Spaniards in the pool and Chinese locked up: where is it easier to stop an epidemic?

The return of Covid-19 to Spain via Tenerife holiday resort It has been conducive to odious comparisons. One of the most repeated emphasizes certain national irresponsibility based on the story of the inmates, who revealed how many had decided to give themselves a swim in the pool despite the prohibitions of leaving the room.

In short: while millions of Chinese have been waiting patiently in their homes for weeks to curfew, we cannot stay quiet Not a few hours.

An idea that is in tune with certain cultural and political prejudices that have flown over some reasoning about crisis management. If a country with greater population control, more vertical power structures with much less freedoms As China has not been able to stop the epidemic, what will happen in Europe, with its open borders, freedom of movement and democratic guarantees?

In other words, to what extent is a totalitarian state more efficient? With a point of fascination, some wonder: what other State could have built a 1,500-bed hospital in just 10 days?

Authoritarian countries base their legitimacy on their best 'results' regarding what a democratic regime would allow

WHO itself has stressed in recent days the importance of the sacrifice made by the Chinese population. Bruce Alyward, head of the mission in the eastern country, wondered “how many countries have plans to have hospital beds, fans, oxygen supply and laboratories?”, while recalling that the other countries “simply not ready”To face a similar situation.

"From an authoritarian system, greater efficiency can be expected and, in fact, it is common for these systems to base their legitimacy on their best 'results' with respect to what a democratic regime would allow," he explains. Grace Abad Quintanal, Professor of International Relations of the Faculty of Social Sciences of the Nebrija University and specialist in the People's Republic of China. “However, the lack of transparency that also characterizes the Chinese system has made it not so, because initially, far from taking measures to slow the progression of the disease, there were steps to hide its existence or, at least, the severity that the episode could reach. ”

For the expert in International Relations, the way to deal with the situation, especially in its first moments, “far from serving to show a skillful management that would reinforce that legitimacy based on the results, gives rise to question the supposed management efficiency of the Chinese Government, thereby undermining its main source of legitimacy. ”

Pandemics and dictatorships

"There is a lot of accumulated knowledge on the topic of infectious diseases and the use of coercive measures," he adds Ildefonso Hernández, spokesman for the Spanish Society of Public Health and Health Administration (Sespas) and Professor of Public Health at the Miguel Hernández University of Alicante. “In general, the criteria to be applied is that of the proportionality, since the measures perceived as excessively coercive they usually cause negative consequences. ”

When the measures are not understood, the population begins to think that they have no sanitary objectives and increase dangerous behaviors

As the former Director General of Public Health of the Ministry of Health explains, it is easier to see an Italian complaining that she cannot receive her treatment than a Chinese citizen, which does not mean that it does not happen, but only that it is not go. In other words, it is more difficult, due to the control of the press, to know those unwanted consequences: “If distrust of public and health authorities arises or the population does not understand the measures, they begin to think that they have other objectives different"

It is a more dangerous scenario, since, as Hernández adds, it usually leads to increased behaviors that make it difficult to control the disease. It is shown by some of the videos that have circulated in recent days, in which Chinese citizens are seen trying to circumvent the blockades, including putting your life at risk or that of others. Something that would not happen in the same way in countries where the information and trust in the authorities is greater.

“The principle that guides public health is respect for human rights, so any restriction of personal freedom must be very justified, proportionate and there must be evidence that it works", Add.

A good example is what happened in Liberia in 2014, when in the middle of the Ebola crisis it was decided to decree the sanitary quarantine in the neighborhood of West Point in Monrovia, where they lived 75,000 people. The decision triggered protests and clashes that not only plunged the neighborhood into chaos, but also caused unwanted uncontrol escape attempts.

The sick try to go unnoticed when they are persecuted, which is much more dangerous

Hernández, who has worked with sexually transmitted disease patients, remembers that when the sick are persecuted They don't disappear, they just submerge. That is, they try to go unnoticed by the health authorities, which is much more dangerous.

This does not take away so that each country can establish its own population control devices. In Spain, the Law of Special Public Health Measures of 1986 or the Organic Law of the States of Alarm, Exception and Site of 1981 establish processes to impose restrictions, prior parliamentary and judicial control. "But it only applies in tremendously exceptional situations." Most likely None of us will ever see it.

At European level, the Schengen zone member countries can unilaterally decide to reintroduce border controls. One of the main concerns, therefore, it is in the possibility that some countries like Austria carry out this measure, whose utility The European Commission doubts, as happened in 2015.

The SARS lessons

The epidemic of severe acute respiratory syndrome (SARS) not only left around 744 dead, but also new patterns of behavior to guarantee the "homogeneity, multisectorality and compatibility of global actions", as reflected in the 2005 revision of the International Health Regulations (RSI). In other words, all countries belonging to WHO (almost all) must respect the same principles.

No country can establish additional health measures to those stipulated by WHO whose usefulness is not scientifically proven

“One of the purposes of the International Health Regulations is that rules that are detrimental to the mutual benefit or the general interest of the international community are not applied, since imposing coercive or restrictive measures indiscriminately creates situations that may not be good, both now and in the future, ”explains Hernández. “For example, imposing any restrictions on the movement of people or goods for health reasons may result in the use how pretext in other situations. "

Hence the WHO has insisted that still there are no reasons to restrict free traffic. An article published in 'The Lancet' in mid-February expressly requested that the RSI regulations not be violated during the Covid-19 epidemic. The text cited article 43, according to which no country can establish additional health measures to those stipulated by WHO, and that any addition must be based on scientific principles and evidence or in the recommendations of the organization.

The text did not refer to both totalitarian regimes and movement restrictions imposed by some countries, which "Cause more harm than good". As the authors recalled, these measures are harmful, since "they prevent provisions from reaching the affected areas, slow down the international response, stigmatize entire populations and disproportionately harm the most vulnerable." Not only that, but they have a last contagion effect: when a country decides not to follow international law, others tend to do the same.

The Nobel Prize in Economics Amartya Sen He explained in 'Poverty and Famine' how most of the great famines of the 20th century had taken place in authoritarian contexts. “There has never been a severe famine in a democratic country, neither poor nor rich,” he explained in 1999. “Among other things, it is difficult to win elections after a famine. And the governments of democratic countries are not immune to criticism and censorship that can be dedicated to them by the media and Parliament if the population begins to starve. ”

The mortality of Covid-19 depends on the availability of health resources, as shown by the difference between Wuhan and Hubei

That's why famines had been frequent in single party regimes ("The USSR in the thirties, China in 1958-1961, Cambodia in the seventies or North Korea"), military dictatorships ("Ethiopia, Somalia or Sudan in recent years") but also in countries governed by colonial or foreign powers, such as India or Ireland when they belonged to the United Kingdom.

Last Wednesday, an article also published in 'The Lancet' recalled that Covid-19 mortality in relation to its incidence depends, above all, on the availability of health resources, as the differences between Wuhan (mortality of more than 3%) and Hubei (average 2.9%). Not the force exerted to retain citizens in their home, but the ability to mobilize resources quickly, transfer medical personnel and protect the health of professionals. There is the Chinese success.