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Life is full of unexpected events and being prepared for them makes the difference between success and failure. This is true at any level: individual, local, or governmental. Responding to unexpected events successfully involves improving preparedness by, among other things, clarifying roles and responsibilities around management of risks.

Most research has focussed, so far, on management of risk at the local or governmental levels and very little has been dedicated to the individual level. If that is true at the response stage of an unwonted event, almost nothing has been done at the preparation stage.

Making individuals living antennas for the detection of an incoming event may be too ambitious, although there are examples of it. For instance, in Spain there is a network of volunteers that measure weather conditions throughout the territory and are a source of daily information to prevent climatic events. Creating such a network for any type of event could reinforce the resilience our society dealing with high impact events. Such living antennas could be trained to lead their neighbours in the early response to a high impact event. For such network to be effective, the components have to be deployed across the territory, making in-person training very expensive. E-learning could be the answer for training a vast number of living antenna volunteers to manage High Impact – Low Probability (HILP) events.

An anthropogenic approach is needed when designing a system directed at diminishing the effects of an emergency, be it human made or natural. Most Early Warning Systems (EWS) have been designed by professionals and, in most cases, designed around a specific threat. Vulcanologists are worried about telluric movements, maritime scientists regard tsunamis as the biggest threat, and firefighters are concerned about the consequences of forest fires during the hot summers.

But there is a point of contact in all those EWS that is not involved in their design: people. People are at the center of any emergency and yet they are the forgotten link in any EWS system.

It is easy to involve people living on the slopes of Etna into participating in a EWS designed to save their lives. Etna is a live entity that constantly reminds the people living nearby that it can erupt anytime. It is more difficult to do the same with the two million people living in the vicinity of Vesuvius. The memory of its last activity is long forgotten. And what about making people aware in Barcelona that tsunamis exist in the Mediterranean and that they are just few centimeters above sea level?

The challenge then is to get the general public involved in being part of the EWS. To achieve that, e-learning and gaming in particular are tools that have to be explored; these have had positive results in other areas. A well-structured and simple e-learning system has to be devised to complement any EWS. The challenge is that it has to satisfy all kind of persons. It cannot be forgotten that the population is made up of old people with limited ICT skills, disabled people that have to be involved in their own survival, kids that have to be taken care of, and nerds who think they know better. The success of the EWS relies on the ability to cater for all those people at the same time.

Most disasters or crisis-related emergencies involve a migration problem: the bigger the emergency, the bigger the number of displaced populations. Lately, Europe has been shielded from big emergencies involving huge population movements. The last such event originated in its territory dates to the Balkan Wars; that changed with the Ukrainian crisis, bringing in almost 4 million displaced persons. Those in-born crises do not take into account the on-going crisis and constant inflow of people originating in the East and South of the continent. Thousands if not millions of Middle East and Sub-Saharan individuals are ready to jump over the Mediterranean as soon as the autocrats governing the countries east of Europe or Northern Africa decide that their role as gate keepers is not worthwhile for them.

Focusing on the healthcare sector, Europe has been able to deal with the recent flow of Ukrainians mainly because those arriving had a relatively high standard of care in their country. But what would happen if the gate keepers opened the door for those trapped in Turkey or the southern shores of the Mediterranean?

So far the response, in a most peculiar if not plainly hypocritical way, has been to ignore their health needs and process their cases as expeditiously as possible, so as to make their return to their point of origin the main objective of the European policy. Ignoring the fact that they have migrated because their existence in their countries is unbearable and without any future does not make for good policy. Ignoring the fact that Europe is in the midst of a demographic crisis and a good flow of immigration and new blood could help to alleviate the crisis does not make for good policy. Ignoring the fact that all the available research suggests that migrants pay more in taxes than what they receive from the state does not make for good policy. It seems then, that the only policy guiding our policymakers is the appeasement of the far-right groups and their focus on immigration as the root of all evil.

But suppose we in Europe change gear and decide to incorporate the flow of immigration into our societies? One of the aspects that would have to be considered is their healthcare needs. Primary care, as the entrance to the healthcare system, would be where the pressure would most be felt. And primary care has been overcome by the Covid-19 pandemic, even more than hospitals and ICUs. My question is: have policymakers realized the importance of strengthening primary care? Even without the change in immigration policy, primary care needs a boost. Europe cannot attempt to survive without a strategy to absorb millions of newcomers and without a strategy to make a healthcare provision fitted for the future: an older population together with a younger migrant population.  

There are multiple factors to consider when testing the level of resilience of a society in the event of a crisis. The well-known model of “prevention – preparedness – response – recover” for risk management summarizes the basic steps for an efficient answer to an unwanted event that puts in jeopardy the well being of a group or of an entire society.

Most people in the developed world have been fortunate not to have been faced with a war. Since WWII, Europeans and North Americans have not been involved in a war affecting their homes. But that placid world has been shaken since the start of the twenty first century by several high-impact events that have disrupted the well-being of large chunks of western society. First was the financial crisis of 2007-2008. With some countries still recovering from the damage, the Covid-19 pandemic struck in 2019, turning the world upside-down. And in the midst of recuperating from the effects of the pandemic, the Russian Federation decided to attack Ukraine, disrupting the energy market, fostering inflation and sending, yet again, many families below the poverty level.

Those three high-impact events have something in common that could serve as a model for well designed “preparedness” management. I have pointed out the common denominator of the three events: sending many families below the poverty level. That common denominator is present in many unwanted events; for instance, floods or earthquakes. When a big disruption occurs, some layers of society – mostly those at the bottom of the social pyramid – see their living standards directly affected. These are the ones which rely more heavily on public social and health provision.

We can see clearly that the socio-health sector is the one that has to come to the fore when a high-impact event occurs. Dimensioning the socio-health sector for “normal” times is not sufficient. Dimensioning the socio-health sector for early response, e.g. emergency response, is not sufficient. The socio-health sector has to be ready for medium-term action since the effect of a high-impact event is going to be prolonged in time. Many of the families who lost everything during the financial crisis have been in need of assistance for many years, and the same is true for those most affected by the pandemic or the inflation shock of today. Societies have to dimension their socio-health sector taking into account that, once the shock is absorbed by the early “response”, the “recovery” phase is a long undertaking, and for that reason, “preparation” has to be clearly and sufficiently dimensioned. If in doubt, see the effect of Covid-19 on primary health care, which two years later is still struggling to cope with the increased demand on its services and is now being asked to cope with a new demand caused by the wave of refugees from Ukraine.

DG Home in general, and Mr. Philippe Quevauviller in particular, have been doing incredible work since 2014 through the Community of Users for Safe, Secure and Resilient Societies (CoU), the prequel to today’s Community for European Research and Innovation for Security (CERIS).

During the last week of March, CERIS sponsored a most interesting dual (in person and virtual) event involving stakeholders in the DRS community. For those who were unable to attend I encourage you to go to https://www.cmine.eu/page/ceris where you have access to recorded video streams and presentations.

DRS is a very hot topic. One can only record with horror how unprepared our societies were when faced with the SARS-CoV-2 pandemic. Unfortunately, Covid-19 is only one example of the lack of preparation of our societies when dealing with low probability/high impact events. Even if, hopefully, these events will have a lesser impact than Covid-19, I believe they are here to stay, and more so considering the effects of climate change. Floods, heat waves, snowstorms and other climate-related destructive events are forecast to increase in the near future. That is why CERIS work is so important.   

Un ejemplo de lo que hacemos desde PhysUp en el área de la formación es el curso básico sobre Cirugía Mayor Ambulatoria que hemos desarrollado en colaboración con el Instituto Quirúrgico Porrero.

Si estás interesado en el curso, descárgatelo en

https://physup.thinkific.com/courses/cirugia-mayor-ambulatoria

Esta primera edición del curso está en castellano, pero tenemos previsto en un futuro traducirlo y adaptarlo al inglés.

Los socios de PhysUp acumulamos una experiencia de más de treinta años en apoyo del sector socio-sanitario. Esta experiencia se complementa con una visión realista de lo que las tecnologías de la información y la comunicación pueden aportar para una mayor eficacia del sector.

PhysUp ha desarrollado varias aplicaciones informáticas, siendo el curso de Cirugía Mayor Ambulatoria el comienzo de una nueva línea dedicada a la enseñanza on-line a profesionales socio-sanitarios. Estamos abiertos a colaborar con profesionales socio-sanitario en el desarrollo conjunto de herramientas de formación. Si ese es el caso envía un correo a physup@physup.com y nos pondremos en contacto contigo.

Puedes acceder a más información sobre PhysUp y al catálogo de nuestros productos en https://www.physup.com/portfolio

Te esperamos.

Traditionally, the healthcare process starts with a person asking the advice of a physician, who will then prescribe a cure. At that moment, the person becomes a “patient”. The patient will patiently assume that the physician knows better and will follow the instructions.

The first revolution to that process started with the spread of internet. Dr. Google become a second source of knowledge jeopardizing the almighty standing of the physician.

Then came the Covid-19 pandemic, during which the physician was mostly unreachable. The patient was left alone to deal with his or her health problems. In the best of cases the physician was reachable by some kind of teleconference.

All the above added up to make the patient realize that he or she could deal with a health problem in ways that do not necessarily involve a physician. At that point, the patient becomes a consumer: a consumer of information and of alternatives other than the ones prescribed by the healthcare professional. A new demand from a new consumer has been born.

The consumer demand has to be met. Accordingly, on the supply side, many start-ups and technology giants have plunged into the market, offering everything from innovative services to medical wearables and apps of all sorts, all destined to complement, if not to substitute, the physician’s knowledge.

The trend should be welcomed by all. Health consumers now have a wider range of resources to choose from; physicians now have more time to dedicate to serious health issues. At the same time, as the consumer becomes more active in his or her wellbeing, pressure on the traditional healthcare sector can be alleviated. In all, we have arrived at the win-win situation so long craved in the healthcare sector.

Those words by Olof Scholtz (German Chancellor) struck me as a very simple motto and, at the same time, something that we all need to practice. Expect in the coming year a few occasions where practicing “never to be hysterical” will be helpful. For instance, when facing the surge of the Omicron variant of Covid-19, or the EU relations with Russia or China, not to mention the on-going renewal of the Iran nuclear deal.

Let us focus on the Covid-19 surge. Most countries in the EU have fallen back to restrictions that were established in previous surges. The difference is that now most people are vaccinated, so the EU Digital COVID Certificate can be used as an extra tool in avoiding the spread of the virus.

Have we learned anything from the previous surges? Unfortunately, the answer is NO. Two variants have spread recently and caused respective surges: Delta and Omicron. The first originated in India and the second in South Africa. According to most researchers, variants originate in populations with low vaccination levels, e.g. South Asia and sub-Saharan Africa. Has COVAX fulfilled expectations for supplying the quantity and quality necessary to those regions? Again, the answer is NO. On 29th November 2021, the WHO stated that “the majority of the donations to-date have been ad hoc, provided with little notice and short shelf lives.” Images from the BBC show how Nigeria, with as little as 5% of the population vaccinated, had to destroy one million vaccines due to their short expiration dates.

Will 2022 bring about a change to that situation, with the USA and EU countries for once making good their commitment with COVAX in quantity and quality? Will South Asia and sub-Saharan Africa attain a level of vaccinated population so as to prevent new variants? If so, most likely, we could put Covid-19 in our rearview mirror, still present but not affecting our lives so much.

The headline comes from a recent webinar intervention by Annabel Seebohm[i]. We are negatively experiencing in our everyday lives how the very much praised and extended “just in time” inventory management method has turned our lives upside down. Car factories are on hold, electronic gadgets are missing from the shelves, ports are blocked and unable to process incoming   goods. And, last but not least, the health system is stressed to the limits, because it was designed for “normal times”. “Normal times” does not take into account out-of-the-norm factors like a pandemic, like “just in time” does not take into account disruptions caused by lockouts due to a pandemic.

When Covid-19 struck, the health system designed for “normal times” was absolutely unprepared to cope with an unexpected inflow of patients: there was a need to build new hospitals, a need to recruit more health professionals, a need to explore new treatments, a need to design new care processes, a need for extra masks, medical aprons and other medical goods. And all of that had to be done in the shortest possible period of time, since people were dying by the millions (17.3 million so far according to The Economist)[ii].

Suddenly, we realized that “just in time” was not the panacea that everybody thought it was. Suppliers should move back to the point of need. That trend is obvious in the chip market, with the USA and the EU putting forward state subsidies to build chip factories in their territories, avoiding the actual dependence on the far east manufacturers.

The health sector is suffering from a similar malaise, even if the causes are different. There was an initial dependence on China for some medical products, but the two big restrictions came from inside the system: 1) lack of infrastructures such as ICU’s and hospital wards; and 2) lack of health professionals.

The first restriction has an easy solution since it can be solved with political will and money. The second restriction has a more difficult solution, it requires a great degree of advance planning. It is necessary that the design of the health system incorporates human resources for “abnormal times”. That leads to a degree of over dimensioning of human resources during normal times, contrary to “just in time” management system, incorporating the “just in case” management proposal. I am aware that this means increased budgets during “normal times”, but the rewards will be collected during “abnormal times”. It is our choice, the same kind of choice we make when buying insurance, in the hope that “abnormal times” will never come.


[i] linkedin.com/in/annabel-seebohm-ll-m-380b0392

[ii] https://www.economist.com/graphic-detail/coronavirus-excess-deaths-estimates?fsrc=core-app-economist

It is a fact that in most cases, those living in a risk area know that they live in a dangerous place but that they assume that it will never materialize. Accordingly, they do not plan to move out. Be it near a volcano, – almost 2 million people live within the range of the Vesuvius, – or by the banks of German rivers that regularly overflow, most people don’t lose sleep over these risks.

It does not matter that authorities draft very detailed risk maps. People refuse to move for various reasons: sentimental, lack of alternatives, indifference to the risks, not believing in science, conspiracy theories, etc.

How to overcome that resistance to move to safer quarters? I think that the most important step is to bring science to civil society. Indifference, science negation, conspiracy theories and such, are bred in misinformation and lack of information. If risk maps were drawn together with representatives of the people living in the affected areas, then the scientific backing for designing an area as dangerous would be transmitted to the population. The will of the people will be always the driving factor for deciding to remain in a risky area or to leave. But at least, those remaining in dangerous places will take their decision based on the latest scientific findings.