"With the coronavirus, we have had to act like the doctors of 100 years ago, without trials, based on experience"

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This Sunday starts the first National Congress on Covid-19, the largest scientific meeting that has been held in Spain so far on the epidemic, in which 52 scientific societies and more than 20,000 health professionals participate.

The congress, which will last until next Saturday and in which 500 unpublished investigations will be presented, has tried to bring together against the clock the changing scientific knowledge available to date on covid-19, in aspects as disparate as the immune response to SARS- CoV2, the implications of covid on the respiratory system, its link with kidney and cardiovascular disease, the impact of the pandemic on mental health, the role of primary care and emergencies or pre-exposure prophylaxis to coronavirus, among other aspects related to the covid-19 epidemic.

It is precisely this breadth of vision of the meeting that makes it more than difficult to draw a single conclusion from the congress, which has decided to address covid-19 in the image of the disease itself, with a clearly multidisciplinary nature, which affects not only numerous medical specialties but also to other health fields such as pharmacy, nursing or physiotherapy.

Warming up for the meeting, which

, some relevant studies have already been made public and will be presented at the congress.

Among them, there is an investigation from several Madrid hospitals on the influenza sentinel network that confirms that there was no generalized circulation of SARS-CoV-2 prior to the explosion of cases in March, to one from the Marqués de Valdecilla Hospital that concludes more than 50% of patients with covid-19 develop antibodies against the virus in the first days of the infection, among the more than 500 that will present themselves at the meeting.

Julián Olalla, coordinator of the Scientific Committee of the congress, knows well that in a disease like covid-19 it was only possible to renounce the usual hyperspecialization of medical congresses and hold a meeting of these characteristics, which would

.

Knowledge about covid-19 is changing very fast and sometimes erratically.

What will remain standing within a few months of what is being discussed today in this congress?

Knowledge about covid has changed as much as the epidemiological curve itself.

Even knowing that knowledge can change, it was our obligation to gather everything we know so far about covid-19, as of September 2020, in order to consolidate precisely that knowledge and allow us to continue investigating.

What have we learned so far about covid-19? We have learned a lot as a society.

If they had told us a year ago that we were going to be able to confine the entire country for weeks, we would have said that was science fiction.

Society has learned at least that biological threats exist, that they are a reality and that they can put us in check. As a doctor, what have you learned? The doctor has also learned a lot.

We are a generation of doctors who had grown up with evidence-based medicine, always making decisions with the support of well-designed randomized clinical trials, and yet we have had to act like doctors of a hundred years ago, making decisions without trials , based on the simple experience of the moment.

When at the beginning of the epidemic we used, for example, hydrochloroquine, we did it not because there were good clinical trials behind that backing up that decision, but because colleagues from China who had already faced the virus had done so.

What scientific certainties are there so far about how to treat the disease? Although it seemed like an eternity to all of us, only six months have passed and in those six months we already have trials that tell us that corticosteroids are effective, that they reduce mortality in patients. severe cases;

trials are under way with biological treatments with a view to reducing the inflammatory response ... we are constantly generating knowledge.

We have learned a lot and we still have a lot to know. Is there already a clear criterion on quarantines?

Regarding quarantines, you have to think that humanity has faced something that we did not know.

It is normal to go from a state of not recognizing the seriousness of the matter at first to the opposite, to an excessive zeal in the measures that are adopted.

When the pandemic began there was no other way to fight it than harsh confinements, there was no vaccine in sight, no effective treatment, and no evidence to tell us what was useful and what was not.

It could only be fought with what in reality is still the mainstay today, public health measures.

I don't think we can say what we have learned from quarantines, I think we are still learning about this issue.

There are groups that advocate shorter quarantines, but all these hypotheses will have to be tested to see if it is really enough to do a PCR and save shorter quarantines, 7 days or 10 days, or not. any conclusions at the congress on reinfections, which are also still involved in doubts?

What has been published so far about reinfections is that there have been isolated individuals in whom the virus genome has been detected again.

Does that really imply that this individual could be a source of infection or that this virus could make them sick again?

That is yet to be known.

It is not published that these patients have developed an infectious picture again.

Some of these cases are cases in which there was an admission for another cause and a control PCR was detected positive, or travelers who had a routine PCR performed at an airport, but it is not published in the In the medical literature, it is still true that this really has a translation into harm for the patient or for those around him. Spain has experienced the pandemic with special healthcare stress, has there really been time to investigate? I know that basic and vaccine research is being done .

But from a clinical perspective, a lot of research has also been done.

At forced marches, but clinicians have also tried with great effort to put order in knowledge, first describing the series of how patients arrived, which ones were doing better or worse, and later testing treatments not only from an empirical perspective, but also also reflecting, comparing groups.

I believe that it has been investigated at forced marches, but a lot

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