Tuesday, July 5

The explosion of infections puts Primary Care in check again

History seems to repeat itself: a part of the health system stressed to the point that it cannot fulfill its functions. The Generalitat de Catalunya has communicated that Primary Care is collapsed and asks contacts who are positive for SARS-CoV-2 not to go to health centers if they do not have serious symptoms, which are simply self-confining. In that community there are more than 2,000 cases for every 100,000 under the age of 30, that is, 1 in 50 has been infected in the last 14 days. Most of them have not yet been vaccinated, the main reason for this growth, according to the Ministry of Health. Young people do not usually develop the disease in a serious way, but who assumes their care is Primary; and who is in charge of contact tracing, Public Health. Members of both health levels have been working tirelessly since January 2020. And they have also been involved in the vaccination campaign for months.

The Government relies on vaccination and tracking to stop the outbreak of infections

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The overload also comes in the middle of the summer season, always a resource slump in Primary Care that is not usually reinforced these months despite the cut in resources that the holidays of its workers entail. Only some communities, such as Valenciana and Canarias, anticipated the incorporation of personnel in advance in June. The SATSE union denounces that on average only between 30 and 40% of the nursing professionals in the entire system are covered; that is, of every 100 nurses who go on vacation in July and August, only 40 join.

The incidence of recent infections in each age group

Evolution of the incidence of cases in 14 days per 100,000 inhabitants in each age group since March 2021

Catalonia leads the incidence rate, but other communities fear that it is only the advance and soon it will be their turn to make decisions similar to that of close contacts not coming to the centers. For this reason, the Valencian Community, which from the rates of 50 cases per 100,000 inhabitants a few weeks ago has jumped to 250, has asked the Justice to reauthorize the curfew. It was also raised this Wednesday, among another battery of measures, by the Minister of Health of Castilla y León, Verónica Casado, to Minister Carolina Darias and her counterparts in the Interterritorial Council. “The curfew is not on the table,” Darias settled. President Pedro Sánchez also flatly denied that possibility from Lithuania. The easiest way to impose it without legal problems is a state of alarm, difficult to justify with more than 50% of the population with a dose, health sources explain. The Ministry also does not take a position on nightlife, which was allowed to reopen last June and something that many experts link this rebound to, especially after the macro outbreak in Mallorca that involved some 5,000 people. They respect communities that have closed it, such as Catalonia, but they do not coordinate any action in this regard.

The Government hopes that reinforcing the traces will be enough to stop this already classified as the fifth wave. For this, they have given the communities five million tests for screening and the Army trackers, which are not a specific number but Defense will make available those that are needed, health sources comment.

They also hope that an acceleration in vaccination will stop the escalation of cases, but the Ministry does not dare to predict when the situation may be controlled. They do want to promote vaccination among young people, given the fear that because they feel less vulnerable they may not have as good a response as that of their parents and grandparents, and that is why they are preparing a campaign aimed exclusively at them, surely with figures reference for those generations. The message has to be empathetic but they also have to convey the risks, indicate from Health.

How is the epidemic evolving now?

Evolution of the cases and deaths reported, those hospitalized and those admitted to the ICU each day and the variation in the last 7 days

Source: Ministry of Health

The infections of young people also generate collapse

The first objective of all restrictive measures of the pandemic has been to free hospital saturation. During the first, second and third waves, hospitals had COVID occupations in ICUs that were far above reasonable (in the first, more than 100% in some areas only for this disease; in the third, close to 50%, counting the new infrastructures incorporated).

That is not the problem now. On average, slightly less than 25% of conventional beds are occupied by patients with coronavirus. Vulnerable groups are protected by the vaccine (100% of those over 70 with a complete schedule) and thanks to that, the percentage of people in intensive care has been dramatically reduced. The hospitalization rate does increase somewhat with this rise. In Catalonia they already warned at the beginning of the week that a rebound in income was beginning to be noticed.

Some people vaccinated without the full schedule or who, due to drug efficacy limitations, have not developed immunity – Pfizer has one of the highest efficiencies and this occurs in approximately 10% of those who receive it – can become seriously ill. In addition, so many young people are infected that, although proportionally they continue to be a minority, numerically the serious ones are more. In a month, the average age of COVID patients in Spanish hospitals has dropped from 51 years to 48, according to Health data, which calculates that it is possible that this figure “will continue to decrease, but little.” The average in ICU remains stable, between 50 and 52 years.

“The film is now completely different because we have vaccines, the fatality without vaccines would not be as it is, we would be like months ago,” says Amós García Rojas, president of the Spanish Association of Vaccination and technical advisor to the Ministry. But “the fact of having so many cases is not good: because the virus continues to circulate and, without such a tremendous image as before, there are more people in the ICU; and also because of Primary Care. We are used to talking about the health system as if only outside the hospital environment, and no “. The problem is, therefore, that they are living in Catalonia and also in other communities such as Cantabria, which anticipate what may happen in other territories where infections continue to multiply: the collapse of Primary Care and Public Health. That there are not enough staff in Primary Care causes, in addition to stress for health workers, that care for minor ailments is postponed and the situation of patients becomes more serious.

“I also want everyone to be fully immunized, but we are not yet in that phase,” explained Adrián Aginagalde, director of the Public Health Observatory of Cantabria and coordinator of many tracking tasks. “There is a regional alert that is difficult to manage. People do not die, but this is causing many problems.” Everything has come with “a general public perception that the thing was channeled and that it did not matter so much that someone [los jóvenes] infected because it was going to have a favorable prognosis and it was not going to infect anyone “, analyzes Ildefonso Hernández, spokesperson for the Spanish Society of Public Health. It has been difficult, starting from there, to explain to the public that it is a problem that the young people get infected.

Several autonomous communities have already started with self-appointments for those under 30 years old and almost all have done so with those under 40, so the Government’s confidence is that the situation will be channeled in a few weeks. There is a third vector of the problem: several countries, including France and the United Kingdom, keep us on their list of unsafe countries due to COVID rates, and that can have dire consequences for the tourist season. In addition to reinforcing the vaccination campaign and Primary Care and Public Health, experts such as Pedro Gullón, a member of the Spanish Epidemiology Society, proposed “restricting nightlife or, if it is not possible at all, perhaps a few hours or at least the interiors “. “In the places with the highest incidence, the de-escalation of this type of leisure should not be accelerated, but safer outdoor activities can be promoted, since it is summer”, such as festivals, which are still allowed in Catalonia.