COVID-19 and sanitary system

Although the pandemic began at the end of 2019 in Asia, Uruguay reported its first case in mid-March 2020. The experience of how others parts of the world handled the crisis allowed our country to model its health system to the needs and characteristics of its population. Uruguay with only 3.4 million inhabitants, and with a moderate population density, 20 inhabitants per km2 has reported the existence of 1927 cases, and a mortality of 13 people per million inhabitants, standing out as one of the least affected countries in the world ⁶.

Uruguay does not have a magic formula that justifies its statistics; despite this we could find an answer in the characteristics of its territory and population. Although it has a metropolitan area that comprises practically half of its population, it has a low density. Another possible explanation could be associated with the high number of tests carried out in relation to confirmed cases, unlike that carried out by other countries in the region ⁷. One of its strengths is the presence of a health system with universal access in which all its inhabitants have health care coverage.

The government have carried out evaluation, recruitment, monitoring and treatment programs at different levels of care based on the guidance of groups of experts and scientific societies, within which the Uruguayan Gerontology and Geriatric Society (SUGG). SUGG participated directly in the creation of protocols for care, control and monitoring of nursing-homes.

Among the proposals made, it was suggested to approach caring through solidarity coverage of care in nursing homes, carried out by all public and private health providers. An initial evaluation, a diagnosis of the situation, an intervention plan and prevention were carried out through multidisciplinary teams. Taking all this into account it became evident that Uruguay had significant social and health deficiencies, and that in some long-term centers basic human rights were violated.

Other of the strategies applied were social distancing, although it has its statistical and probabilistic justification, is associated in elderly with other consequences not initially thought of. The limitation of visits and contact with other people who may be carriers of the disease surely led to a decrease in infections, especially in institutionalized ones.

This relative success focused on the pandemic, hides other less positive effects such as; the decrease in active and independent life, isolation, depression, the manifestation of geriatric syndromes such as frailty, immobility, falls and their worst and most serious consequence, fractures. This other silent pandemic will increase dependence, as well as reduce the ability to identify acute decompensation of chronic diseases, reduce the diagnosis of other diseases or only allow their diagnosis in advanced stages. This pandemic not only brings us a viral disease but it will also leave us with a serious consequence that can only be evaluated in the long term, fundamentally associated with the great adverse effects generated in the elderly; dependency and functional decline.

At a time when the UN promotes the decade of healthy aging, the pandemic seems to bring the opposite; however, this is a great opportunity to generate a deep cultural and structural change in a society that discriminates against them. Perhaps it will be the opportunity to integrate them as the fundamental social piece for future generations.