COVID-19 SPAIN

VIRTUAL CONFERENCE CPME on June 12, 2020 Brussels

Analysis from the I. Virtual Multidisciplinary Congress on COVID-19

27 – 30 May 2020

During the state of alarm health professionals have managed scarce material resources, reinforcements from other units and new personnel without specific training in intensive care units and also emotions. Many emotions. “We have felt vulnerability in this time, although the Covid-19 has made us better; fear, especially the first days, of entering ground zero, of infecting our families; and tiredness, physical and mental ”. Increasing burn out rates.

To take into account for the learning process are different aspects of the pandemic, such as diagnostic tests, protection of health professionals, monitoring of infection chains, lack of autopsy and the influence that the pandemic will have on our lifestyles. All of them provide lessons learned and possible strategies to improve the system in the face of future waves of the Covid-19 pandemic or health emergencies.

From the point of view of critical care, it is necessary to improve listening to professionals "on the field" at all times, and update protocols based on this listening. It is committed to renovating the infrastructures so that they can be prepared with the necessary space for an emergency and remember that materials and PPE must be available at all times and be adequate.

But if there is one thing to place special emphasis on, it is training and specialization. Both in the learning of communication skills and teamwork and in specific training: It also asks for specific hiring exchanges and to relocate professionals from each center who already have this training to these units.

Diagnostic tests, PCR and serological tests, and masks have been two of the protagonists of the pandemic, making headlines, either due to the lack of these materials or due to their poor functioning.

One of the questions in the air is the sensitivity that PCR really has. There are few studies and evidence available on this matter. Lack of clear reference methods for making good evaluations is the main difficulty. Some studies speak of a sensitivity of 70%. And samples from the lower respiratory tract are usually more reliable. But they are more complicated to take than nasopharyngeal or oropharyngeal. Doing both with the same swab to increase sensitivity, nevertheless PCR gives a large number of false negatives, which led to thinking of supposed reinfections in patients, which really they were false negatives.

Serology also has its own drawbacks. The kinetics of the antibodies is still unknown. Seroconversion of IgG and IgM immunoglobulins has been described practically at the same time in many patients and some who do not make antibodies even after the disease has passed. Others, in critical condition, have very high IgG titers, contrary to what it would be expected . A second problem is the quality of the serological tests. Techniques such as Elisa or QL are better recommended, and that each one make their evaluation within the laboratory. The abundance of false positives of IgG, the fear of possible cross-reactions with other viruses, and whether the immunoglobulins detected are neutralizing antibodies that would confer immunity to the patient or not, have yet to be resolved.

The other great workhorse of professionals in this pandemic have been protective gear and face masks. To take into account is the wide typology of existing masks and those that are suitable for the safety of health workers. The size of the virus, its ability to be transmitted through drops but also from aerosols that are generated in certain healthcare procedures, requires the use of masks grouped within EPI products, different from surgical masks, typified as medical devices.

Therefore, if the toilets are at risk of contact with the virus through drops less than two meters away, they should use FFP2 and if there is a risk of aerosols, FFP3. PPE masks for toilets with exalation valves are not valid for patients,  and neither should be used by toilets, since they let the exaggerated material pass and could facilitate asymptomatic and presymptomatic cases transmitting the virus.

Much has been said about the unmarked CE masks that have been delivered to toilets during the pandemic. The European Union, the WHO and the Government allowed working with masks without the European marking, made for use in the USA. or China. Thus, the level of filtering of the FFP2 was equivalent to that of the N95 and KN95, and the FFP3 have their equivalence in the N100 and KN100.

One of the questions that have been raised in this session of the First Virtual Congress of Covid-19 is why have so few necropsies been done in the world in deaths from this disease. In Spain, with 27,000 deaths, a few necropsies have been performed. The same has happened in other affected areas, such as China, Italy and the USA. The reason for security given by the Ministry of Health is not shared by all experts who believe that in Spain the requirements are given to do them. In Spain there are six empty rooms with a maximum security level. We need to know what the virus does, where it does it and how it does it.

But also the adaptation of professional roles during the pandemic, which show that professional competencies must be redefined and barriers between specialties must be permeabilized. To be also underlined is the plasticity of primary care radically changing the way it works to respond to the needs of the pandemic.

These lessons should lead to inescapable structural reforms. Among them, the improvement of the public health system and a change in the social health system of the residences, which will have to be more sanitary and be supervised by public health and primary care. Furthermore,  the R + D + i system needs to be reformed, especially clinical research.

Since the coronavirus crisis broke out, Spain has been among the countries with the highest rate of infected healthcare professionals. Two circumstances have caused that our country is in this sad group of head. On the one hand, we are the fifth country in the world with the highest number of cases of infected people. They do exceed the United States, Brazil, Russia and the United Kingdom, all of them with a volume of population much higher than ours. On the other hand, supplies of personal protective equipment failed and still fail (although today to a much lesser extent).

These two factors have caused the figures we have today. A total of 51,482 health professionals have been infected with coronavirus. The figure represents more than a fifth of the PCR diagnoses that the Center for Coordination of Health Alerts and Emergencies has registered since the epidemic began in our country.

As of today 7,722 health professionals remain on sick leave, according to data published by CCAES last week. Of these, 4,730 are hospitalized and 631 are admitted to intensive care units. The rate of contagion in our health centers seems to have slowed but each infected professional is a slab for a health system with strong healthcare pressures. Between May 11 and 28, 1,062 positives were reported among the person. Of these, 670 have been infected in the last 14 days and 212 this week. The most terrible data without a doubt the 63 that have passed away.

ASPROMEL, Granada and Madrid, June 2, 2020