A 62-year-old man, admitted for pneumonia since last 20 at the Virgen del Rocío hospital in Seville, has become the first case of infection of the coronavirus registered in Spain. The diagnosis is of great importance as it confirms the suspicion that many specialists were harboring after the sudden increase in cases in Italy. "The virus has been circulating in Spain for several days and we had not detected it," said the head of the infectious diseases department of a large hospital on Wednesday.
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The patient is a neighbor of Huelva who has not left Spain in recent weeks, confirmed the Junta de Andalucía, which pointed to "a meeting held in Malaga" as a possible moment of contagion. The one in Seville is one of the four diagnoses known yesterday. The other three - in Madrid, Barcelona and La Gomera - were, like the previous nine, in people who had been infected abroad.
The sudden increase recorded in the last two days and the confirmation that the virus is already transmitted in Spain opens “a new scenario in which the health system and society must learn to live with the virus,” agree all the experts consulted. Something relevant, but that is not welcomed with special drama. “Coronavirus mortality is relatively low, between 2% and 3%, and lower outside of China. And the transmissibility, although not negligible, is not explosive either. We will not see hospitals collapsed with thousands of patients. The Spanish health system is well prepared to face what is coming, ”explains Pere Godoy, president of the Spanish Society of Epidemiology.
An example serves to size the problem. All the cases diagnosed in Italy until yesterday - 400, most of them mild - are approximately the same as those that any large Spanish hospital attends in a week for the flu during the annual peak of the disease.
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The finding of the local contagion of the coronavirus is not the result of a coincidence, but of the change in clinical protocols that led hospitals, after what happened in Italy, to look for the virus where it was not done before: in their own patients admitted by pneumonia of unknown origin. The change, formalized on Tuesday by the Ministry of Health, began to take shape on Monday when infectologists and microbiologists realized: “The virus takes between 7 and 12 days to cause pneumonia and Italy did not detect the first in a person who had not left of the country until Friday the 20th. This means that the virus was circulating there without being detected for more than a week. With the close relations that exist between the two countries, it was foreseeable that the virus would also have arrived here, ”explains the head of microbiology of another large health center.
But the protocol in force until Monday only contemplated performing diagnostic tests on people who had traveled to China. “We couldn't even do it to patients with pneumonia of unknown origin. With the history of Italy, these patients became a good sample to discover if the virus was already circulating in Spain. The response has not taken long, ”explains the head of the infectious diseases department.
New protocol
The new protocol not only expands geographically the risk areas for contracting the virus - four Italian regions, Japan, South Korea, Iran, Singapore and all of China - but also indicates that coronavirus tests should also be done for all respiratory patients that have severity criteria such as pneumonia, admission to the ICU and sepsis, among others.
For the Junta de Andalucía, a huge public health work is beginning to measure the extent of contagion. “We are like Italy last Friday. Those infected can be five, 10 or 100, we do not know, ”explain the sources consulted. The Andalusian Government has begun by investigating all contacts maintained by the patient, who remains admitted to an isolation room, although his condition is not serious.
“We are investigating all the contacts the patient had. We are extremely cautious, we do not want any of us to escape. Since 13.30 today [yesterday] we have started traceability of the case, ”said Inmaculada Salcedo, spokesman for the advisory committee for the coronavirus in Andalusia. So far, all tests done in the patient's environment have been negative, according to the Board.
The new protocol, which also provides that the disease can be passed at home in the mildest cases, shows how Spanish public health has begun to adapt to the new reality. The experts consulted consider it impossible, at least in the medium term, that the coronavirus can be eradicated, as was the case with the first SARS, which has not been reported since 2004 after causing more than 8,000 cases and 774 deaths.
The Ministry of Health has raised the risk of local transmission from low to moderate throughout the national territory, explained the director of the Center for Coordination of Health Alerts and Emergencies, Fernando Simón, before it transcended the local contagion of Seville. A measure that is taken "out of prudence" and "so that health systems are alert." Simón clarified that “in most of the country [Spain] the risk is low. In areas where there are cases, it is clearly moderate, and can even be high, ”he added.
For now, the highest concentration of patients in Spain is the Tenerife hotel where 800 people remain confined. There have been diagnosed four Italian tourists who contracted the virus in their country.