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The strategy for de-escalation is based on the reinforcement of Primary Care , to which, according to the protocol published by the Ministry of Health on May 4, "diagnostic capacity and case management at that level will be guaranteed with the necessary material ", including PCR and personal protective equipment. Well, neither one nor the other, according to a survey by the Spanish Society of General and Family Doctors (SEMG).

Only 13.1% of Family doctors who have answered the SEMG survey claim to have unlimited access to PCR tests - one of the basic pillars of the ministerial strategy - with the consequent difficulties that this restriction has for the rapid detection and isolation of new infections. And if the diagnostic response is weighed down, the protection of professionals is also more theoretical than real: only half of the respondents (51.6%) say they have access to a complete PPE , and up to 24% say that in their area No health screening test has been done for any doctor.

The survey, in which 1,210 professionals from the 17 regions (90% doctors and Family MIRs) participated, was completed between April 24 and May 6, and is the second wave of a survey that the SEMG has launched among its partners to gauge how they cope with the pandemic. The first wave was made between March 10-14.

24% say that professionals have not been tested in their area

The truly alarming thing about this still photo is that it was closed just five days before last Monday until 11 complete autonomies passed to phase 1 of the de-escalation and, in theory, they had to equip their respective primaries with the precise diagnostic means to assume the nuclear role that the ministerial strategy reserves for them.

Well, if CRP is key, up to 29.7% of the primary doctors surveyed claimed on May 6 that they did not have access to them; 58.3% could have these tests, but "with many restrictions", and only that 13.1% of Family doctors could perform PCR "without limitations, whenever necessary". How is it possible to reverse these percentages in just 5 days and equip the elementary school with these 11 autonomies with the precise diagnostic capacity? The response of Pilar Rodríguez Ledo, vice-president of the SEMG, is clear: it is not possible.

"With such a narrow window of time, this deficit can only be solved by improvising, which is what I am afraid most of the comrades are doing. There are many protocols - by the way, all of them very changeable and heterogeneous by autonomy - but nobody gives clear and precise instructions , among other things, because to give them you need resources and means ".

29.7% of PC physicians did not have access to PCR 5 days before the start of phase 1

The president of the SEMG, Antonio Fernández-Pro Ledesma, Family doctor in the Toledo Health Area, is one of the doctors who is part of that 58.3% of professionals with restricted access to PCR: "The hospital reference has access to a limited number of tests per day, and with these it is with which we have to work. Now, it is possible that in a few days that capacity will be expanded, because we are still in phase 0 ".

In any case, Fernández-Pro is clear that "with restrictions, you cannot do what, in theory, primary should do. We are not just talking about an early and rapid diagnosis -in less than 24 hours-, we are talking about the fact that This diagnosis is the initial base of a whole protocol of isolation, follow-up and tracing of possible new contagions between the patient's contacts. In short, we are talking about the cornerstone of the strategy. "

"Scandalous" checkout

And to the diagnostic deficiencies, the lack of protection of the doctor is added, due to the deficits in the protective equipment (EPI) and the lack of control of the infection. Just over half of those surveyed (51.6%) state that they have access to a complete EPI; the rest have to settle for only a surgical mask (27.5%), FPP2 or FPP3 masks (59.9%), a waterproof gown (53.9%) or eye protection (43.3%), combined with differently, but never with access to all of them.

If the lack of PPE suggests that, in return, surveillance tests are reinforced among professionals, then neither: a "scandalous" -in the words of the vice president of SEMG- 24% of respondents say that in their health area they do not so far it has not done any tests on professionals; 52.4% say they have access to them, but only when they have symptoms or "close contact" with a suspect, and only 23.1% state that all professionals in their area have had access to the test (65 , 8% of them, by means of a PCR).

Only 51.6% of respondents say they have access to a full PPE

"That only a quarter of primary school professionals are adequately protected, through tests without restrictions and with all the guarantees, says a lot about the gap between theoretical discourses and the reality of everyday life; about the difference between saying that we are a basic pillar in the strategy of de-escalation and that we really are ", Rivera Rodríguez Ledo.

With these percentages in hand, the grades that the Primary professionals give do not exceed the approved grade . From 1 to 10, the average mark that the respondents give to the level of protection with which they carry out their work remains at 5.4, compared to the 4.1 they gave in the first wave of the survey, almost two months ago . And if in that wave the "average concern level" of the doctor was at 7.4, today it has risen to 8.68.

Although both questions have more to do with professional perception, the SEMG vice president clarifies that "they are not exclusively emotional responses, because there is a statistically significant relationship between perceived safety and felt concern with the availability of PPE or access to test".

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