If you are already subscribed, enter here:Monday, December 27, 2021 Updated at 2:46 AMby Felipe Cabello Cárdenas December 15, 2021The analysis of the history of the epidemiology of infectious diseases in Chile in the last 48 years clearly shows, in my opinion, that the Chilean State is incapable of managing their prevention and control in a scientific and adequate way, administratively and politically.The State also lacks the correction mechanisms, bureaucratic and democratic, that allow modifying the wrong course of these activities, which harm their potential success and the health of the population.This has been clearly demonstrated with the COVID-19 epidemic, but for years before the country has been dragging epidemics such as AIDS and other sexually transmitted diseases, such as syphilis and gonorrhea, which evolve, and probably continue to evolve, without control. .In addition, statistics show significant outbreaks of tuberculosis and also recurrent epidemic increases in whooping cough and measles, despite existing vaccines against these diseases.Although it is true that in the last thirty years there has been some improvement in the diagnostic capacity of infections, the possibilities of doing epidemiological research on them to discover their sources, causes and their routes of dissemination, continues to be primitive and restricted.Demonstrated by the mysterious pediatric epidemics of viral meningitis, the repeated outbreaks of acute diarrhea that remain without clear cause, the apparent introduction to the country of the Q fever pathogen and its subsequent spread, and manifestly by the continued limitation of testing policies. , traceability and isolation (TTA) to prevent COVID-19.The second half of the 20th century was marked by optimism about what was called the triumph of medicine over infectious diseases, as important causes of illness and death, especially in countries with relatively good socioeconomic levels.This formulation, which soon proved premature and wrong, was the peak of the theoretical and practical materialization of knowledge that began in Medieval Italy with the implementation of quarantines to stop the spread of the plague (Black Death), will go through the creation of the theory of live contagion in the Renaissance, the invention of the microscope in the 17th century, the introduction of vaccination in the 18th century, and the fundamental developments in the microbiological work of R. Koch and L. Pasteur in the late 19th century .The work of the latter established the microbial cause of infections and expanded the use of vaccines and serotherapy in their prevention and treatment and turned microbiology into a modern science of great predictive power, as is now shown by their successful approaches to the future evolution of COVID-19.Also, in the late nineteenth century, the pathologist Rudolf Virchow identified the social and economic determinants of infectious disease, expanding the causes of them to these factors, expanding the causal origin of infections beyond its restricted and apparently unique microbial origin. .The introduction of asepsis by I. Semmelweis, Florence Nightingale, and J. Lister in the same 19th century, and then the introduction of antimicrobials in the first half of the 20th century, also helped to reinforce the concept, held by scientists and laymen, of a miraculous and permanent triumph over infection.However, in the mid-twentieth century, the application of the theory of evolution to the study of microorganisms, discovered their ability to vary genetically and become resistant to antimicrobials and immunity generated by vaccines, in addition to their potential to change forms evolutionary processes of increased infectivity and pathological power.Complexity to which was added the reappearance of diseases postulated as defeated, such as syphilis and cholera, and the appearance of new diseases, a significant number of them of animal origin (zoonotic), such as COVID-19.The latter as a result of the industrial breeding of animals for human consumption, by the invasion of new wild habitats by agriculture, industrial development and urbanization.Examples of these processes in Chile are, for example, the appearance of Hanta virus infections, the detection of scrub typhus and the presentation of cases of Q fever.Climate change has also expanded the habitat of bacteria, viruses and parasites capable of infecting humans, as has happened in Chile with Vibrio parahaemolyticus and Hanta virus and with dengue virus and malaria protozoa in other countries.The introduction to Chile of the advances in microbiology and epidemiology that began to encircle the infectious disease at the end of the 19th century in Europe were quite slow.The negative impact of the high rates of infections, such as tuberculosis, smallpox and exanthematic typhus in the Chilean population, stimulated during the first half of the 20th century groups and unions of workers, groups of doctors and politicians to try to improve, Through laws, the living conditions of the population and expanding social security and medical care, establishing laws such as Preventive Medicine (1938) and creating Institutions such as the Employees Medical Service (1942), the Social Security Service and the National Health Service (1952).These creations were the fruit of long and arduous processes, which in general the medical profession and conservative politicians were opposed to, according to them, attacking the free practice of medicine and their economic interests, and favoring the laziness and neglect of Workers.The activities of these services and the strengthening of the Public Health Institute, and the improvement of living conditions, began to gradually decrease the role of infections as causes of illness and death in the country.This slow but ascending progress was dramatically interrupted by the military dictatorship, which, negatively affecting living standards and destroying and degrading health services through budget cuts and reorganizations, created the conditions for a dramatic setback in the management of infections. and that it resulted, during his government, in a series of epidemics.Including severe epidemics of typhoid fever, hepatitis A, dysentery, pertussis, measles, scarlet fever and sexually transmitted diseases and increases in tuberculosis and several cases of paralytic polio.From the epidemiological point of view, the reorganization that most negatively affected epidemiology was the fragmentation and impairment of its activities caused by the municipalization, which attacked the reliable collection of disease and death statistics and atomized its prevention efforts to level of primary care, dismantling the rationality of ascending complexity of their work.The false and interested medical ideologies promoted by the World Bank, the International Monetary Fund and the Inter-American Development Bank about the disappearance of the infectious disease and the introduction of the entelechies of the epidemiological transition and that health is a personal problem, In addition to political violence, they sealed off this destructive task, whose costly results in preventable illness and death continue to be paid today.In Chile today, the fruit of the work of Pasteur and Koch (140 years ago!), Characterized by the laboratory diagnosis of infections, is absent for a significant majority of Chileans.This is due to the fact that primary care in territories lacks adequate microbiology laboratories for this fundamental health activity.This serious deficiency in the diagnosis of infection also undermines the effectiveness of its antimicrobial treatments and also the possibility of permanent epidemiological surveillance and investigation, to identify early increases in infections and the potential appearance of new pathogens and prevent their spread.This situation is even more miserable in relation to viral infections and the use of first-line molecular techniques for the diagnosis and epidemiology of the infection, such as PCR, genomic methods, and others.The absence of reference laboratories in the regions also adds complexity to this scenario, since it prevents the rapid resolution of local infection problems, delaying their diagnosis, treatment, and epidemiological study.This lack of laboratories also negatively influences the hygiene of food, water and veterinary medicine.The gradual decrease in infections as a cause of disease and death in Europe and the USA, which began more than 100 years ago, in addition to being the result of the rise in living standards, was the result of the creation of networks of local and regional microbiological laboratories, covering the entire territory of these countries, thus applying microbiological and epidemiological science to their comprehensive geographic context.Undoubtedly, it corresponds to a modern, decentralizing and territorial Constitution, to ensure that the benefits of microbiological science and the epidemiology of infections reach the inhabitants of all regions of the country equitably and, with this, pay off a debt. with them of at least a century of existence.Through its Twitter account, the agency reported that SAE messaging was activated to alert people in the sector and made a ...by María Luisa Ortiz and María Soledad Jiménezby Alberto Martínez Qby Germán Silva Cuadraby Felipe Cabello Cárdenasby Eduardo A. Santos Fuenzalidaby J. Tomás RosasSent by Aníbal Wilson P |December 26, 2021Submitted by Héctor Casanueva |December 24, 2021