prudencia racional

Rational fear

“Don’t be afraid of Covid,” President Trump tweeted, on the same day that the White House outbreak spread further and another several hundred Americans died from virus complications.

The president has survived Covid-19 so far, with help from more aggressive medical care than virtually any other American would have received. But about 210,000 of his fellow citizens have not survived, according to the official death count. The real toll, based on the number of excess deaths this year, is probably closer to 275,000.

Given Trump’s campaign to make the virus seem like a minor inconvenience, I think it’s worth taking a minute this morning to take stock of the virus:

Only cancer and heart disease will kill more Americans this year than Covid. Already, the virus has killed more than twice as many Americans as either strokes or Alzheimer’s disease, about four times as many as diabetes and more than eight times as many as either gun violence or vehicle accidents.

---

Un juicio prudencial

La cautela racional de la precaución
en contraste con el miedo irracional de la coronafobia.

Coronaphobia [DSM adjustment disorder] may be likely to occur in those who feel vulnerable to disease, are predisposed to anxiety, or are intolerant of uncertainty. Preexisting mental health conditions can also be exacerbated by periods of quarantine, self-isolation, and lockdown, which can lead to panic attacks, chronophobia (fear of passing time), and suicidality. [REF]

---

Por cuanto,

• Las medidas de prevención y la mitigación del riesgo de un peligro mortal son una responsabilidad individual y un deber social.
• La prevención de la causa de ese peligro debe ser proporcional al daño, potencial y realizado.
• Los daños colaterales relacionados a la mitigación de esa causa deben ser proporcionalmente menores al daño que se procura prevenir.

Por tanto,

• cuando un daño mortal es prevenible por la acción individual y colectiva inmediata de los miembros de una comunidad, y
• mientras la mitigación de un daño prevenible no produzca daños colaterales de mayor magnitud, y  
• el daño producido por la causa de un mal exceda el daño esperado por otras causas,

entonces,

• se justifica la obligatoriedad de acciones preventivas que favorezcan al bien común, aun cuando limiten las libertades individuales en una comunidad.

Ejemplo: COVID-19 en EEUU

1. COVID-19 es una enfermedad mortal transmisible y prevenible por medidas de contención y de mitigación probadas por la ciencia de la salud pública.

2. La mortalidad por COVID-19 actualmente excede la mortalidad esperada por todas las causas de muerte.

3. Los daños colaterales asociados a las restricciones de la actividad económica para prevenir el COVID-19 no exceden al daño causado por COVID-19. [Ref]

---

Por lo tanto, están justificadas la obligatoriedad del uso de mascarillas, del distanciamiento físico en actividades cotidianas y las medidas de higiene personal a nivel individual, así como restricciones (no necesariamente clausura) de actividades económicas y sociales que reduzcan el riesgo de propagación masiva (superspreader events), como lo son la proximidad física de larga exposición (> 15 minutos) en espacios cerrados sin adecuada ventilación (cines, casinos, bares, restaurantes, gimnasios) y el hacinamiento en espacios abiertos (aun con mascarillas).

---

Scientific American has never endorsed a presidential candidate in its 175-year history. This year we are compelled to do so. We do not do this lightly.

The evidence and the science show that Donald Trump has badly damaged the U.S. and its people—because he rejects evidence and science. The most devastating example is his dishonest and inept response to the COVID-19 pandemic…

---

Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs. –NEJM

---

COVIDPR.pitirres.org

CONSULTOR

José Becerra, MD, MPH, FACPM
Atlanta, GA and San Juan, Puerto Rico

Retired Centers for Disease Control Medical Epidemiologist

Adjunct Associate Professor of Epidemiology and Biostatistics
Graduate School of Public Health, Medical Sciences Campus
University of Puerto Rico