As Adolfo Gilly once said, the creation of a system of unproductive plots was Cardenismo's crassest economic mistake. 

Second, and just as serious, the perpetuation of nepotism sustained by a single, deeply corrupt and organically tribal party. Recurrent elites (like an imperial oligarchy that inherited positions and privileges) plundered the country and weakened democracy to the point of making it despicable, inoperative and undesirable. We forgot how and why we should vote, because it made no difference whether we showed up or left everything in the hands of the same satraps.

Third, we inevitably became the privileged route for drugs to the world's largest market. This condition of transporters rather than producers caused an unprecedented socioeconomic imbalance. Incoming dirty money that no one had ever dreamed of. This led to the emergence of murderous gangs, hitmen to implement them and a change in the social perception of the powers that an indomitable society like ours (as well as Colombia, North Africa or Southeast Asia) was not prepared to face.

The results were predictable. More violence, more poverty, more discontent and the ungovernability we have been suffering.

In the midst of all this gloom, the pandemic broke out. Obviously, it took us by surprise and insufficiently prepared. Our people today are alarmed and prey to a generalized hypochondria that cannot be solved with tragic sums or unfulfilled promises. To dissolve the "day of healthy distance" when contagions multiply is as much as to make the population sick, leaving them to their own luck.

We should not expect a President or his entourage to be the saviors of the country; that is not even credible in free textbooks. But we can trust that the distribution and application of resources for health will be fair and proportionate, that the search for pharmacological answers and vaccines will be encouraged, and that we will receive a consensual guide as to which sectors of society deserve more care or greater protection.

The poor, the old and the chronically ill are dying unnecessarily. I wonder: is it not the duty of the State to prevent this, to restore our faith in concrete measures of assistance and health care instead of taking on the role of damage accountants?

I remind you of what the English doctor Rachel Clarke bravely stated: "The true metric of success in the face of this pandemic is the number of deaths that can be prevented. The goal of our response to COVID-19 is not the flattening of curves, enhancing the news or publishing illustrious headlines, protecting healthcare systems or inventing meaningless mathematical equations: it is and should be the prevention of unnecessary deaths."


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