l servizio sanitario in Germania ha retto molto meglio la pressione della crisi Covid-19 rispetto al quello italiano. Stiamo pagando scelte di spesa e investimenti sbagliati, e una burocratizzazione estrema del sistema ospedaliero. Cosa potrebbe succedere qualora in autunno il virus tornasse con forza?

PERCHÉ È IMPORTANTE   Sia in Italia che in Germania circa lo 0.4% della popolazione è risultato positivo al Coronavirus. Mentre la curva dei contagi sembra seguire la stessa traiettoria, la percentuale di morti su 1000 casi è di 3,5 volte superiore in Italia che in Germania.

Perché? Gli ospedali tedeschi hanno una maggior resistenza in tempo di crisi, grazie ad una forte competizione tra di essi, siano essi pubblici o privati.

TESTARE LA DIFFERENZA   Al contrario di quanto avviene in Italia il governo centrale tedesco, insieme ai lander, ha dato via libera ai laboratori privati ai test e nel momento in cui scriviamo più del 3% della popolazione è stata testata. In Italia invece i test si limitano allo 0.5% della popolazione fermandosi a quota 3 milioni circa di cui la metà nelle regioni di Lombardia, Veneto e Piemonte.

Ricordando che in Germania l’epidemia è iniziata circa 10 giorni dopo rispetto l’Italia possiamo ampiamente notare come il governo a guida Merkel abbia reagito diversamente da quello Italiano.

CENTRALISMO VS. FEDERALISMO   Infatti non solo in Germania sono i cittadini a decidere se fare il test e dove, ma il governo federale ha anche istituito grazie al supporto di aziende private, i cosiddetti laboratori drive in dove i tamponi vengono fatti direttamente dal finestrino dell’auto.

In Italia al contrario si è deciso per centralizzare tutto in alcuni laboratori statali, e seguendo le direttive OMS, si è deciso di fare i tamponi solo ai soggetti fortemente sintomatici (fatta eccezione per il Veneto dove invece il governo locale ha deciso di testare tutta la popolazione sia essa sintomatica o meno), portando questi laboratori al quasi totale collasso.

SPESA PUBBLICA E POSTI LETTO   Ma veniamo ad un’altra domanda che in tanti si chiedono. Come mai abbiamo così pochi posti di terapia intensiva quando la spesa sanitaria è la seconda voce per volume della spesa pubblica dopo le pensioni? ln Germania i posti letto a inizio pandemia erano circa il triplo di quelli Italiani (8,6 ogni 100 mila abitanti in Italia contro i 33,9, tedeschi) arrivando a circa 50.2 letti ogni 100 mila abitanti a inizio Maggio. 

Se si considera che la maggior parte dei posti in terapia intensiva sono nelle regioni del Veneto, Lombardia, Piemonte ed Emilia Romagna (circa 3600 su un totale di 9200) si può ampiamente dire che una buona parte dell’Italia è quasi completamente scoperta.

Il motivo di questa scelta è da vedersi nelle scelte dei governi degli ultimi 10 anni in cui si è deciso di investire sul welfare più che sulla cura della persona, e dove si è deciso di non copiare i modelli del nord d’Italia ma di proseguire una politica dedicata a sussidi pubblici ad enti burocratici non funzionanti.

UN PAESE A RISCHIO   L’emergenza è passata e ora c’è da chiedersi siamo pronti per una nuova ondata, che molti esperti dicono arriverà in autunno. Siamo attrezzati per una nuova pandemia?

La risposta è no. Dobbiamo lasciare i privati investire, seguire il modello lombardo di organizzazione sanitaria, che in tanti criticano ma che ha resistito ad uno tsunami, e aggiungere il campionamento a tappeto fatto in Veneto. Bisogna insomma riformare la nostra sanità in stile tedesco, lasciando spazio ai privati di fare competizione al pubblico, senza mai dimenticarsi il principio di universalità del sistema sanitario nazionale.

È necessario riformare il nostro sistema e farlo alla svelta, i modelli vincenti ci sono. Sarà la nostra classe politica pronta a fare questa riforma oppure sarà ancora schiava di logiche clientelari?

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

What were public health officials at every level of government doing last year? Were they preparing for a pandemic? Or were they using their office to meddle with your lifestyle choices?

The partisan political sniping over Covid-19 is completely predictable and counter-productive. There’s plenty of fault to go around, but the blame-gaming should be ignored or discounted for what it is: self-aggrandizing grandstanding.

It is, however, worthwhile to examine a tension that has been brewing in the public health world for decades. That dichotomy is: should we focus on communicable diseases, as has long been the mission of public health institutions, or do we have enough bandwidth and resources to venture out into the much more controversial area of non-communicable diseases (NCDs)?

To get to the answer, think about this. What were public health officials at every level of government doing last year? Five years ago? Were they first ensuring that their track and trace systems were in place for a pandemic? Or were they using their office to meddle with your lifestyle choices?

The discipline of public health has long been rooted in fighting contagious diseases. For the most part, it has done very well. Notwithstanding the current Covid-19 pandemic, sanitation, vaccines and therapies—mainly drugs—have dramatically reduced the toll of communicable diseases.

That success has led many in public health agencies, especially in the United States, to argue that we must now use our limited resources to combat NCDs, and that we can address both effectively. It isn’t exactly working out that way.

Efforts to fight non-contagious diseases such as heart disease and diabetes frequently raise questions about individual liberty, including the freedom to make poor choices. All too often, the politicized debate causes both sides to overstate or manipulate the science supporting their viewpoints.

When former New York City Mayor Michael Bloomberg, the biggest booster of today’s public health movement, campaigned against sugary drinks like soda, it landed the city’s health department in hot water. For instance, a taxpayer-funded ad campaign created by the Department of Health showed a photo of a man purportedly with amputated legs. The city’s ad agency had Photoshopped his legs out of the photo to support the valid claim that Type 2 diabetes can lead to amputations.

The Bloomberg administration’s antics, which even elicited criticism from within the health department, indicates the degree to which his wing of the public health movement has lost sight of its most primary and unifying functions: preparedness.

This lack of preparedness is not partisan. It exists in the current Republican administration, as it did in the prior Democrat administration. Cities, counties, and states long governed by each party were equally ill-prepared for a pandemic.

Commentators on the left and the right have referred to Coronavirus and Covid-19 as a “black swan event.” But it doesn’t meet the definition. A pandemic of this type was not only predictable, it was something communicable disease experts have warned about rather specifically for many years. The warning signs were ignored, and we were ill-prepared.

A 2007 review article in the American Society for Microbiology’s publication, Clinical Microbiology Reviews, entitled, “Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection,” concluded: “Coronaviruses are well known to undergo genetic recombination, which may lead to new genotypes and outbreaks. The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.”

Rather than marshal finite resources towards preparedness for a coming communicable disease, lots of public health resources, including taxpayer dollars, media attention, and legislative priorities, were deployed to address non-communicable diseases, from domestic violence to gun regulation.

Think back to a different time not so long ago. During the second half of 2019, federal, state and city health officials throughout the country were busy confronting a new and scary lung disease. The health reporters covering them churned out news articles, regularly garnering front-page placement. Major charities such as Bloomberg Philanthropies were making large public health grants. So it should come as no surprise that the American public and political leaders were keenly focused on this emerging health threat.

The disease wasn’t Covid-19, of course. It was a something the Centers for Disease Control called e-cigarette or vaping product use-associated lung injury, or EVALI.

At the time, public health activists were, for years, calling for bans on the types of e-cigarettes used to quit smoking. Despite strong evidence that nicotine e-cigarettes are 95 percent less harmful than smoking and can help smokers quit, public health agencies treated e-cigarettes as the most important threat to public health. Yet they still failed to convince policymakers to institute widespread bans on the most popular e-cigarettes.

But as consciousness of EVALI reached a crescendo, states began to ban most flavored e-cigarettes, and the FDA further tightened the regulatory screws on nicotine-containing e-cigarettes.

It turned out that none of these nicotine e-cigarettes were ever responsible for the lung disease that bears their name. It took until late December for the Centers for Disease Control to (partly) acknowledge that the lung injuries were caused not by vaping liquid nicotine e-cigarettes such as Juul, but by the use of THC oil contaminated with vitamin E acetate.

Public health agencies were so ideologically opposed to e-cigarettes as a tool for tobacco harm reduction that they sowed panic, promulgated misinformation, and actually caused a failure to identify the true culprit in a life-saving and timely way. Still, nobody has been held accountable.

So, back to the question about communicable and non-communicable disease: Has public health been able to “do both” well? It turns out, that when purportedly trying to do both, public health hasn’t been able to do either effectively.

I’m not suggesting that public health’s EVALI scandal was the only or even primary culprit for the failure of public health departments around the country to ensure that their communities had an adequate supply of personal protective equipment in the event of a predictable communicable disease outbreak, or that the CDC was otherwise preoccupied. Instead, the EVALI episode was more of a symptom of something wrong in public health.

The institution of public health has largely been co-opted by those with a desire to control individual choices to such a degree that it has largely lost sight of its fundamental role of pandemic preparedness. At this point, taxpayers should realize that we are giving the keys to the public health car to people who have long been driving in the wrong direction.

Originally published here.

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org