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The São João Hospital and University Center prepares for an eventual third wave of the pandemic in early January, says the president of the board, Fernando Araújo, who does not agree with the way in which the awards were given to the professionals of the health and criticizes the Lisbon Centralism. “Very concerned” about non-covid-19 patients, the doctor and former Undersecretary of State for Health added that waiting lists in São João decreased by 50% due to the decrease in referrals from health centers and absences that doubled during the pandemic. “In cardiology and oncology, less than one in three patients was referred compared to the average for recent years. We are losing patients ”, he laments.
What is the situation at the São João hospital?
Today [terça-feira] we have 120 hospitalized patients, 45 of whom are in intensive care. Demand for emergencies from COVID-19 patients has dropped and the positivity rate in tests has also decreased, but we still have a very high number of patients in intensive care, many of whom are serious and will take days or weeks in power remove them from the fans.
São João Hospital pioneered the adoption of various measures at the beginning of the pandemic. The guardianship was slow in the decisions that later validated the options of São John?
We had to make decisions quickly. Sometimes national directorates need more data to try to find informed decisions with working groups and experts that can be applied across the country. But at that time, we had no choice but to continue the process. The use of masks was one of the most relevant measures, infections reduced the peak in the hospital. The first rule of the Directorate General of Health also said that patients had to be hospitalized, but if we were all hospitalized, we could not respond. The decision to follow up on an outpatient basis, calling less seriously ill patients at home, was the lifeline to avoid the collapse of the hospital.
The national contingency plans were developed without listening to the hospitals?
Somehow they were heard late, especially in the second wave. The fact that the fall-winter plan emerged in early fall and in a very general way meant that, if some institutions expected very practical rules, there would be a significant delay in implementing those rules. We enter this second wave with excess of confidence and that has its costs.
Are you expecting a third wave soon?
It is predictable that there may be a third wave. Hopefully not, but we are clearly gearing up for a third wave in January. We have to prepare for the worst scenarios. The pressure in emergency and hospitalization is expected to increase in mid-January, so we did not demobilize the entire machine, we maintain it and improve some aspects so that, when necessary, we can activate it. We are currently at level three of the four levels of the contingency plan.
The emergence of the new strain of coronavirus in the UK is a sign that we will still have many mishaps in the coming years. months?
I think no. It is true that variants exist, that the virus is mutating, but as for the efficacy of this vaccine itself, I would say that it is safeguarded from a more global point of view.
Do you think the government was very lenient with Christmas by not instituting a maximum number of people in each house that night?
We fear that this Christmas season will lead to an increase in new infections and that in mid-January we will have a new peak of hospitalized patients and, above all, of patients hospitalized in intensive care.
The Order of Physicians suggested a maximum of 10 people at the Christmas dinner. I insist: the government should have indicated a number maximum?
There is no magic number. The number varies from country to country. I think above all there has to be a great courtesy.
You have said that the SNS is not working in a coherent and integrated way. Maybe more specific?
There has to be a greater effort, a joint strategy, a global vision so that patients do not move from one place to another without knowing where to go.
He also stated that the SNS is at a point of no return and that it will have the greatest proof of life in the 2020/2021 biennium. Anticipate a crisis in the short finished?
The pandemic brought very negative aspects, but it also brought opportunities and challenges. Looking to the future is not rebuilding the SNS we had in 2019, but building a much more efficient and user-centric SNS. The test of life for the NHS is to reinvent itself. Covid brought us a paradigm shift, we have to take advantage of this momentum to change the SNS. One of the most discussed topics is the referral of users to primary health care. This is a gap that must be bridged quickly. This year we had approximately 30% fewer referrals to primary health care and an increase in patient absences for appointments. In cardiology and oncology, less than one in three patients was referred compared to the average for recent years. We are losing patients.
Are you concerned about non-covid patients?
I am very concerned about these patients. When there is no screening, when there is no diagnosis, it means that we lose patients that we do not know. The incidence of the disease has not decreased, heart attacks have not decreased … If we do not detect patients early, we will detect them during the year at a later stage. And we are talking about very high figures.
Waiting lists have dropped very?
We must end the year with 50% less. The truth is that this happened a lot at the cost of reducing demand and increasing production in summer.
What is the percentage of patients who missed appointments?
In general, we have an absenteeism rate of around 8-10%, but with the pandemic doubling, it ranges from 15-20%, which means that people do not seek medical attention out of fear.
How many healthcare professionals have you hired due to the pandemic?
We hired about 200 people, mainly nurses and operational assistants, the doctors were a very limited number. The contracts were for four months, possibly renewable, and that in the case of doctors is not very attractive.
It is not planned to hire more professionals to deal with the eventual third vacant?
What is planned are substitutions. We only have autonomy for substitutions, for four-month contracts. We need autonomy from the Ministry of Finance to make indefinite contracts in the areas that we believe are necessary. What this first wave demonstrated was the ability to have autonomy with responsibility. It is not possible to go on for months and months sometimes waiting to hire a health professional when we have studies that clearly demonstrate the added value, even from an economic point of view, of that hiring.
How do you see the award given to a few professionals?
With some dissatisfaction. We act as a team. For some to treat covid patients, others had to treat non-covid patients with the same commitment and effort. And there are other areas of support as or more important that will not have a prize either. This creates some disappointment. I think [o prémio deveria ser atribuído] globally to those who have been working.
The pediatric ward was due to be completed in 2021 after an investment of 20 million euros. Will these goals be achieved?
We are doing our best in this direction. It is true that there were problems because we had infected construction professionals, material that came from other countries and did not arrive on time, but I still have great expectations of fulfilling the promise that was to finally see this dream successfully concluded in 2021.
It is more difficult to be president of the board of directors of São João or secretary of State?
It is much more difficult to be president of the board of the hospital. It is true that, when we are Secretaries of State, we take very transversal, more comprehensive and impactful measures, but in a hospital we are much closer to reality, patients, professionals, problems and this turns out to be much more dramatic and demanding. Down on João Crisóstomo [no Ministério da Saúde] we are too far from people.
He said that in Lisbon the rest of the country is unknown.
I have no doubt, I feel it more and more. The reality, particularly in the north of the country, is much less known in Lisbon, in the ministries and the public administration, and this clearly limits the ability to intervene in places and regions. This should also be rethought.
