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An image is often worth a thousand words and in Miami right now there are two that almost perfectly reflect the health system of the United States.
On the one hand, queues of vehicles in the parking lot of a stadium to be tested for coronavirus; on the other, one exclusive island and home of the elites with a private clinic open only for rapid tests of covid-19 to all its residents and employees, more than 1,000.
There are many details that are not seen in those images, such as the evidence in one place and another they are different and, therefore, they fulfill different functions, but both show the profound inequality in access to healthcare in the self-proclaimed land of freedom.
In the midst of a pandemic such as that of the coronavirus, this difference can determine whether you live or die, so it is not surprising that in the face of such a dramatic situation that we are experiencing, these two photographs generate controversy.
Fisher island
The controversy grew after the newspaper The Miami Herald It published that Fisher Island, one of the wealthiest neighborhoods in the United States, had decided to buy thousands of rapid tests for covid-19 from the University of Miami Health System (UHealth), a private entity.
“To further minimize the spread [de covid-19] on the densely populated island, where half the residents are over 60 and at high risk, Fisher Island asked UHealth to provide them Covid-19 antibody tests for all of your employees and residents“Island spokeswoman Sissy DeMaria explains to BBC Mundo.
Fisher Island, attached to iconic Miami Beach, has opened a center for the occasion and tests are underway, along with other prevention measures.
From UHealth they recognize that their service “may have given the impression that some communities would receive preferential treatment”, but they assure that it was not their “intention”.
“One of the first confirmed cases of coronavirus in Miami-Dade County was on Fisher Island, more than half of the population is over the age of 60, and many residents were returning from the northeast,” the area hardest hit by covid- 19, spokeswoman Lisa Worley highlights in a brief statement.
The university center has been collaborating with government and public health agencies and launched an initiative to test covid-19 antibodies on 3,500 random people in Florida, local media reported.
Despite this, the news about Fisher Island quickly generated a wave of frustration and anger, given the shortage of equipment and limited access to tests.
“Americans, and sometimes the rest of the world, are shocked to discover that very wealthy people can use their resources to get advantages when they have a medical need, included in a plague, but that has always been the case. It’s something Americans seem to tolerate, “says Arthur Caplan, director of medical ethics at New York University.
“The United States has never recognized the right to health. Many Americans get their health coverage through work, which means they ethically have to earn it. And if they stop working, they lose it.”
The American health system works mostly with private insurance, but Millions of people do not have one or have insufficient coverage.
“When you don’t have a system that everyone is a part of, then there is a lower ethical sense of community responsibility,” reflects the expert.
In this crisis, the government is acquiring a greater role than usual at the federal level, but in many ways it’s the states that are in control. Also in health issues.
In Florida, the authorities have installed eight mobile clinics in the most affected communities, according to what the Department of Health explains to BBC Mundo.
One of the services with the highest demand is located in one of the car parks of the stadium Hard rock in Miami, where the Super Bowl final was held this year.
There, medical teams perform daily so-called PCR tests, which check whether a person has covid-19, through a sample collected from the nose or throat and laboratory analysis.
That consultation is different from Fisher Island, a rapid blood test that can only determine if a person has already passed the disease, but not if it is infected.
Given the number of people who went to the Hard Rock parking lot, healthcare staff had to hang up the closed sign shortly after opening the doors on several days of last week.
NEW: Hard Rock Stadium is expanding its testing criteria to include anyone with COVID-19 symptoms. https://t.co/ar1DyI0X1t
– Miami Herald (@MiamiHerald) April 13, 2020
This led to an increase in capacity, from 400 daily tests to 750, and lower requirements.
Medical “concierge”
However, that of Fisher Island is not the only case that shows the inequalities in this health crisis, of which the United States is already the nation most affected in the number of deaths and infections, according to official accounts.
The local press includes, for example, the case of a biomedical multinational in Colorado, it decided to buy rapid tests for covid-19 antibodies for an entire county, home to about 8,000 people, including two of its executives for part of the year.
This is an unprecedented initiative in the country, which faced difficulties but seemed to be back on track, according to a statement from the county government.
BBC Mundo contacted the firm for more information, but received no response.
For his part, the expert in Medical Ethics mentions the case of a wealthy community in Westport, Connecticut, which also tried to access private tests, and cites the services of the so-called doctors “concierge“, who are offering tests at home.
David Nazarian is one of these professionals. With a clinic in the luxurious Beverly Hills neighborhood of Los Angeles, the doctor has registered a persistent increase in queries from the beginning of the epidemic and set up a test center with attention to people from their vehicles.
“I have worked very hard from the beginning because I consider it to be very important (…) This is a crisis that we are all facing. Poor and rich. It’s not about that. This is what we can all do to control this virus. If we don’t, we won’t stop the infections and we won’t be able to get people to take their lives back. That is the most important question, because if not, everyone will suffer, “he believes.
Its clientele is made up of families or individuals from the world of entertainment or top executives, but it ensures that its services are available to everyone at a price that it prefers not to disclose.
However, Nazarian has been treating a percentage of his patients for 10 years free, a task that he continues to carry out at this crucial moment, he assured in conversation with BBC Mundo.
The doctor’s team has carried out PCR or antibody tests at home or in his mobile clinic, as well as for companies, with the materials he was able to buy and a little innovation in the absence of resources, creating some materials themselves.
“There is no question of inequalities and unfortunately it has always been that way. Hopefully it was not. Everyone should have access to good healthcare. Everyone should be able to get tested,” he says.
In his opinion, the government should be doing more: “It is unfortunate that we live in the United States and are falling behind in testing capacity compared to other countries. “
After the problems with the tests at the beginning of the pandemic, the USA now it is doing about 150,000 tests per day. But the greatest experts in the field consider that the number should be much higher: between 5 and 22 million a day.
“This country is a failed state“A nurse anesthetist from a New York hospital lamented earlier this month, revealing one of the most tragic moments of his career.
The professional, Derrick Smith, shared the last words of a critically ill covid-19 patient on Facebook before intubating and connecting to a respirator.
“Who is going to pay for this?” Snapped the patient with visible problems in breathing and speaking, and before they let him call his wife, since many patients “never recover after being intubated,” he said.
The dramatic scene inevitably leads to reflection: Will this brutal pandemic cause change in the United States?
“I wouldn’t bet on it,” ditch Caplan.
In the United States, the expert remarks, the old conservative ideas weigh: health is a privilege, not a right.
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