miércoles, 23 de diciembre de 2020

Management of the covid19 pandemic, individual and social barriers (social justice), by Juan Gérvas and Meredes Pérez

Pandemics are not health problems but social ones, like almost all questions around infectious diseases (with the good understanding that medicine and public health theirselves are more politics than clinical work). That is, for example, to end cholera what is needed are not antibiotics and vaccines but political decisions that ensure the supply of drinking water and the purification of wastewater.

Thus, in addition, will be avoided cholera and many other diseases that are transmitted by water.

For this reason, the covid19 pandemic has made evident the problems of social justice in a society that has done little in “social medicine”. A pragmatic social justice approach, addressing both health disparities and access barriers, should inform pandemic management (1).

Unfortunately, it is easy to see only personal responsibilities and ignore the public component (2).

A good example is the proposal for "Swiss cheese model" published in the New York Times, with an ideology that burdens the individual with the weight of the barriers against the covid19 pandemic (3). 

“Multiple layers of protection, imagined as cheese slices, block the spread of the new coronavirus, SARS-CoV-2, the virus that causes covid19. No one layer is perfect; each has holes, and when the holes align, the risk of infection increases. But several layers combined — social distancing, plus masks, plus hand-washing, plus testing and tracing, plus ventilation, plus government messaging — significantly reduce the overall risk”.

This proposal, of implicit neoliberal ideology and lacking in solidarity, comes to be accepted by many people, without realizing their presumptions.

You can compare the American figure published in the New York Times with the figure that we propose below. Please look for the differences (and matches).


Mental images of the covid19 pandemic tend to over-imagine individual responsibilities.

These images include assumptions and ideology that we accept without thinking.

It is time to have a broad vision that also highlights the social justice that we need to provide an effective and supportive response.

Juan Gérvas, Doctor of Medicine, retired rural general practitioner, CESCA Team, Madrid, Spain jjgervas@gmail.com  @JuanGrvas

Mercedes Pérez-Fernández, Specialist in Internal Medicine, retired general practitioner, CESCA Team, Madrid, Spain mpf1945@gmail.com 

Member of NoGracias

NOTE.- The drawing with the proposal for social justice measures, on the ideas of the signatories, of his grandson Juan Gérvas Zorrilla. In case of reproduction, mention of the intellectual authors and the cartoonist would be appreciated.



1 DeBruin D et al. Social justice in pandemic preparedness. Am J Public Health. 2012 April; 102(4): 586–591.


2 Gérvas J. Culpabilizando a la población de la mortalidad por covid19 en España. Salud, dinero y atención primaria. 20 diciembre 2020


3 Roberts S. The Swiss Cheese Model of Pandemic Defense. New York Times. 7 December 2020.




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