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The closure of health centers has become a threat that he plans as a possible solution to this coronavirus crisis. There is no official confirmation, but it does seem to be an open secret that primary care doctors are beginning to worry about. If this happens, "who cares for the vast majority of people who suffer from the disease with mild symptoms and do not need to go to a hospital?" Says Salvador Tranche, president of the Spanish Society of Family and Community Medicine (Semfyc) . It should be remembered, he clarifies, that these patients are 80% of all those affected by SARS-Cov-19.
The position of these professionals in the field of struggle is key. It is they who can filter cases to prevent hospitals from being overloaded . How? Discriminating those who are in a position to continue in their homes from those who must be referred to the hospital center. It is estimated that 15% of those affected will require admission and 5% will present a critical evolution that will require intensive care.
With the rest, from a medical point of view, "we can analyze their evolution day by day through telephone monitoring," says Tranche. Specifically in the Community of Madrid, this work is being carried out with more than 55,000 people suspected or diagnosed with coronavirus.
However, "only the number of ICU admissions is being shown and not the thousands of patients treated early to prevent them from reaching a state of seriousness," relate Primary Care doctors through a document published on the website of the Illustrious Madrid College of Physicians (Icomem).
What would happen then with this brake if the health centers are closed? " It would be like removing the infantry that acts as a barrier, exposing the heart. This way, they liquidate us for sure, " warns the president of Semfyc. This, without taking into account other collateral damage: the care of chronic patients, pregnant women and reviews and vaccines of minors, apart from acute processes not related to the epidemic. "You can't dismantle a system that works," say primary care doctors.
Although there is no official confirmation, in the Community of Madrid there are clear instructions for restructuring healthcare activity according to the different foreseeable scenarios for the evolution of the epidemic. "Following the opening of the hospital in Ifema , toilets are needed and this is where the possible closure of some health centers is being considered," Tranche explains.
In fact, during these first days of operation, according to the Icomem statement, "several Primary Care physicians volunteered and then they were forced to continue to provide their care there, thus abandoning their usual place of work." In the words of Concha Herranz Calvo, Pediatric Primary Care physician, "we are clear that we will go where they send us, but we must guarantee that the current work of the centers does not disappear ." Between these 'casualties' and those of the toilets that are affected by Covid-19, everything points to the fact that this restructuring will go through the closure of the healthcare centers.
Without a doubt, "a catastrophe", says the president of Semfyc. "You are burdened with the assistance of the vast majority of those affected by coronavirus: that 80% who do not need to go to a hospital." The problem is that the National Health System in Spain "has chosen to follow the model of countries such as China, South Korea or even Italy, which do not have developed Primary Care" and triage is carried out in field hospitals. But "in Spain we have a very powerful Primary Care that can contain up to 80% of these patients with Covid-19, let's not dismantle it. Let's not respond to a 21st century epidemic with 19th century methods."
In this sense, several societies of family doctors and pediatricians of the Valencian Community have reminded the Ministry of Health that closing health centers to transfer their professionals to hospitals and field hospitals is a "serious error", since it leaves patients without care or follow-up.
Test, in health centers
This is not the time to close health centers, but rather to promote the work of primary doctors . Far from giving them another role in field hospitals and that this example is followed by other autonomous communities, "they should allow us to maintain our role as a filter to free hospitals , to follow up on mild patients by telephone, to give us the possibility of indicating and doing diagnostic tests (in many regions it is only allowed in hospitals) and, of course, continue to attend to those cases not related to Covid-19 ". If not, who will?
All without forgetting that it is necessary to equip the centers with individual protection equipment to guarantee their safety. "We are in unfortunate conditions and, although we see slight symptoms, they already have the capacity to infect," Tranche emphasizes.
In this way, "we will be able to teach other countries with a competent primary school, such as the United Kingdom, that the only way to respond is not the hospital."
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