The judicious, measured, tempered and current words of Antoni Castells, a prestigious gastroenterologist and at the time medical director of an institution of the stature of Hospital Clinic in Barcelona, recently published in Gastroenterología y Hepatología [Gastroenterology and Hepatology],1 a journal under his worthy management, should not fall into oblivion. Although the topic is not directly related to the speciality, his words are important insofar as they address a medical matter of general interest.
The COVID-19 pandemic has had, is having and will continue to have a devastating effect on health services and on people’s lives, obviously greater still when we take stock of the loss of life. In terms of the recovery of the individuals, families and society as a whole, the effect is going to last a long time. The economic losses, both those already registered and those to be registered, will be beyond any calculation imaginable by normal individuals, including this writer. The collapse of the economy is a fact, the disappearance of small businesses, the massive destruction of employment – already contemplated and recognised even by the central government and the autonomous regions – the ruin of the state, are already here. Extremely tough decades are ahead for citizens, and not only in Spain.
Castells’ duality, both as clinician and healthcare manager, means he has participated in managing an unprecedented crisis. Those of us who have only participated as clinicians to a greater or lesser extent, depending on our distance from the front line caring for patients with symptoms and diagnosis of COVID-19, can understand what we have experienced and are still experiencing, trying to guess what is still to come. We may not be able to understand what it means to make decisions in these circumstances, like airline pilots, who are essentially prepared for crisis management,2 even though we handle crises on a daily basis. Castells’ brief but hard going letter1 mentions the ability to adapt: to an unexpected situation – a crisis; to decision-making – a difficult and complex process; to the lessons we have all learned; to the lesson of humility that we have all received; and to the recognition of the responsibility and professionalism of all those who are part of, and participants in, the various healthcare systems. For those of us dedicated to Medicine, to healthcare, regardless of the role and function we play as professionals, these observations are a very important message for the community.
Many questions and doubts, both medical and non-medical, remain to be clarified. For example, how many post-mortems have been performed on COVID-19 patients? Post-mortem examinations are the highest level of quality control for an institution, especially a university hospital, with or without imaging3 and it is an invaluable tool for expanding our knowledge of this and any other disease. For instance, although we have information from the multiple studies now underway, when will we have a safe and effective vaccine? For example, what were the political and social factors which led to the different mortality rates depending on the country? The Government of Spain had already published documents on the prevention and action against the influenza pandemics in 2005, 2006 and 2007.4 And so on.
Castells has emphasised very important aspects of managing this crisis, such as the mention of inadequate financing for the Spanish health service or, to quote him, “It would be nice if the ‘experts’ who advise the different governments recognised that they make up for their ignorance with doses of ideological arrogance, only comparable to the selfishness and partisan interest of those they serve….”; words which I share, endorse and subscribe to. This would be another lesson which anyone reading Gastroenterología y Hepatología would recommend these actors to learn.
In any case, I reiterate what I said at the beginning of this short document, that Castells’ judicious, measured and tempered words should not be forgotten. Healthcare professionals have complied. The rest, under obligation, must comply. What will follow the pandemic is not just an economic or social crisis. It will be living with uncertainty and death. It will mean more nationwide safety protocols being established, which will then be the excuse for greater control of our lives; and it will mean a need to guarantee protection of citizens against such abuse.
Please cite this article as: Mestres C-A. COVID-19: una pandemia de valores y algo más. Gastroenterol Hepatol. 2020;43:385–386.
