How to inform, persuade and remind about COVID-19 vaccination

Pedro Rey
 

@varelalaf

After a year in which the fight to control the transmission of COVID-19 has set the agenda, the debate is now focused on how to get a sufficient percentage of the population vaccinated to achieve the so-called "group immunity" as soon as possible. The objective now goes to the supply side: it is about establishing the sequence in which different population groups should be vaccinated (and with which vaccine each one) and making sure that the prioritization is fulfilled. We must also resolve as soon as possible how to eliminate bureaucratic obstacles so that vaccines are more easily accessible, more operational from a logistical point of view and can be purchased by the states at a reasonable price. However, solving the supply problem will be futile if we fail to stimulate demand so that the effective vaccination rate is as high as possible. For this, it is essential to understand both how the potential vaccination subjects behave ‒guided by their beliefs, their perceptions about safety and risk and by their cognitive biases‒ and in what way we can influence that behaviour to guide them towards the socially desirable direction that allows the reduction of disease incidence. 

Care for chronic patients during the pandemic. 5 proposals from hospitals

Nacho Vallejo

Image by Parentingupstream from Pixabay

Faced with the difficulties of a third wave of the pandemic, clinicians again need to express their concerns. And not only because of the exponential increase in the number of COVID-19 patients but also because of the feeling of once again leaving behind the care of patients with chronic health problems. It’s a situation sadly favoured by the collapse of primary care and hospitals.

Trust, an ingredient needed to innovate

Mònica Almiñana

"One, the citizenry will not forgive the president for hiding health information that can help save their lives. Two, in a crisis, people must feel like a soldier, not a victim. Three, telling the truth generates trust, silence generates fear. "

CJ Creck, The West Wing. Season 3, Episode 9 (2001-2002)

When Aaron Sorking wrote these sentences for his character, the White House press chief in the series The West Wing, in a chapter where a health problem was addressed, came up with some of the keys needed to manage the communication of this type of crisis. In a recent article in BMJ Leader, "Leadership during the COVID-19 pandemic: building and sustaining trust in times of uncertainty," Susannah Ahern and Erwin Loh also outline some of the keys to leadership in times of uncertainty. And one of those keys is trust. The authors themselves define it as "The expectation or belief of an individual, often in vulnerable circumstances, that another person's actions or motives will be honest, fair, and based on integrity (following sound ethical principles)." (1)

The pandemic in healthcare professionals

José Joaquín Mira
 

The COVID-19 pandemic represents an unprecedented challenge for healthcare systems around the world. To the initial uncertainty, the scarcity of equipment and the difficulties in maintaining the supply chain were added the constant changes in instructions, the interruption of all non-delayed care, the isolation of hospitalized patients (many dying alone) and unprecedented acute stress on healthcare staff, particularly those dedicated to direct care of COVID-19 patients. The term second victims of SARS-CoV-2 have been used by our group, and by others, to describe this experience.

Does anyone think about “the day after”?

Joan Escarrabill

It's all over. It's the way of life, as my grandmother would say. Health problems can end in different ways: a very specific treatment (the magic bullet), changes in the environment (sewerage and sanitary control of water), adaptation and coexistence with the disease (now there are people with tuberculosis, but we don’t need sanatoriums) and, for sure, we would still find others. The same thing will happen with the COVID-19 pandemic. Perhaps we will mitigate the impact of the pandemic with vaccines, perhaps we will have better diagnostic tools, and perhaps we will be better organized to follow up on cases or a combination of all of the above. It’s likely that, in the end, we will carry on living a long time with a highly contagious disease that, in some cases, has very serious consequences. What is certain is that this tension caused by the successive waves of the pandemic will end.

Remote visits, are they always the best option?

Glòria Galvez

By Healthwatch Dorset 

The coronavirus pandemic has had an explosive and profound impact on health care systems, especially concerning traditional care. Presently, in addition to caring for patients affected by a coronavirus, it’s necessary to continue caring for the "invisible patient", who is still there, affected by other pathologies evolving at their usual pace, some of them potentially severe. Remote visits, which in a short time has gone from being a rare modality to being the usual form of interaction with the patient, are presented as the best option to carry out their follow-up, thus avoiding crowded waiting rooms and the risk of infection.

Primary care gaps: what's failing and how can we fix it?

Pere Vivó

The health crisis is placing unprecedented strain on the health care system and in particular on primary care. Saturated agendas, disorganized demand and forced abandonment of some functions to assume new competencies, all added to the social crisis and the extra demand on the part of some users have as a result a generalized discouragement and psychological exhaustion of professionals.

Parallels between pandemics and the bystander effect

Cristina Roure
 

I remember how, just a few weeks before the declaration of the state of alarm, we looked first at China and later at Italy with astonishment and disbelief, as if what was happening there was not with us, as mere spectators. Perhaps we thought that borders could protect us, or at least give us time to anticipate and do better than the Chinese or the Italians. When we took action, our still fresh health contingency plans were pulverized in less than 48 hours by a tsunami that drove us straight to the ground of improvisation.

The health care system of the future is here now

Josep Mª Monguet
 

Who took the chestnuts out of the fire?

In difficult moments, everything is shown as it is and that is when authentic leadership can be identified. In this sense, a revelation of the recent stage, which we could already intuit, is that health care professionals have shown an exceptional capacity for response. It’s not a common occurrence in the public system. Despite the multiple deficiencies faced, they have assumed the difficult part of the situation and overcome it.

Technology helps us to be more human

Paco Miralles

"Learning to read is the most important thing that has happened to me in life," acknowledged Vargas Llosa in his speech at the reception of the Nobel Prize. I share his discernment, although I have had some more important achievements. This task is something inherent to the doctor, one of the weapons that help the indispensable humanistic aspect of medicine.

Treat us like adults

Alexandre Lourenço
 

The development of the Portuguese health system suffered, like so many others, from excessive paternalism and over-centralization. Perhaps part of our failures in responding to the covid-19 pandemic lies in these two issues.

Last December, a Spanish friend shared an article from the El Mundo magazine where he gave some inputs: "nos tratam como niños, y nosotros tan contentos." The infantilization of Society - "the NHS will take care of everyone, everything is fine, the warm weather is the only cause for the excessive mortality, the cold weather is the sole cause for the excessive mortality, the vaccines are there and will solve everything" - demotes individual responsibility. Look at the peskiest kids fighting for the first sweets: vaccines. In the face of terrible mortality indicators, it is not so strange to see people's gatherings without any protection at the first ray of sunlight.

A year later, the inability to deploy an effective contact tracing and testing apparatus demonstrates our failure to do more than the routine. As with the ever-forgotten prevention, the system tends to focus exclusively on the conventional cure structures.

Last month, the British Government presented to its parliament the white-paper "Integration and innovation: working together to improve health and social care for all".  The topic is not new, but it is a sign that gives us hope in the middle of a pandemic. It is this kind of discussion that engages citizens and brightens our future.

It is not the millions from the European "bazooka" that will make us better. Persons, their ideas, and a vision that unites them will make us better.  As my colleague said: If the Government wants to engage Society, the first thing it has to do is to conceive us as adults.

The crisis as an accelerator of latent changes

Cristina Adroher
 

It has been said by active and passive: a different society will emerge from this crisis, with profound changes in its values and practices. As for the healthcare system, there will be a time to analyze it, once the storm subsides but those of us in the backstage can go paving the way. Here are three proposals for aspects that I think could begin to be amended.

Telemedicine and telemonitoring: theory and practice for the era of coronavirus

Frederich Llordachs
Co-founder of Doctoralia, partner at Docplanner Group and partner at Braincats Consulting

The basic definition of telemedicine is the one that corresponds to its etymology: this is how the provision of medical services at a distance is defined (from the Greek “tele”, distance, and medicine). This definition is broader than it seems since it encompasses traditional technologies that would also be telemedicine, such as the warning bells of the arrival of lepers or requests for health resources and medicines by cable telegraph during the American Civil War.

Transitional Primary Care

Salvador Casado

Edward Coley-Jones
Head study of Perseus 1875

If even a pandemic like the current one has not been able to strengthen and improve Primary Care many wonder if anything will. And it will not be for money, given the generosity of European funds. With the devastation and the enormous burden it has assumed, it has become clear that the system has neither the capacity to adapt nor the energy to take on inexpected situations. Any increase in voltage overheats professionals who are already being pressed by high voltage. Those who attend to patients over forty every day are likely to move into the next hellish circle with ten or twenty more. 

À la recherche du temps perdu

Alexandre Lourenço 

Portuguese studies from different entities have showed excess mortality from causes unrelated to COVID-19 since early April 2020. Entities like the National School of Public Health, the Faculty of Medicine of Porto, or the Faculty of Medicine of Lisbon have warned about this trend. Later, the Portuguese National Statistics Institute has confirmed it.

The response to COVID-19 has limited the regular provision of healthcare and the postponement of elective healthcare services has led to significant losses in the health and well-being of populations. In April, we called for creating conditions for resuming the regular health services in an organised and coordinated way, through a dual-track NHS. By this time, tens of thousands of surgeries and hundreds of thousands of consultations have been cancelled.

Primary Health Care Centres management notes

It is not the same to sail with no wind as it is to sail with a swell, it is not the same to manage a health unit in calm weather as in a pandemic. But it is useful to learn from storms because, as the sailor knows, they never come alone. 

Europe's public health systems are huge structures that could be likened to a fleet with hospitals as huge ships and Primary health centres as smaller, more agile ships. In these days of disruption with a shower of protocols from the general command but without a clear vision of what we were up against, each unit did what it could. Some maneuvered quickly, others less so; some did so skillfully, others were overtaken by circumstances.

Primary Health Care: Working in the Darkness

Working as a family doctor these days is not easy because we're walking blind. First of all we are trying to do as much work as possible over the phone to prevent patients from travelling and coming to a health facility if it can be avoided. On the other hand we do not have reliable data. Every day we receive various protocols, instructions, directives, official emails and so on in what has been a fluctuating data overload in addition to what everyone receives through their personal social networks, Whastapp groups and so on.