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

In both Germany and the United Kingdom, around 0.18 per cent of the total population has recently tested positive for coronavirus. While the spread of the pandemic is roughly equal in these countries, the fatality rate is 420 per cent higher for patients treated by the NHS compared with those treated in Germany. This is because Germany’s hospitals are better placed to be resilient in times of crisis, thanks to the private and competitive aspects of the country’s healthcare system.

Germany’s decentralised and private laboratory network had already tested over two per cent of its population when the UK’s figure still stood at a meagre 0.7%. Britain’s centralised testing system, and its failure to scale up Covid-19 tests, might explain part of this mortality gap. One could assume that only very severe cases are being tested by the NHS and, as such, the fatality rate of this more concentrated group is higher.

Even if you make very generous adjustments to the figures and assume that Britain’s fatality rate would remain unchanged even if the NHS tested as many people as the German system, the UK would still have a 49 per cent higher death rate.

Not only are the NHS’s testing facilities incapable of dealing with black swan events, the entire healthcare system simply doesn’t have sufficient resilience to minimise the harm caused to patients by a virus such as Covid-19.

Conversely, Germany’s mainly private and non-profit hospital system leads the way in Europe when it comes to successfully facing this wave of patients. In early March, hospitals had already freed up beds in intensive care by pushing back elective surgeries, and the total capacity of ICU beds was ramped up 40 per cent within a month. Germany’s hospitals now have a total of 40,000 ICU beds and 30,000 beds with respiration units.

And all of this was achieved while still ensuring the provision of critical services such as cancer care and screening, which is something that the NHS is struggling to do – a problem that may cause more harm than Covid-19.

Thanks to the recent increase, Germany has now 48 ICU beds per 100,000 inhabitants, which is more than seven times the capacity the UK currently has. This month, the NHS published the occupancy rate of critical care beds in February, which showed over 80 per cent of those were in use. And while Germany was deploying a new public database showing critical care capacity per hospital, which is updated at least once a day, the NHS paused the publication of many of its own statistics, and those that are released are at least a month old.

What’s more, Germany’s new online ICU capacity register was built overnight, a tool that provides patients and doctors with invaluable guidance. One map, for example, shows that in Bavaria, which is the state worst-hit by Covid-19, just 16.1 per cent of ICU beds are occupied by patients with coronavirus. It also shows the available number of empty ICU beds. Bavaria still has 37 per cent of all its ICU beds empty and can, therefore, comfortably treat three times more Covid-19 patients than now.

This successful approach has taken place within a system where the government owns less than 30 per cent of all hospitals. Germany’s universal healthcare system embraces competition and private ownership of hospitals and outpatient services. So while the social insurance system covers 90 per cent of the population, the provision of care is mainly carried out by private for-profit hospitals or charities. 

Simply put, private hospitals and competition lead to much more efficient structures, and Germany’s decentralised healthcare system, which allowed for a speedy mitigation strategy, is now showing its value by saving thousands of lives. Indeed, Germany is not only weathering this storm better than the NHS but it is even able to fly in and treat hundreds of patients from Italy, France and Spain.

British policymakers will need to show courage in the coming months and be honest about the failings of the UK’s healthcare system during this crisis. There are two crucial lessons that will need to be learned in order to prevent, or at least mitigate, another lacklustre response in the future.

The first is that introducing more market mechanisms in the NHS would not mean that patients were denied care – you can have universal healthcare in a social insurance model too. And the second is that having more private hospitals does not necessarily lead to fewer hospital beds, but a better allocation of skills and resources. Indeed, it allowed Germany to scale up its ICU capacity, as well as keeping services such as cancer treatments and screenings open in different locations.

The centralised nature of NHS does not allow for any part of the chain to fail. Unfortunately, failure is in our nature and less centralised systems are therefore necessary in order to achieve resilience and adaptability in times of urgent need.

We should make the UK fit for the next nasty virus by decentralising testing and allowing for more private sector involvement in our healthcare system. It’s high time we faced the facts about the NHS and stopped ignoring success stories from around the world.

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