Los controles para la detección de COVID-19 en Singapur comenzaron en el Aeropuerto Internacional.
Uno de los primeros lugares en sentir el impacto del nuevo coronavirus fuera de China fue Singapur, donde los detectives estaban al acecho de posibles casos positivos de la enfermedad en un intento de estar un paso adelante del virus. ¿Cómo lo lograron?
A mediados de enero, un grupo de 20 turistas provenientes de la ciudad china Guangxi llegaron a Singapur para celebrar el Año Nuevo Lunar. Visitaron algunos de los sitios más sofisticados.
En su itinerario estaba una simple tienda de medicina tradicional china que vendía aceite de cocodrilo y hierbas. Esta tienda es popular entre lo turistas del continente.
Fueron atendidos por una dedicada vendedora que les mostró varios productos, inclusive les dio masajes con aceite medicinal en los brazos. El grupo de turistas regresó a casa, pero dejaron algo atrás.
La tienda de medicina.
En ese momento, los casos de coronavirus en Singapur habían sido encontrados únicamente entre los que llegaban de China continental.
Sin embargo el 4 de febrero, el gobierno de Singapur informó que el virus se había propagado entre la comunidad local y la tienda de medicina china Yong Thai Han era el primer foco, con la guía turística y aquella entusiasmada vendedora ya enfermas.
A partir de la tienda 9 personas se infectaron, incluyendo el esposo de la vendedora, su bebé ed 6 meses y su empleada doméstica indonesia. Otros trabajadores también se contagiaron.
Aunque las personas ya se recuperaron, pudo haber sido much peor de no ser porque Singapur cuenta con un sofisticado y extenso programa de rastreo de contactos que sigue la cadena del virus de una persona a la siguiente, identificando y aislando a esos individuos y a todos sus contactos cercanos antes de que se pueda propagar más el virus.
‘’Hubiéramos terminado con Wuhan’’, afirma Leong Hoe Nam, un especialista en enfermedades infecciosas del hospital Mount Elizabeth Novena y un asesor del gobierno de Singapur.
‘’Los hospitales estarían desbordados’’.
A partir del 16 de marzo, Singapur había confirmado 243 casos y ninguna muerte. Para alrededor de 40% de esas personas, el primer indicio que tuvieron fue cuando el Ministerio de Salud les dijo que debían ser sometidos a una prueba y quedar en aislamiento.
Hasta esta semana, más de 6,000 personas han sido rastreadas y contactadas mediante una combinación de imágenes de cámaras de seguridad, investigación policial y arduo trabajo detectivesco a la antigua, que muchas veces se inicia con una simple llamada.
Las llamadas.
Fue en una de esas llamadas, recibida una soleada tarde de sábado, durante un asado, que Melissa (usaremos alias para proteger la identidad de los individuos), una maestra de yoga británica que vive en Singapur, supo que estaba en riesgo de haber contraído el virus.
‘’Fue surrealista’’, dice describiendo el momento en que un número desconocido apareció en su teléfono. ‘’Preguntaron, ‘¿estuvo en un taxi a las 18:47 el miércoles?. Fue algo muy preciso. Supongo que entré un poco en pánico, no podía pensar con claridad’’.
Melissa finalmente recordó que había estado en ese taxi -y luego, cuando revisó la app que usó para conseguirlo, se percató que había sido en un viaje que duró apenas seis minutos. Hasta ahora, no sabe si fue el conductor u otro pasajero el que estaba infectado.
Todo lo que sabe es que fue un funcionario del Ministerio de Salud de Singapur quien hizo la llamada y le dijo que tenía que quedarse en casa y entrar en cuarentena.
Al día siguiente, Melissa se enteró de lo serios que eran los funcionarios. Tres personas aparecieron a su puerta, vestidos en batas y con mascarillas.
“Fue como en una película”, comenta. “Me dieron un contrato -la orden de cuarentena- que dice que no puedes salir de tu casa o tendrás pena de una multa y encarcelamiento. Es un documento legal”.
“Dejaron muy en claro que no se podía salir de casa. Y yo entendí que no violaría la orden. Sé que vivo en un lugar donde haces lo que te dicen”.
Dos semanas después, Melissa no había manifestado síntomas de covid-19 y pudo salir de casa.
En Singapur, la mayoría de la gente conoce a alguien que ha sido rastreada y contactada, y eso es parte del asunto. Con casi 8.000 personas por kilómetro cuadrado, es uno de los países más densamente poblados del mundo. Un foco de infección no identificado podría propagar la enfermedad rápidamente.
El potencial impacto sobre la economía y el servicio de salud sería enorme. Singapur no tuvo muchas opciones salvo encontrar y asilar a todo el que estuviera en riesgo.
Detectives
Conceicao Edwin Philip es uno de tres rastreadores de contacto en el Hospital General de Singapur, uno de los centros sanitarios estatales encargados de tratar a los pacientes con coronavirus.
Su equipo es el primero en hablar con los pacientes cuando llegan al hospital para saber con quién han entrado en contacto y dónde han estado.
“Una vez recibimos los resultados de laboratorio de un caso positivo, tenemos que cancelar todo y trabajar hasta las tres de la mañana. Al día siguiente, retomas de nuevo”, dice.
Le entregan esa información vital al personal del Ministerio de Salud que continúa con el proceso: “Sin esta primera pieza, no se puede conectar nada. Es como un rompecabezas, hay que armarlo por completo“.
Zubaidah Said dirige uno de los equipos de Ministerio de Salud que tiene la tarea de seguir el siguiente paso.
Muchas veces, su equipo enfrenta desafíos en la recolección de información -algunos pacientes están muy enfermos para contestar, por ejemplo- y eso hace su labor más difícil.
“Hasta donde sea posible, con muchos casos tratamos de obtener una segunda información, pero otra vez, eso ha sido difícil”, reconoce.
Ahí es donde entra el siguiente equipo, porque Singapur también tiene la ventaja de contar con unidades de investigación criminal de la policía al frente.
“La policía y el ministerio sostienen teleconferencias diarias para intercambiar información”, expresó a la BBC por correo electrónico el alto comisario asistente de policía Lian Ghim Hua, del Departamento de Investigación Criminal.
“Un promedio de 30 a 50 agentes están trabajando todos los días en rastreo de contacto y la cifra algunas veces se eleva hasta más de 100 agentes”.
El rastreo de contacto se hace además de los deberes diarios de la policía -algo que es posible debido a la baja tasa de criminalidad en Singapur.
En ocasiones, los agentes también engancharon la asistencia del departamento de investigación criminal, la oficina antinarcóticos y los servicios de inteligencia de la policía.
Usan imágenes de CCTV, visualización de datos e investigaciones para ayudarlos a rastrear contactos cuyas identidades no se conocen en un principio, por ejemplo, los pasajeros de un taxi que no lo contrataron por app o que pagaron en efectivo.
La eficiencia es clara con el caso de Julie, que fue al hospital con dolor de cabeza y fiebre a comienzos de febrero.
Menos de una hora después de que los médicos le informaron que estaba contagiada del virus, el sistema se activó.
“Estaba tendida en la cama del hospital cuando recibí la llamada”, contó. Lo que siguió fue un meticuloso interrogatorio de todo lo que Julie había hecho y toda persona con quien se había visto en los últimos siete días.
“Querían saber con quién había estado, qué estaba haciendo, cómo se llamaban y cuáles eran sus números de contacto”.
Los funcionarios estaban buscando contactos cercanos, típicamente alguien que hubiese estado más de 30 minutos con la persona infectada, en un espacio de dos metros.
“No había interés en alguien con quien me hubiese rozado el hombro, aun si era algún conocido mío. Buscaban gente con las que había pasado algún tiempo”.
Julie habló con el rastreador durante casi tres horas. Al final de la llamada, había identificado 50 personas. Todas fueron contactadas por el Ministerio de Salud y cumplieron la orden de 14 días de cuarentena.
Modelo de referencia
El rastreo de contactos no es algo nuevo -ha sido utilizado durante décadas para encontrar pacientes que pueden haber pasado sus enfermedades a otros durante una estadía.
Pero el uso del sistema en Singapur durante esta crisis fue elogiado por epidemiólogos de la Universidad de Harvard (Estados Unidos) a principios de febrero, que lo describieron como el “modelo de referencia de detección casi perfecta”.
La Organización Mundial de la Salud (OMS) también elogió a Singapur por ser proactivo antes de que el primer caso fuera detectado.
Singapur, al contrario de Estados Unidos y la mayoría de Europa, inició el rastreo de contactos con anticipación para estar delante de la propagación en la comunidad.
“Si lo dejas para mucho más tarde, todo se vuelven mucho más difícil de hacer, porque hay demasiados casos”, opinó la doctora Siousxie Wiles, profesora asociada de la Universidad de Auckland en Nueva Zelanda.
Pero ese nivel de precisión y detección aplicado en Singapur no sería posible en la mayoría de los países.
No hay muchas naciones que tienen el nivel de vigilancia civil que tiene Singapur, que la OMS comentó a la BBC en un correo electrónico, “ha permitido la rápida identificación y tratamiento de los casos”.
Eso va de la mano con el comportamiento mayoritariamente obediente de la población en general, cuando el gobierno llama y pregunta, es casi absolutamente seguro que todo el mundo coopera.
El Acta de Enfermedades Infeccionas de Singapur hace ilegal que alguien rehúse cooperar con la policía en sus esfuerzos por recopilar información.
El castigo es una multa de $6.900 dólares y cárcel por seis meses, o ambas.
Casi dos meses después del inicio del brote, no han registrado muertes en Singapur.
Para Singapur, el mérito lo tienen sus sistemas de salud, pero también al rastreo de contactos.
Les ha ganado tiempo para que los médicos puedan tratar en el hospital a los pacientes que realmente lo necesitan, sin abrumar los servicios de cuidado de salud de la forma en que ocurrió en Wuhan.
La realidad es que Singapur tendrá que abandonar el rastreo de contactos si las cifras continúan en ascenso. Es un sistema costoso, arduo y en algún momento el virus rebasará a los rastreadores.
Pero, hasta ese entonces, es una carrera contra un enemigo invisible. Los rastreadores bien saben que solo se necesita unos cuantos casos que no sean rastreables para que el virus empiece surgir entre la población.
Con información de bbc.com
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