Understood as “the art and science of preventing disease, prolonging life and promoting health through organized efforts by society” (Acheson, 1988; WHO), Public Health was faced with a problem that, despite not being entirely surprising to professionals who dedicate themselves to this area of Medicine. The pandemic demanded the utmost attention and multiple diligences with a view to offering the necessary response with the greatest efficiency and, simultaneously, with the anticipation that a scenario such as that of a pandemic, “long identified as plausible by Public Health ”, requires.
The number of people infected with the new coronavirus already exceeds 14 million worldwide. Over here, there are more than 48 thousand cases of infection by SARS-Cov-2, and the total number of recovered people has risen to 33 thousand, in a global health crisis that reached the world at different rates and scales, exposing vulnerabilities. At the same time, the pandemic has taught important lessons so that, in the future, and armed with the knowledge and experience now acquired, we will be able to intervene with a better and more effective response, as explained by Ricardo Mexia, Public Health Physician in the Department of Epidemiology (DEP) of the Ricardo Jorge National Health Institute and Invited Assistant Professor at FMUL.
In the opinion of the epidemiologist and President of the National Association of Public Health Doctors, when we are facing a pandemic, “waiting, typically, leads us to waste time for a situation that is too complex”, so it is urgent to act. And making decisions “in a context of particular uncertainty” was and continues to be one of the biggest challenges, says Ricardo Mexia, noting the speed achieved with the knowledge that has been accumulating at an unprecedented rate as the epidemiological situation has evolved. “Which, on the one hand, facilitated speed in approaches, but created communication difficulties”, he stresses, recognizing in the state of emergency a timely measure and a “solution that, although drastic, was the only possible at the time”.
Ricardo Mexia highlights as a positive point the control of the pandemic in Portugal in the first phase, when the country was able to “flatten the curve and prevent the rupture of the health system”, which “handled the pressure well”. However, the epidemiologist attributes a negative grade to planning, stating that “we did not provide the country with the resources to face the increase in the number of cases expected at the end of the lockdown”. Despite the improvements in the current situation, Ricardo Mexia says he does not forget “the collapse of the SNS 24 line” and “the difficulty in making diagnoses available” in the first encounter with Covid-19.
In an interview with news@FMUL, he highlights “prevention and early case identification” as a fundamental part of the response to a pandemic such as the one we are now facing and commented on the difficulty felt with the gradual resumption of normal activity, especially in the Lisbon and Tagus Valley region.
Planning is the watchword. The country is expecting a "complicated" winter, so "it is important to anticipate" and "scale the response to a predictable increase in demand", says Ricardo Mexia, who sees in the current containment measures that govern individual behaviour for the reduction of contagion of the new coronavirus, a favourable advantage. This is because frequent hand hygiene, respiratory etiquette, physical distance and the use of a mask should also have “a significant impact in controlling the spread of flu”.
According to Ricardo Mexia, it is also imperative that each sector of activity adopts solutions that minimize the spread of the disease "and it is up to the Government to provide the country with the necessary response capacity". He refers to the anticipation of the flu season and the placement of more health professionals in the field as the most suitable strategy, as it guarantees that “more human resources are needed to act as quickly as the pandemic requires”.
He regrets that the “greater flexibility in hiring processes” that occurred in the management of the pandemic in Portugal, is “a reality that was limited to the hospital environment”, noting that “the recruitment of volunteers is not a permanent solution, nor is it with Public Health”.
Bearing in mind that “alarmism or panic do not add value, we have to understand the three possible solutions to the problem: the vaccine, group immunity or the cure”. And given that, currently, we still do not have the conditions to find, with total safety and scientific rigor, one of the three viable solutions to stop the pandemic, the only alternative is to use a mask which, in addition to physical distance and hand hygiene , makes up the combat trio, whose effectiveness Science has already proven, which is essential to prevent the transmission of the new coronavirus.
In his opinion, the Portuguese are still “in a process of learning and adapting” with regard to the use of the mask, which has become essential in everyone's daily life and is a habit to maintain, at least as long as there is no other way to prevent and treat covid-19. “But culturally it is not something that is usual and, in addition, the Portuguese live a lot in a context of being present”, explains the epidemiologist, alluding to a typical attitude of the Portuguese, who often continue to go to work regardless of having physical symptoms of illness.
Although there has been “a progressive increase in the correct use of the mask by the Portuguese”, Ricardo Mexia has no doubt that communication about the proper use of this personal protective equipment, the subject of favourable scientific studies, can still be improved.
It is never too late to act and knowledge does not occupy space, as the popular saying goes, so “there is still space for an awareness campaign” and education for civics, especially when it comes to discarding the mask, reiterates the Public Health doctor in a clear demonstration of the correct use of this PPE (personal protective equipment).
Promote health and prevent disease. This is what Covid-19 is about, a public health issue, whose resolution is everyone's responsibility so that we too can all overcome the problem, together, united in conscience and commitment, with the necessary resilience to create a better future.
Sofia Tavares
Editorial Team