Health facilities cannot cope with seasonal epidemics of respiratory viruses. In late 2023, the flu has returned with a vengeance after several seasons of unusual behavior due to the coronavirus. And this is joined by Covid, which, with lower impact and toxicity, is also present in consultations due to higher patient demand and reduced staff due to the Christmas holidays. “Emergencies outside the hospital (in outpatient clinics) are completely saturated,” Lorenzo Armenteros, spokesman for the Spanish Society of General and Family Physicians (SEMG), summarized.
The latest epidemiological data published by the Carlos III Health Institute is from a week before Christmas Eve. By then, notifications of acute respiratory infections in primary care had increased by more than 100 points compared to the previous one: from 806 cases to 916 per 100,000 inhabitants. And everything indicates that at later dates, there is a steady increase in family gatherings with and in between celebrations. New data will be published this Thursday, but experts expect infections to continue rising in the coming weeks and reach a peak in the second half of January.
Despite the predictability of these winter waves, history repeats itself every year with greater or lesser impact in health centers, a chronic shortage of professionals that the pandemic exposed and which shows no signs of being resolved. The Health Ministry itself had admitted in a report a year ago that there were a thousand fewer family doctors than in 2018. And in May, semFYC came out with another report assuring that it would allow 10,000 professionals to join over the next four years. Retirement, something that seems very difficult, since the conditions and salaries offered by autonomous communities in health centers are pushing many professionals to work in hospitals or abroad.
In Málaga, where Leovigildo Ginel, a member of the Spanish Society of Primary Care Physicians (SEMARGEN) serves, this Christmas he has broken the record for patients arriving without appointment: 178 in a single day. The four doctors who were working were already involved in his agenda. “More than 60% or 70% come down to the same thing: respiratory symptoms,” says Ginell. Most are flu, whose incidence is double that of Covid. Both are joined by other pathogens with similar symptoms that are not commonly recognized.
In most health centers, tests are not carried out to find out which virus it is, something that is reserved for so-called “sentinels”, who work to measure the impact of the pandemic in the country. Treatments also do not differ for people with no underlying diseases, regardless of the virus. Good hydration and paracetamol to relieve discomfort. That’s what doctors generally recommend, besides taking precautions to avoid infecting vulnerable people.
For this reason, Armenteros calls on people who are not at risk not to go to the health center at the first symptoms: people over 80 years of age, or those with co-morbidities or who are immunosuppressed. “There is no need to panic, you need to give it 48 hours to see how the symptoms develop, take a low dose antipyretic or anti-inflammatory and see what the situation is. If it has not improved after this time, medical attention is also not necessary; “It should be abandoned for more serious symptoms, such as shortness of breath (suffocation sensation), fever lasting more than four days, worsening of respiratory disease, change in the color of sputum…”, Armenteros listed. Does.
A problem for many patients is that they need a medical certificate to prove their sick leave. “Here we have a very strong service area that cannot be telecommuted. The ideal would be something that other countries do and that we have been calling for for some time: patients’ self-responsible declaration of sick leave that lasts no more than three or four days. This will partially prevent saturation of health centres,” claims Ginell.
In Armenteros’ opinion, this flu wave could have been softened with higher vaccination rates and greater monitoring of the safety measures implemented by society during the pandemic, such as the use of masks and air filtration systems. Data from the vaccination campaign for the whole of Spain are not yet known; The Health Ministry will make it public when the season ends. But Armenteros’ impression is that coverage has been “low”, even among children, who account for the most cases, despite the fact that the first mass vaccination campaign for children under five is scheduled for 2023. was launched.
This is supported by the data reported this Tuesday by Catalonia, where only 46% of the population over 60 years old has received an injection, while the objective was to reach 75%. In the Valencian Community, the health minister, Marciano Gómez, has called on the population to get their doses, while also announcing that they are considering returning to mandatory masks in health centers due to the increase in infections.
Are we facing a more severe pandemic than other years?
The majority of viruses spreading this season are influenza A, which usually leaves stronger symptoms than other types. But it is still a well-known pathogen. The data published so far shows that Spain is not facing any extraordinary situation.
José María Eros Bauza, director of Valladolid’s National Influenza Center, said last week that “we are seeing a normal situation” in the Northern Hemisphere at this time of year. “Flu is an infectious disease that occurs in the autumn-winter months, associated with weather conditions and overcrowding. As a message to those who may be infected, it is not the same as those who are healthy, without underlying pathology, who can tolerate without going into the health system. Those who are in delicate health or who are elderly.
It is the latter that usually require hospital care due to respiratory viruses. Income is increasing, but the condition of hospitals is far from health centers. Antoni Torres, member of the respiratory infections sector of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), emphasizes that primary care is declining, as most patients are not critical. “There is already some income, but still very little. We will see the data at the end of the pandemic. There are still high levels of overcrowding and infection,” he concluded.
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