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The pediatrician and former president of the Medical College, Henry Paris, has just completed six months as Minister of Health. It debuted in June, coinciding with the decline in the coronavirus infection curve in the Metropolitan Region. In his style, he mollified daily reports, summoned experts and academics, delivered the first good news – in months – and lifted quarantines. It brought calm to the troubled wallet.
Probably what comes next will be your litmus test. The cases of Covid-19 in the capital are on the rise, at a speed that has accelerated, and the specter of confinement haunts again, especially after the retreat, en bloc, to Phase 2. At the same time, this week the The government committed 20 million doses of vaccines that would arrive in the country before June and, in total, 30 million doses for all of 2021, which would allow immunization of 80% of Chileans. Paris explains that the agreements have been signed and the delivery schedules, at least in their initial phase, are ready, so that, if the plan is fulfilled, the threat of the coronavirus could fade from next spring. Not before.
How would you rate your first six months?
They have been very intense. At the beginning from Monday to Sunday, with the daily reports. And after that, everything else was waiting for me in the office: heap of documents to be reviewed, meetings, summons from Congress. There is no day off. I was afraid of this, but I did not imagine that it had so many variables; something happens and I start calling, asking for information. I have to be on top. And every day there is a fire, or several, and issues that come from before …
Like the delivery of emails to the prosecution, which took a long time …
The aim was to have enough time to review everything calmly. And Entel did not deliver the emails. But they were not 49,000, they delivered 1,200,000 emails. And, in the end, there were 15 that had to be saved, only 15 emails. But we didn’t know. And it was complicated, normally on the street people greet me, ask me for photos. But at that time the only thing they yelled at me was ‘deliver the emails’.
Another complex scenario is the progression of the pandemic. You simulated three scenarios, one of them even catastrophic. How do you see the situation?
The numbers have not kept pace, thankfully. It has not been that long, but we are concerned because the numbers are increasing, they are growing at a rate of 10%, or 8% per week at the national level. That percentage in the Metropolitan Region, with the population it has, is a lot. People do not realize it, but the incidence has also been increasing. We were used to rates of 49 or 55 cases per 100,000 inhabitants, and now we are in the order of 60.
And it is already beginning to be noticed in hospitals and clinics …
Nationwide, we have 36% of ICU beds occupied by Covid-19 patients. So, of course, we are converting, but it is not about doing nothing else, about not operating on other people who need it. In addition, we have noticed something that requires explanation, but that also occurred in Europe. At the beginning, 20% of those infected came to the hospital, 15% to the intermediate or basic care area and 5% to the ICU. But now 2.5% is coming.
What do you attribute it to?
I think doctors have learned to better manage the initial picture, with high-flow oxygen or drugs that were tested on the road. And there is another important thing: the average age of the cases has dropped, from 54 years to 39, which implies less associated pathologies.
Did the second wave start?
I don’t see it yet as a second wave, because of the type of curve, flattened. But it worries me.
Do you see a general quarantine in MRI possible?
Today (Friday) there were 2,404 cases, that’s worrying. We are having increases in the Metropolitan Region of 27% in the last seven days. This worries, as it indicates that we are still in a stage of probable growth in cases. But we are going to analyze it on Monday 21 (tomorrow), we must also see what happened in the United States: after Thanksgiving there was a gigantic outbreak. So we have to think about it well. A regional quarantine I do not see so feasible, but the communes are very dissimilar.
Can we celebrate Christmas and New Years?
I think it’s going to be something similar to the “Fondéate” plan for National Holidays. But everything remains to be seen, we have to see the numbers.
Europe, in the middle of winter, is with a peak of cases. Here we start the summer. How quickly can people be immunized to contain a new wave?
We have an agreement with Pfizer to receive now, in December, the first (20,400) doses that we will use in the Metropolitan, Biobío, Araucanía and Magallanes regions. 9,875 people are going to be vaccinated with these first doses. In January we will receive three more shipments, of approximately 86 thousand doses each. In February there will be another four shipments, each of 129 thousand doses. In March it will be almost 600 thousand. And with the Sinovac laboratory, which we signed the night before (Wednesday), there are five deliveries, which between January and February add up to almost 10 million doses.
Is everything ready to start the vaccination campaign?
Yes. God willing and the vaccine arrives on Monday (tomorrow) we will vaccinate on the 22nd and 23rd. But if it arrives on the 22nd, we will leave the next day. We are going to start next week, but we are not sure of the day they will arrive.
According to the schedule, how many people could be immunized in the first trimester?
Five million people, approximately, between January and March. Both vaccines require two doses.
That is, in March, should the infections begin to decrease?
I think not yet. Because this virus has an RO (contagiousness) of over 2. In order for you to have an umbrella, cocoon or flock type coverage with a virus with that RO, you have to have two conditions: a vaccine that is around 90% effective and vaccinate 80% of the population. And we are not going to achieve that in March.
The President announced that 80% of the population could be vaccinated by June 31. From that moment on, would the trend of the pandemic change?
There we could have a very important protective effect for the entire population, even for the unvaccinated, but we think we will have to continue with the measures until the figures show that the virus has disappeared. That could be in September or October, perhaps. Remember that the vaccine is not effective immediately. When you get vaccinated, especially those that use two doses, it is only on the seventh day after the second dose that you get the immune response. In addition, there are people with chronic diseases who may not respond as effectively, or who are taking some medications that prevent the vaccine from stimulating the immune system in the same way.
When will the general population begin to be vaccinated?
I think in February. Although the older adults would be earlier, in January, because we put them first, immediately after the Health officials. That is the recommendation of the advisory council, that we prioritize older adults, because they have a greater chance of getting sick and reaching the ICU. It is a much more preventive maneuver. The young and healthy population is going to have to wait longer, unfortunately.
How much is being spent on vaccines?
A budget of 200 million dollars was set for vaccines. But the only purchase we have paid for is Pfizer, which was $ 17 million.
How much do the different vaccines cost?
Pfizer’s costs $ 12 per dose. And Sinovac’s, 11.4 per dose.
Are there negotiations with other laboratories?
We are going to start a pre-conversation with the other Chinese vaccine, CanSino (Sinopharm), which is even being studied in Chile. We have to be open to all possibilities.
Children and adolescents are not considered in the plan, for now. Would you be in favor of resuming normal classes in March?
So far there have been no outbreaks in schools. Second, Minister Figueroa has repeated ad nauseam that admission is voluntary. The parents will see if they want to send or not send the child; the teacher if he wants to go or not, and the school if he wants to open or not. So if we keep those rules, I don’t see any problem with classes starting. For this reason, we have included teachers in an unprecedented way, I would say, in the vaccination campaign.
Will classes be able to return to normal in the second semester?
Maybe once we have 80% of the population vaccinated.
How are you going to choose who gets the Pfizer vaccine or the Sinovac vaccine? Pfizer’s has declared more effectiveness …
It will depend on how they arrive. But Sinovac has not yet given us the information, as it did this week with Pfizer, at the meeting of the Institute of Public Health, where they were given permission. Next week we will receive all the information on Sinovac, but I could assure you that its effectiveness exceeds 80%.
Many people think that with the arrival of the vaccine, there is little left of a pandemic …
There is not little left and people have to remain very alert. The vaccine does not take effect immediately, it can take a month, and not all people respond with the same immunity, maybe coronavirus can give the same, but milder. And before the end of June we will not have a massive population protective effect. That is why we must continue the same: hand washing, mask and physical distancing, at least, until the middle of the year or more, September.
Are you worried that people will relax and stop taking care of themselves?
The main fear is that cases will continue to increase as we are seeing now, that this will overload our hospitals and cause more fatigue, more tiredness in our staff. That is why I ask the population for the greatest collaboration. Ideally, no one comes to the hospital, that should be our goal, and for that we really need the collaboration of people. But that is not working if there are clandestine parties, if every weekend they take and lose control and do things that should not be done. Much collaboration of public opinion is required.
How do you see your 2021, Minister?
We will keep doing things. In these six months I have enacted six laws and I have attended Parliament almost every week. We have the law that reforms Fonasa, we have already had two sessions. In addition, we are going to send this week the law that modifies the Health Code and incorporates other health professions. And I want to modify the law that regulates the operation of the Compin and send a project so that there is a single medical law that governs all doctors, chemists, pharmaceuticals, biochemists and dental surgeons, because there are lots of them and that is what makes the difference in the salaries.
