A well-deserved recognition: the awarding of the Princess of Asturias Award for Concord to healthcare professionals, who have been at the forefront of the coronavirus. At the foot of the canyon to care for and also to be cared for because in these almost three months, around 50,000 of them have been infected and 70 have died (as of June 1). That is, neither more nor less than 20% of all cases registered in Spain. We have earned "the dubious honor of being the country with the highest number of Covid-19 cases among healthcare workers, " states a Spanish article that has just been published in one of the magazines with the greatest international impact, the British Medical Journal.

In Italy, this percentage is around 10%; in the US, 3% and in China, almost 4%. The difference is remarkable and of course, I could not explain it that perhaps in Spain more diagnostic tests have been done that detect positives. "Absolutely not," emphasizes the first signatory of the document, Javier Crespo, president of the Spanish Society of Gastroenterology (Sepd) and head of gastroenterology and hepatology at the Marqués de Valdecilla University Hospital (Santander, Cantabria).

What is it then? Firstly, insufficient protective equipment. Professionals complained about the lack of waterproof gowns, nitrile gloves, adequate masks (FFP2 / 3), even surgical ones in some centers. In Crespo's words, "at the beginning, the close contacts of the doctors were not sought, they were recommended to leave less than 14 days, which is recommended to the rest of the population, tests were not performed on health professionals with symptoms mild or symptom-free [when infection can be transmitted by asymptomatic individuals] and testing by health professionals in contact with confirmed cases was never recommended "...

Completely unjustifiable because in January and February, "the main international health agencies , including the European Center for Disease Prevention and Control (ECDPC) and the World Health Organization (WHO), repeatedly warned about the possible seriousness of this infection and the need to prepare . " However, nothing was done in our country.

For not doing, the massive public events were not suspended either, despite the fact that on March 2, the ECDPC advised countries to warn the general population about the imminent threat of covid-19, to establish protocols for the diagnosis of covid- 19, to build stocks of protective equipment and implement social distancing to interrupt transmission. According to the article, "the Health Authority of the Spanish Central Government did the opposite: the population was not informed, the diagnostic plans were inadequate for the general population, personal protective equipment was not ordered for health professionals , and a multitude of public events were to come. " Beyond 8M, football games, cinemas, theaters continued ... The virus spread and despite the increase in the number of infected during the weekend of March 7 and 8 and the WHO declaration of a pandemic on March 11 March , "it was not until the 15th that Spain entered the closure, losing two essential weeks."

The article, in which Antonio Zapatero, head of the temporary hospital Ifema and now deputy minister of Public Health of the Community of Madrid , participates stresses the importance of having a health system that works at its maximum capacity in a pandemic. However, this could not be the case because it had had problems for years and with the management of several governments. "Health has always been underfunded with respect to countries around us," Dr. Crespo told this newspaper. "Our health system has had serious structural problems for several decades and worsened after the 2008 global financial crisis."

Nor does it help that "the Spanish health system is so excessively fragmented" (due to the division into 17 regions) [...] Health has been disinvested, there is no proactive strategy to trace contacts and the inadequate response of industry and investment Insufficient research and innovation have limited adaptation in this pandemic environment. "The expert adds:" That a country cannot make its masks and have to depend on products from Asia speaks very poorly of it. "

The collaboration of Antonio Zapatero has raised suspicions about his current position as Deputy Minister of Public Health and Plan Covid-19 of the Madrid Regional Government . In fact, in the "conflict of interest" section, none is declared. In this sense, Crespo explains that the publication is scientific, sensible, slow and not political, with the sole objective of making self-criticism and doing things better. "Regarding Zapatero," more than a month ago, I sent the article to the magazine 'BMJ', when Zapatero was not a deputy counselor and signed as president of the Federation of Scientific and Medical Associations (Facme).

Lessons for the future

Aside from controversy, the article recalls that when the pandemic hit Spain, health services had little hope of containing and defeating the virus. However, "society has carried out the confinement very well, the confinement has been a total success" and thanks to the "responsibility, flexibility and adaptability of the toilets", it has been possible to increase beds in hospitals, facilities of intensive care, the Ifema hospital in Madrid ... Without the "outstanding efforts of many professionals , this situation could not have been sustained"

Once the errors have been identified, it would be interesting to draw conclusions. The objective of this article "does not seek controversy" but to raise awareness of errors to "try not to repeat them again". In the short term, in addition to social distancing and confinement, "immediate investment in protective equipment and the use of reliable diagnostic tests to evaluate all health professionals are critical, and health professionals treating patients covid-19 should be tested regularly. " In the medium and long term, it is essential "to increase investment in our biotech and healthcare sectors, as well as to improve our field work in epidemiology."

In his opinion and that of his colleague José Luis Calleja is vice president of the Spanish Association for the Study of the Liver (AEEH), "the blockade should not end completely until sensitive and specific tests are widely available to evaluate the population, and then measures must be gradually lifted. Our authorities must not make the mistake of putting economic or political interests ahead of health. If they do, we will see a recurring outbreak that will lead to increased morbidity and mortality. "

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