Francisco Goiri Madrid
Madrid
Updated Tuesday,16January2024 - 01:17
- Health Flu vaccination: "This year's composition offers an efficacy of more than 60%, we still have time to increase coverage"
- Health The legal errors of the Health Ministry in the imposition of masks that lead the Basque Country and the Balearic Islands to appeal
The expression recurrent crisis is an oxymoron, but the health system seems to accept it as inevitable. If the crisis recurs every year (and almost at a fixed date, as happens with the flu), it is theoretically preventable and, therefore, would not be such a crisis.
In theory, of course. The average incidence of acute respiratory infection that Spain has accumulated in recent weeks shows that this principle does not apply to the National Health System (SNS), which has faced this year's flu campaign with its guard down. Can you do better? Do you have the tools to do so? Do you apply them as and when you should?
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Bless you.
Flu Incidence Nears Peak: Cases Drop but Hospitalizations Rise
- Written by: PILAR PÉREZ Madrid
Flu Incidence Nears Peak: Cases Drop but Hospitalizations Rise
Bless you.
Emergencies and the flu: a cyclical 'virus' that chokes the health system
- Written by: FRANCISCO GOIRI Madrid
Emergencies and the flu: a cyclical 'virus' that chokes the health system
On behalf of the NHS, it can be argued that the specialists who know the most about infections, prevention and public health admit that this winter's campaign brings together factors that explain, in part, this high incidence. Luis Buzón Martín, spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology, says: "We are only facing an epidemic of seasonal winter flu, although it is true that this year the days of intense cold have come earlier and have coincided with the Christmas holidays, which is when we get together the most; If we add to that the fact that the vaccination campaign has not achieved, by any means, the planned objectives and that hygienic measures have been relaxed, the problem is served."
Result: the sponge doesn't drain. "Last year, for example, the flu epidemic was less abrupt, distributed between January and early February, more gradually, so that the system had the capacity to assimilate. This year, the downpour has been so intense and concentrated in time that the sponge gets soaked, saturated, and the system is not able to assimilate such a significant number of cases in such a few days." Translated into healthcare incidence, the image of Buzón Martín reads as follows: "For all these reasons, we are experiencing a particularly intense seasonal flu epidemic this winter, and which has led the health system, as a whole, to considerable stress".
The flu, a recurring ailment every winter
Apart from the annual incidence of the epidemic, Buzón Martín elaborates, precisely, on the recurrent nature of the problem, "because the flu is a seasonal phenomenon that, day up and day down, reproduces itself in very specific weeks of the year. It has an expiry date, but it is not avoidable, although it can be mitigated, and we have to work on that, because those three or four weeks can do a lot of damage to the health system."
By training, but also by conviction, prevention is a verb that Manuel García de la Vega, president of the Spanish Society of Preventive Medicine, Public Health and Health Management (Sempspgs), conjugates almost automatically when he hears the word flu. "To a greater or lesser extent, the peak of respiratory infections always catches us off guard, except for the pandemic years, and that's for obvious reasons. The new normal, which has been talked about so much, also means that the preventive awareness that arose as a result of covid is not diluted."
This year, the 'downpour' has been so intense and concentrated that the sponge gets soaked, does not drain and the system becomes saturated
Luis Buzón Martín, spokesperson for the Seimc
And it will not be, García de la Vega points out, due to a lack of tools, because the SNS, assures the president of the Sempspgs, is well equipped, at least on paper. There are protocols for action, and not only at the regional level, but also at the national level.
Of the latter type, the preventivist points out, there are "at least two": the National Plan for Preparedness and Response to an Influenza Pandemic, which the Ministry of Health published in 2005, and its 2009 corollary on avian influenza. There are also technical tools "very reliable", recent and not so reliable: the now famous Acute Respiratory Infection Surveillance System (Sivira), which was launched in the middle of the pandemic, but which is based on the sentinel surveillance systems for mild acute respiratory infection (ARI), primary care, and severe acute infection (SARI) in hospitals.
The Juan Ramón Jiménez Hospital (Huelva), where García de la Vega works, is precisely one of the five hospitals attached to IRAG in Andalusia, "and we provide very precise information, updated weekly, in Andalusia and throughout Spain, on the evolution and trends of the curve, the nature of the strains, the expected incidence, the estimation of peaks... From the beginning of September we began to have very reliable data, and it is then - if not before - when the Ministry of Health and the communities have to convene coordination meetings and set clear and homogeneous action protocols for the entire NHS, not on January 10", denounces the Andalusian preventivist.
We already have data in September, and that is when coordination meetings should be convened, not in January
Manuel García de la Vega, President of the Spanish Society of Preventive Medicine, Public Health and Health Management
In the same vein, Buzón Martín, head of Internal Medicine and the Infectious Diseases Unit at the University Hospital of Burgos, specifies that "we cannot wait for the weekly cumulative incidence figures to be through the roof to take concrete measures". However, he adds, for this "it is necessary to structure objective and, if possible, homogeneous plans throughout the NHS, which are based on numerical, quantifiable criteria, and not that each community does what it thinks is appropriate at all times".
'APPROVE' IN SEPTEMBER
September is also the month cited by Marcos López Hoyos, president of the Spanish Society of Immunology (SEI), to start a "good, proactive and conscientious national vaccination campaign", which reverses the traditionally low flu vaccination rates, even among the most vulnerable population. "The strains mutate every year, and this one, for example, influenza A has been especially present. Getting vaccinated does not prevent infection, but it does make it milder, shorter in time and not so many infections," he sums up.
The president of the SEI points out that the overall rate of infection of respiratory diseases is similar to that of the previous year - or only slightly higher, if the data for weeks 52 of the years 2022 and 2023 are compared - and that what has skyrocketed has been the incidence of influenza, precisely because people have been vaccinated less, "Among other things, probably, because of pandemic fatigue, which affects the use of masks, but also vaccines. In coronavirus, vaccination was perhaps not such a priority, because previous immunization has been intense and widespread, but in influenza we could not let our guard down, and we have done so."
Vaccination data for the 2023-2024 season shown by the Grippómetro reveal an average coverage of 63.2% in people aged 65 and over. If the official data of the communities (which the ministry requests in February from all the councils) confirm the figures of the Gripómetro, vaccination coverage in this age group would be 3% lower than last season, but it would be well below (as almost every year) the objective that the Administration had set: reach or exceed 75% in the elderly and in health and social care personnel, and exceed 60% in pregnant women and people with a risk profile.
Each annual campaign is going to have its peculiarities, argues López Hoyos, "and last year, without going any further, we had two spikes in respiratory syncytial virus (RSV) and influenza in children at the end of September and in December, with a plateau between the two. This year, fortunately, it seems that the usual behavior of these infections in children has been regulated again."
In short, that singular strains and behaviors aside, what the health system, and its managers, have to engrave in fire is that the structural approach to acute respiratory infections requires, every year, the adoption of concrete measures, well assessed, coordinated at the national level and advanced in time.
And the basic measures, insists the president of the SEI (and, with him, his colleagues), we know by heart. And, in addition, the pandemic evidenced its effectiveness: "Masks in the presence of symptoms of acute respiratory infection, powerful vaccination campaigns and, let us not forget, health education for the population, because this year health centers and hospital emergency services have been saturated with a lot of banal pathology."
Accepting the "inevitability" of the problem, says the president of the Sempspgs, does not mean, therefore, that the NHS is immune to it, "and if before specific controls were made for influenza, now, the regional contingency plans include controls of all acute respiratory infections". But the packaging is useless if there is no content, adds his counterpart from the SEI, "because winter contingency plans have existed for years in all hospitals, but they must be provided with the infrastructure and staff reinforcements necessary for them to be effective".
A 'REHASH' OF WHAT IS ALREADY KNOWN
The measures issued by the ministry in the Interterritorial of January 8 are, in essence, a summary of the documents, protocols, action plans, recommendations and control measures that have been drawn up in recent years at the national and regional level. The SEIMC spokesperson also recalls that the protocols are very much in line for each type of infection.
Winter plans exist in all hospitals, but they must be provided with resources and staff
Marcos López Hoyos, president of the Spanish Society of Immunology (SEI)
"In terms of influenza, we cannot tire of recommending every year the administration of the vaccine in all the risk groups for which it is recommended, especially in a season of high incidence like this one, and for that the ministry and the Autonomous Communities must carry out crushing and coordinated campaigns that reach the population en masse," says Buzón Martín.
With regard to RSV, the head of Internal Medicine at the Hospital de Burgos points out that its approach "has changed a lot and will change even more in the future, with the generalisation of the vaccine, which we hope will be a reality in the very short term". In the meantime, "it is necessary to promote the use of monoclonal antibodies (nirsevimab) for the prevention of this virus in infants, young children and pregnant mothers [all communities have introduced RSV immunization in the population at risk and in newborns, extending it to 6 months of age]."
And there is, of course, covid, "a virus that, 4 years after its outbreak, we still do not know for sure how it will evolve in the future, and whether it will acquire a seasonality similar to that of the flu or whether we will have a more or less uniform transmission throughout the year. Logic suggests that it will remain a seasonal virus, but in 2023 it has not behaved like this, and its presence has been constant. Even so, the prescription is also known: intensive vaccination in the at-risk population and the administration of oral drugs that have been shown to be very effective in reducing the severity of the infection in the first 5 days."
When it comes to planning for the future, Buzón Martín cannot resist putting back on the table what he and his colleagues have been demanding for years in vain: "The definitive approval of the specialty of Infectious Diseases is urgent. It is not acceptable that Spain still does not have formal training in such an important field."