Rapid de-escalation, terrible political management, without resources in Primary ... Keys why Spain suffers the worst second wave in Europe

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• ROCÍO R. GARCÍA-ABADILLO

  Madrid

Saturday, 19 September 2020 - 22:50

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  Ayuso restricts the mobility of 850,000 people but experts ask to reinforce primary care

It has not been an easy summer.

We thought that because of the high temperatures, but especially the outdoors, our habit of living outside in the summer was going to help us keep the Sars-CoV-2 virus at bay until the cold returned.

and, although the experts themselves believed that it would be in autumn, at the end of July Spain was already the country in Europe with the most uncontrolled pandemic, as this newspaper published, both by number of outbreaks and indicators such as cumulative incidence.

Far from limiting community transmission before work was returned to work and schools were reopened in September, the accumulated incidence figures have skyrocketed throughout the country, especially dragged down by some communities such as Madrid (682.57 diagnosed cases per 100,000 inhabitants in the last 14 days), Navarra (558.69), La Rioja (420.14) or the Basque Country (332.91).

Spain is the only EU country that has surpassed - loosely - half a million cases since the start of the pandemic (640,040), far from the second country, France (415,481).

No one doubts this second wave anymore, the question is whether only Spain will suffer it with this force or if

.

But the question most asked by those who observe us around the world (and ourselves) is

, what has happened and whose responsibility it is.

And what will happen when Covid converges with the flu and other seasonal viruses or if we continue to not learn the lesson in successive waves.

EL MUNDO has asked six top-level experts in different areas to give us the crux of these questions.

And most coincide in pointing out several aspects such as a very rapid de-escalation, the failures of our autonomous system, the lack of trackers and reinforcement of Primary Care or the significant relaxation of part of the population.

The virologist and immunologist of the CSIC Margarita del Val already warned in May of the risks of de-tuning too fast and the danger of an imminent second wave.

"Several Autonomous Communities that requested de-escalation knew that they were doing it very quickly, now it is clear that

. The doctors have not recovered from the first wave and we are going to make them go through a second one. It was very fast, giving up too many measures and only one works completely by itself: confinement. The rest do not serve by themselves, they add up all. "

For the coordinator of the CSIC Global Health platform "the problem is not that there are several Autonomous Communities, we have the example of Germany. The problem is the lack of coordination and having all the information, knowledge helps to make decisions."

For Rafael Matesanz, former director of the National Transplant Organization (ONT), in addition to a "

", "messages such as 'we have defeated the virus' or 'we came out stronger' were clearly inappropriate and did not encourage to prudence, as well as the attempts to boost the economy on the fast track, relaxing preventive measures and opening borders with practically no precaution. "

Matesanz adds "a terrible management both from the central government that has gone completely to nothing in the fight against the pandemic, as well as from the regional governments, most of which have squandered the time that confinement had granted them before a hypothetical second Wave doing practically nothing. The lack of trackers, the failure to reinforce primary care and serious errors such as temporary workers, nightlife or drinking bottles have contributed to the current situation. "

For the former director of the ONT, the responsibility is shared.

"The central government has de facto renounced its role of coordinating, leading and homogenizing what the autonomies do, among other things because its continuous errors and changes of criteria during the first phase of the pandemic disable it to assume that role. In addition, A poorly articulated autonomous system from the beginning means that neither the Ministry has clear legal instruments for coordination (and the case of public health is one of the most palpable), nor the autonomies legal instruments to deal with the pandemic, such as, for example , the power to confine, something that the Government promised to resolve and has not done. A perfect storm. But

. "

For Miguel Hernán, Professor of Epidemiology at Harvard University, the current situation is due to a lack of leadership.

"Many Autonomous Communities came out of confinement in a hurry, unprepared to handle a second wave, and the Spanish government lost a golden opportunity to lay the technical foundations that would facilitate coordinated actions in the future."

However, he

.

"Government co-responsibility requires effective mechanisms for shared decision-making, not passing the hot potato from one to the other. Perhaps I am too optimistic, but I think that Spain could have a federalized public health system that works. In fact, the The pandemic has left us several examples that demonstrate the benefits of close collaboration between the Government of Spain and those of the Autonomous Communities. One is the ENECOVID national seroprevalence study led by the Carlos III Health Institute. Another is the RadarCOVID mobile app. led by the Secretary of State for Digitalization and Artificial Intelligence. In both areas Spain is the European leader, which indicates the enormous potential of the country when we all work together ".

Isabel Sola, virologist and director of the Coronavirus Laboratory of the National Center for Biotechnology of the CSIC, is clear that the strict confinement prevented the virus from circulating, "but it does not mean that it had disappeared from the Earth.

from an epidemiological point of view. Although measures and protocols have been established, we have not applied them effectively enough. "

And in that sense, the virologist points to the responsibility that each of us has in this story.

"It would help to have unique and shared measures. This is a virus and it is transmitted beyond one community or another. It is a general problem that affects us all and it would be good to have a unifying message to act quickly in all the CCAA. But it must be done self-criticism from the individual, the institutions and the system ".

"There are no perfect solutions in all areas, but we all have to contribute our part."

Julio Mayol, medical director of the San Carlos Clinical Hospital and professor of Surgery at the Complutense University, believes that "the success of the virus with our species, which is more intelligent, is that it takes advantage of our needs: to go out, move ... "and notes that the countries that have been more successful tend to have less population density.

"Those with more, like Korea, took strict mandatory measures because they had prior experience with MERS in 2015. They have a lot of technology and spend a lot of money on it, but they are also more strict in behaving."

Salvador Tranche, president of the Spanish Society of Family and Community Medicine (SemFYC), considers that "the exit from confinement led to each CCAA developing its own approach strategy, which has led to inequalities between them. On this approach, I believe that unfortunately in some decisions,

has predominated, or

. To this day we objectify very important differences between those CCAA that have opted for the management of Primary Care and Public Health (although they have not incorporated resources ) compared to those that have opted for the creation of hospitals.The minimal development of the Public Health Law of 2011, together with the absence of a state public health center and a very weak surveillance network, have made it difficult to control and the management of the pandemic, both in the first and second waves. "

Everyone thinks that we know more about the virus than in March, but they are not sure if that theoretical knowledge is really translated into practice and if we will not fall back into a third (and successive) wave making the same mistakes.

That is why they

.

"It is essential the collaboration of all and that the rulers abandon short-term attitudes with respect to the economy. As we have said on previous occasions, good epidemiological management is the best tool to maintain a vibrant economy in a sustained manner during the pandemic. It is impossible not to note the irony of the current situation: many voices crying out against the economic effects of confinement have not distinguished themselves in the past by defending public health systems that, for very little money, would have led to less stringent mitigation measures than those that we have suffered in Spain ", emphasizes Hernán.

For Mayol, "we need stability, not lurching. There must be symmetry (if you play it, I play it) and reciprocity (what happens to you, affects me), if I ask others for something I have to give the same because if not, society does not believe it and in times of pandemic

. "

Tranche highlights that "it is a social demand and a requirement for political parties to put aside their differences, put the common good before all else and implement initiatives that allow the pandemic to be controlled and minimize its impact on suffering and human lives."

Questionnaire

Margarita del Val, virologist and immunologist and coordinator of the CSIC Global Health Platform

one).

The fundamental thing has been

.

It was said that one should not go abroad and the families have met like never before (brothers, cousins, grandparents ...) and although the measures were not being complied with, the CCAA have not said anything.

It only began to say about the mask and the population has included it.

For me it is an excess of confidence, if they tell me that everything is controlled and I get together with people who I suppose are not infected I trust myself and under guard, but there was a lot of community transmission.

Several Autonomous Communities that requested de-escalation knew that they were doing it very quickly, now it is clear that the tracking was not prepared in almost any Autonomous Community, the PA was not reinforced, the doctors have not recovered from the first wave and we are going to make them pass for a second ...

and only one works completely by itself: confinement.

The rest do not serve by themselves, they add up all.

two).

The problem is not that there are several autonomous communities, we have the example of Germany.

.

When a problem is so obscure it is good to approach it from different points of view, so taking many different measures is not a bad thing.

Confinement, for example, must analyze well what has been good and what has been bad, weaknesses and strengths to learn from everyone.

It is like the parable of the blind men and the elephant, each one touches a part: a leg, the trunk ... All the information is needed to know that it is an elephant, not a giraffe.

3).

The Spanish idiosyncrasy is spectacular in slowing down the first wave, flattening the curve and maintaining two months without cases, helped by the forced confinement, but it is good.

It is making us protect our elders more so that it does not happen like in the first wave (thus, the median age is now 38 years).

Many people still do very well, but this is spread very easily and silently.

That there are a few who do not comply, that when a family gets together and someone remembers that you have to wear a mask, another says 'come on, don't exaggerate!', That has led us to be now again with the enormous effort of the doctors or of the teachers.

.

4).

We don't know until some time has passed.

It depends on whether we follow the measures, it

, those who have the power to manage and those who have to follow them.

If there are no measurements this is exponential.

There is more knowledge now, we are not going blind.

At first there were people who did not dare to make decisions.

Now they are taken because they have to be taken.

We still have a lot to know, so I insist on what is known about the virus and that knowledge should be shared.

The Ministry has stopped publishing, for example, the data of people with Covid who have other chronic diseases, they only give the data of age.

.

The Ministry has the data but they are not accessible, we have been asking for them for months.

Knowledge helps to make decisions.

5).

I look at what I see.

Already with influenza A in 2009 we saw that in October that second wave was already recognizable, in October it is already colder, we make more life inside and we agglomerate.

and it will follow later, that is why it is important to apply all the measures that we know work not only with Covid, but with other respiratory diseases: distance and hand hygiene;

masks;

teleworking whenever possible and not returning to the centers if you can continue doing remote work, for example, no sets, I am invited to go to many programs and you have to avoid it, especially without a mask;

well-ventilated interiors and that air enters from time to time, as in cars and closed buildings because the virus has to concentrate in the rooms and the more closed they are, the more it concentrates;

quarantine if you are a risk contact or you think you may be infected ...

.

The problem is not that it coincides with the flu, it is the coronavirus itself.

Rafael Matesanz, founder and former director of the National Transplant Organization (ONT)

one).

The confinement was harsh, as corresponded to the magnitude of the first wave, but

as Madrid and Catalonia, with large urban agglomerations and a lot of mobility of people.

Messages such as "we have beaten the virus" or "we came out stronger" were clearly inappropriate and did not encourage prudence, as were attempts to boost the economy on the fast track, relaxing preventive measures and opening borders without practically any precaution.

Added to this is the poor management of both the central government, which has gone completely to nothing in the fight against the pandemic, and the regional governments, most of which have squandered the time that confinement had given them before a hypothetical second wave doing practically nothing.

The lack of trackers, the failure to reinforce primary care, and serious errors such as temporary workers, nightlife or drinking bottles have contributed to the current situation.

two).

The responsibility is shared.

The daily management of health corresponds to the autonomies except in exceptional states unsustainable in the medium and long term, and this is a reality that cannot be changed overnight.

What happens is that

what the autonomies do, among other things because its continuous errors and changes of criteria during the first phase of the pandemic disable it to assume that paper.

In addition, a poorly articulated regional system since its inception means that neither the Ministry has clear legal instruments for coordination (and the case of public health is one of the most palpable), nor the autonomies legal instruments to face the pandemic, such as, for example, the power to confine, something that the Government promised to resolve and has not done.

A perfect storm.

3).

The relaxation of a very considerable part of the population is clear, just by going out and visiting bars, restaurants and many other places.

There are many people who do not take seriously the possibility of being infected or passing it on to others, but I could not say if more or less than those from other countries because at least tourists have behaved worse in these two summer months than Spaniards .

It is true that the fact of living a large part of the population in areas densely populated (more than the

European average) and our way of life relationship has been able to

contribute significantly, but leaving aside the inability of politicians,

.

4).

I wish it were so, because the things that have to be done are quite clear in the current state of our knowledge, but

to face the necessary measures.

Nor am I very sure that, for example, the population is willing, for example, to accept another confinement, with the consequences of all kinds that this would have, no matter how bad the health situation may be.

5).

If an evaluation of what has been done so far is not made by an independent committee of experts, which allows learning from mistakes and marking future lines of action, with a great political agreement that allows avoiding all the partisan struggles and nonsense that have occurred so far,

because there has been no structural change that allows us to be optimistic.

Miguel Hernán, Professor of Epidemiology at Harvard University

one).

In three words,

.

During the months of confinement, many autonomous communities did not create the basic strategic capacities to manage the pandemic (contact tracing systems, measures to guarantee isolation and quarantine, increase in diagnostic laboratories, reinforcement of primary care and hospitals, agile information systems) and the Spanish Government did not define harmonized transparent epidemiological indicators to make decisions on opening and closing.

The result was that

to handle a second wave, and that the Spanish Government missed a golden opportunity to lay the technical foundations that would facilitate coordinated actions in the future.

two).

A federal health model can adequately manage a public health emergency.

We have a close example in Germany.

But running

.

Co-responsibility of government requires effective mechanisms for shared decision-making, not passing the hot potato from one to the other.

Perhaps I am too optimistic, but I think that Spain could have a federalized public health system that works.

In fact, the pandemic has left us several examples that demonstrate the benefits of close collaboration between the Government of Spain and those of the CCAA.

One is the national ENE-Covid seroprevalence study led by the Carlos III Health Institute.

Another is the Radar Covid mobile app, led by the Secretary of State for Digitalization and Artificial Intelligence.

In both areas, Spain is the European leader, which indicates the enormous potential of the country when we all work together.

3).

.

Although there are always exceptions and the occasional madman on the loose, the degree of population adherence to pandemic control measures has been impressive and greater than in other Western countries.

During confinement, the Spaniards have spent months at home with their children and without visiting their elders.

Later they began to use the mask in a generalized way, even before it was mandatory, and normalized social behaviors that until a few months ago were unthinkable.

Realistically, you couldn't ask for more civility.

Unfortunately, the de-escalation was done without incorporating all the available scientific knowledge.

For example, parks, beaches, and terraces are low-risk places when a safe distance is maintained, but shutting yourself out in stuffy restaurants and bars is a high-risk activity, regardless of capacity.

In large cities, it could have been made easier for the hospitality industry to take many tables (and not just two or three) outside, even if streets had to be closed and parking lots eliminated, as has been done in New York.

Instead, the message was conveyed that eating at a 60% restaurant was safe.

.

4).

The initial phase of the pandemic was puzzling because there was no collective memory of anything like it.

.

We have again!

to Madrid with the majority of ICU beds occupied by patients with Covid-19 and the situation is getting worse in other Autonomous Communities.

No other country in our environment is in such a serious situation.

Fortunately, it seems that the lesson has been learned and that

.

This agency, similar to those that exist in other countries with a federal structure, will be in a better position to lead the management of health emergencies in the future.

With the very high level of public health professionals and teachers in Spain, imagine if there were an independent and powerful agency that would attract the best talent, coordinate responses and work hand in hand with the Autonomous Communities.

I can't think of a better way to deal with the next public health crisis.

5).

Successive waves are to be expected.

In the absence of vaccine or a very high percentage of the recently infected population, we will continue to be constantly exposed to further increases in cases as we return to situations of relative normality.

The important thing is to

, which is what is happening again now.

For this, the collaboration of all is essential and that the rulers abandon short-term attitudes with respect to the economy.

As we have said on previous occasions, good epidemiological management is the best tool to maintain a vibrant economy in a sustained manner during the pandemic.

It is impossible not to notice the irony of the current situation: many voices that cry out against the economic effects of the confinement

that, for very little money, would have led to mitigation measures less strict than those we have suffered in Spain.

Fortunately, citizens have acquired enough epidemiological knowledge to demand concrete actions from the rulers and hold them accountable.

Isabel Sola, virologist and director of the Coronavirus Laboratory of the National Center for Biotechnology of the CSIC

one).

The fact that it was very tightly confined means that the virus was not allowed to circulate, but it does not mean that it had disappeared from Earth.

When you give it the opportunity to infect from one person to another, due to its extraordinary contagion capacity, it soon returns to a situation like the one you had before.

from an epidemiological point of view.

Although measures and protocols have been established, we have not applied them effectively enough.

two).

Each of us has a responsibility in this history and it

.

It would help to have unique and shared measurements.

This is a virus and is spread beyond one community or another.

It is a general problem that affects us all and it would be good to have a unifying message to act quickly in all the Autonomous Communities.

People haven't met for a long time, and our starting to do so further fosters the virus specialty: finding people to jump on.

Testing before people got together would have been nice.

That requires investment.

Pull PCR could have been done (

technique

): swabs from several people are put into reagents.

If the percentage that circulates is that out of every 100 people five or less are active, if it is put in a sample it is difficult for many positives to come out, you save time and resources.

If you test positive, you individually do PCR on all those individuals in the samples.

In some sites with positivity rates of 20% now it is no longer useful, but if it is 5% or less it still is.

In moments before we are now it is a useful measure, as people are meeting at jobs and the cabbages start.

On the part of the institutions, this policy of testing would have been important to contain the virus.

That implies endowments, trackers ... investing money, but it is

.

3).

An infected person can transmit viruses to people who are in contact, so the measures must be followed (masks, hygiene, social distance ...).

Better outdoors than indoors, that there is good air circulation ... and all this at all times because the virus does not understand carelessness.

It is not enough to be careful 20 hours and 4 no, if we are careful 20 hours and at night we go to party ... we cannot lower our guard and give the virus a chance.

Or those who are positive and know it and do not keep the quarantine.

How can a central or regional government control each individual?

It would require a police state that would be very sad and difficult to enforce.

We all have responsibility.

Each one of us is potentially a place of amplification of the virus.

There are complaints from users of public transport because it is still very crowded and it would be convenient to keep distances.

No matter how much mask you wear, it helps, but it is not useful by itself.

.

4).

Being positive I think we have learned some things but maybe not enough.

It is one thing to learn it and another to take steps to apply it.

We know more about the virus but that should apply to what we say.

The high transmissibility, the asymptomatic ...

(people get tired) ... and that limits not applying the measures to avoid being as we were.

5).

It is difficult to predict what the curve will be like because it depends on the virus and what we do to contain it.

Thinking about the flu and other viruses, you have to think that

.

They can therefore reduce the impact of other respiratory infections that other years appear alone.

If they appear they will complicate everything enormously.

It is difficult to distinguish between them, you have to do more tests, it could be both, reagents may be missing, etc.

Let's not put resources to the limit.

The virus is going much faster than we can make diagnoses, opening hospitals, etc.

Growth is exponential and the way to succeed is to anticipate.

I think we have learned theoretical things but the practical implications are not so clear to me that we have implemented it.

Regardless of the limitations, it is not being done.

Deniers are already the extreme extreme of living in blissful ignorance.

It is the diabolical question of all this: when someone is irresponsible, perhaps it is not he who suffers, but others who are weaker.

Also in health care, when you have to focus on this,

.

And also in education, face-to-face and distance learning is not the same, especially for those who have fewer resources, and in jobs for those who do not eat if they don't go out to work.

We should all see the deaths and irreversible situations, those of the most disadvantaged.

Julio Mayol, medical director of the San Carlos Clinical Hospital and professor of Surgery at the Complutense University

one).

The confinement had a positive behavior and managed to arrive practically without transmission until the end of June.

Viruses do not understand opportunity or convenience, they fulfill their function and that is that the more people there are, the more it infects, and if the measures are not taken, the more it infects.

In addition, it does so in many cases silently (asymptomatic).

It is true that older people have taken many measures because they were the most affected at first and now they are suffering less, but young people need to go out and move, they are less afraid ... and that the virus has taken advantage of to continue spreading .

.

The countries that are more successful tend to have less population density and those that have more, such as Korea, took strict enforceable measures because they had the previous experience of MERS in 2015. They have a lot of technology and they spend a lot of money on that, but they are also more strict to behave.

two).

It had been warning for a long time that this could happen, but since it did not happen ... we did not think of taking action.

Except for a few countries, the rest are not prepared for Public Health.

It is a human cognitive bias, we believed that it would not happen to us, and

.

The AP also has limitations.

It is not only the Autonomous Communities, but the health system itself, as the system is built, organizations function in isolation, they are like archipelagos.

Politicians are a reflection of society and

.

But the media also have responsibility because they induce the decision-making of politicians.

Many are taken thinking about how it will appear in the press.

This situation requires a lot of strategy and political intelligence, not thinking of winning a few votes in the short term.

It is time for everyone to sit down in the case of the CCAA and put the cards on the table, point out what the priority is now and not

because the virus does not understand whether a person is in Segovia and goes to Madrid or Andalusia travel to the Canary Islands.

3).

In societies as polarized as ours, extremes are generated that go from overprotection to denial.

The virus behaves as it has to behave: if there is someone within range, it infects them.

.

For example, the Koreans I was saying before, if the government wants to, it opens the phone and explores it and they allow it because individual rights are not above collective rights in that society.

That in Europe is inconceivable.

than in other European countries, but we are the first to suffer it in this second wave.

Be careful, because the English and others will come later.

Is there something we can do differently to change?

It boils down to having a plan and fulfilling it all, behaving all according to a single plan.

.

4).

We have learned many things, the behavior of Public Health has improved.

The Primary one, despite the discouragement about the situation, continues to be one of commitment and in the hospitals we have learned to identify cases earlier and not saturate the system so much.

That has allowed us to improve and not yet be saturated, but we are not yet at the peak in this second wave, it is getting worse.

and we have also achieved greater protection for professionals, we have a guaranteed supply and that gives us a better situation than at the beginning.

Creating continuous fear (from the dynamics of everyone, the media, politicians ...) leads society to

.

We need stability, not lurching.

We need leadership, there are no leaders who can take the pull, they pass the hot potato to each other.

And the dynamics with the media have to be firm, forceful, stable and consistent.

Spin doctors are not good advisers in times of pandemic.

There must be symmetry (if you play it, I play it) and reciprocity (what happens to you, affects me), if I ask something from others I have to give the same because if not, society will not know it. believe and

.

5).

It is unlikely to coincide with the flu from what we have seen in the southern hemisphere, where this year there have been fewer cases and not as strong because the measures against Covid are very useful for the flu.

All those mask measures, distance, hygiene ... may not work at all against Covid but they do against the flu and thus avoid overlapping.

We have to prepare for the worst, as if there were going to be everything.

It is preferable to pass and that nothing happens than to have it happen and not have prepared, although later the citizens ask for explanations of why it has been spent on that.

It is difficult to know if we will be leaders again in the worst figures in successive waves, perhaps if we expose ourselves more ... The

published in early September that antibodies remain elevated for four months.

Without vaccine we will not reach group immunity.

Perhaps we have more immunity and we know much more, and

.

Salvador Tranche, president of the Spanish Society of Family and Community Medicine and associate professor in the Preventive Medicine and Public Health Service at the Faculty of Medicine of Oviedo

one).

There is certainly no single cause.

On the one hand, outbreaks have continued to occur due to a precipitous lack of refinement, in some cases;

increased mobility;

the opening to tourism, motivated by the need to reactivate the economy, and by social relaxation, especially in relation to leisure.

On the other hand,

and very few to Public Health, despite having been recommended by practically all the experts since May.

Yes, the diagnostic capacity has been notably improved with the possibility of performing PCR in PC.

This has increased the number of diagnoses made but what is striking has been that cases have continued to occur continuously, giving rise to the second wave when we all thought that it would not appear until autumn-winter.

two).

Absolutely yes, I believe that there must be political responsibilities derived from the management of the pandemic, especially in this phase in which we now find ourselves.

In this sense, there are three elements to take into account.

First, in the first phase of the pandemic, uncertainty, ignorance of the disease and its brutal impact, facilitated the leadership of the Ministry and a coordinated and uniform action throughout the territory.

The release from confinement led to each Autonomous Community - in the recognized and legitimate exercise of its powers - to develop its own approach strategy, which has led to

.

Second, in this approach I believe that unfortunately in some decisions

.

The third element that can lead to political, and even legal, responsibilities is that today we see very important differences between those Autonomous Communities that have opted for PC and Public Health management (although they have not incorporated resources either) compared to those that have opted for the creation of hospitals.

Regarding Public Health, a note should be added: the minimal development of the Public Health Law of 2011, together with the absence of a state public health center and a very weak surveillance network, have made control and management difficult of the pandemic, both in the first and second waves.

3).

Yes, definitely.

However, with a community vision, we understand the need to reactivate the economy to

(which has a decisive impact on the good or bad health of people).

The decision to reduce the times and phases of deconfinement was conditioned by the need to protect the economy and encourage inland tourism.

However, a lax control of leisure environments, especially nightlife, coupled with the 'need' to see each other and interact after weeks of confinement with family and friends' meetings and celebrations, have led to a

that have maintained a high number of cases in practically the entire territory.

4).

Sorry to be pessimistic: I think they are not learning and that the perception of risk that politicians and managers have is very far from reality.

.

From the semFYC we have been denouncing for weeks that no resources have been incorporated to Primary or Public Health, that the number of cases that have been diagnosed over the weeks was and is abnormally high, that the health centers were absolutely overwhelmed, that the management of the outbreaks in some Autonomous Communities was inadequate, that there was an unacceptable delay in the performance and notification of the PCR ... We can say it louder, but not clearer.

The consequences are very serious, both for each one of us and for society as they translate into hospital admissions, disability and death.

It is a social requirement.

5).

Whether it is the second or third wave will be irrelevant: as of today we are already leading the European data and we are already in community transmission in Madrid.

We have been warning for months that in the autumn the coronavirus pandemic will coincide with the flu epidemic and other respiratory infections.

in the first instance in health centers (where we already registered an overload) and perhaps - later - in hospitals.

In this area I am going to expand a little more.

As a doctor, I have to point out that, clinically, it is very difficult to distinguish one disease from another (both have fever, cough, sore throat, muscle pain, headache, etc.), but the diagnostic and therapeutic approach are very different.

If in the first phase there was a lack of PPE and diagnostic tests, now we can find ourselves, hopefully, with enough PPE but not enough reagents or the ability to perform diagnostic tests and, of course (we have been suffering from it since the onset of the disease), with a serious shortage of human resources in Primary.

Perhaps the only signs of optimism come from the news reaching us from the southern hemisphere: it seems that the

.

Safety measures (mask, social distancing, hand washing) probably help to reduce the transmission of influenza as well, and results are being published (pending exhaustive evaluation) that show that elderly patients vaccinated against influenza, in comparison with those not vaccinated, they

.

All these measures will help, but they will not be enough if there is not a decisive political and, therefore, economic commitment to incorporate resources to Primary and Public Health.

It would be unacceptable, ethically, politically and legally if the pandemic were not controlled when today we already have sufficient knowledge about the disease and the strategies that are working nationally and internationally.

It is a social demand and a

before everything else and implement initiatives that allow the pandemic to be controlled and minimize its impact on suffering and human lives.

I would like to highlight the impact that the pandemic is generating on care for other non-Covid pathologies: significant delays in care for non-delayed pathologies, notable increases in waiting times for hospital care, decrease in preventive activities (vaccinations and other ) ... We do not have rigorous information on excess mortality compared to the previous year, but it would not be surprising if a not inconsiderable percentage

.

They would be, as it were, collateral damage derived from Covid.

According to the criteria of The Trust Project

Know more

• Science and Health

• Coronavirus

• Covid 19

• Infectious diseases

• Respiratory diseases

• Rafael Matesanz

Health402 Infanta Leonor doctors cry out desperately: "We are in pre-collapse"

Primary Care Physicians: "Making about 200 calls a day in a health center is exhausting, professionals are lacking and they are not covered"

Covid-19 Virologist who fled Hong Kong presents report suggesting artificial origin of coronavirus

See links of interest

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• The time trial that will decide the Tour, live: Lure - La Planche des Belles Filles

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