Covid infections among young people have once again triggered the incidence in Spain, which, according to figures published by Health on Friday, reaches 153 cases per 100,000 inhabitants. But the consequences of the rebound are presumed different from those brought by the other waves of the pandemic. To begin with, because vaccination is very advanced and, with the bulk of the most vulnerable immunized, transmission is focused on the youngest group, who usually pass the disease mildly. Thus, the experts point out, a massive increase in hospitalizations and admission to intensive care is not expected, although they do warn that the burden of care pressure will be fully transferred to primary care, in charge of treating mild cases.
The health centers have already begun to notice the overload of work due to the barrage of new infections and warn that this rebound threatens a sector already diminished by the cuts: the urgent - the covid - once again displaces the important - the rest of pathologies— and that will affect the health care of the population, they warn.
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Mari Luz Talavera, a primary care nurse in the municipality of Caldes de Montbui (Barcelona), assures that outbreaks among young people are "overwhelming" the health center team. "We have gone from five or six cases a week a month ago to more than 30 and 40," explains the nurse, who is also vice president of the Catalan Forum for Primary Care (Focap). And this situation comes at the worst moment, he points out: “Just when we were beginning to open agendas to more face-to-face visits, to proactively monitor diabetic patients, with thyroid problems or kidney failure. Many of them have spent all these months of pandemic without controls or monitoring ”.
According to the latest report of the ministry on health spending, in 2019, the autonomies invested 9,874 million euros in primary care, that is, 14.2% of the consolidated spending (the total) of the sector, and, according to Health, it is 7.6% more than the previous year. In 2009, however, spending on primary care exceeded 10.4 billion euros. “Any overload in an already precarious primary care will be very noticeable. The historical ills of the sector join the current situation ”, points out Lorenzo Armenteros, spokesman for the Spanish Society of General and Family Physicians.
There are several factors that put primary care back on the ropes, which has been saturated since the beginning of the pandemic, when it acted as a retaining wall for the health system by treating the bulk of mild cases. On the one hand, there is the rise of infections, which forces to prioritize the care of patients with covid for those of other pathologies. In addition, he is in charge of tracking and monitoring the positives and the control of residences; and the primary care nurses are taking over a large part of the vaccination - which is also now massive, not like in the third wave at the beginning of the year - so sometimes they even have to double shifts to attend the centers and puncture doses. And all this, in the middle of summer, with the teams in the frame.
“The respiratory pathology consultation carried out by the nurses at the health center is being unaffordable. We all have the feeling of being overwhelmed and that we leave many things to do and finish solving. It is endless work. Days without resting for a moment, ”says Talavera. Schedules become impossible and getting an appointment at the health center with the family doctor is an odyssey. “In my health center there is a very high level of work, there are days that you have not been able to even greet the companion. A doctor told me that in a day she had made 70 visits between phone calls, online and some in person. This way you cannot work with dignity or quality ”, protests the nurse.
The Catalan Health Minister himself, Josep Maria Argimon, exemplified this Thursday in the Parliament the overload of health centers. “Yesterday [on Wednesday] a person who works in a center in Barcelona sent me a message in the afternoon to tell me that the queue was going out into the street. And what I want us to keep in mind is that the people who were working are the ones who are vaccinating. People are already very stressed and in the end, we will dedicate ourselves to vaccinating or diagnosing. Everything cannot be. We have the hands we have ”.
In Spain there are 30,000 nurses and 36,000 physicians (family doctors and pediatricians) in primary care, according to the Ministry of Health. But all the voices consulted agree that the personnel available in the health centers is insufficient to take on the flood of work that is coming their way. “More cases are foreseen and they will take us more work. And we face it with workforces that have not increased because there are already retirements, there are people on vacation ... ”, says José María Molero, spokesman for Infectious Diseases of the Spanish Society of Family and Community Medicine.
Armenteros explains that vacation absences “are not covered because there are no people to cover them” and adds: “There is no replacement. Enjoying the holidays is at the cost of a partner covering you so that you can go and vice versa. There will be no replacement and everything will get worse and worse ”. The study
Estimation of the supply and demand of specialist doctors. Spain 2018-2030,
commissioned by the Ministry of Health, highlights the lack of primary care physicians, both pediatricians and family doctors, and their poor economic conditions. Between 2010 and 2016, doctors in specialized care per 1,000 inhabitants increased by 6% (1.9 per 1,000 inhabitants) and those in primary care, only 1% (0.76 per 1,000 inhabitants).
The current situation, with the 14-day cumulative incidence among twentysomethings and adolescents shot up at 450 and 406 cases per 100,000 inhabitants respectively, will imply a special burden on health centers.
"They are not going to give us work in terms of clinical control because they are mild cases without underlying diseases, so the follow-up and control is more spaced.
But carrying out tests on them and studying contacts duplicates the work, ”says Molero.
The spokesman for the Spanish Society of General Practitioners agrees: “It is a very sociable population and it will be necessary to do a broader search so that it covers all contacts.
It will be an overload depending on how it increases over time.
The situation is alarming and creates uncertainty ”.
Impact on preventive activities
What professionals already agree on is that the rebound in infections and the pressure on care in health centers will take its toll. Above all, to the patients, because there will be many assistances that will be delayed again. “We have had periods where we have been able to regain activity and control of many chronic pathologies. But these activities that we thought we were going to be doing 100% after the summer are going to stop. The work is going to focus on the management of cases and contacts and what has to do with prevention and early diagnosis, such as cancer screening, will affect him, ”says Molero.
But this rebound in activity will also take a toll on the toilets. “We need to breathe and disconnect because we don't work in a factory. We work with people and with our calm and leisurely attitude we can help and take care of more than with so much stress ”, Talavera values. A study by the General Council of Medical Colleges warns that a third of doctors have problems falling asleep since the pandemic, more than half suffer from fatigue or stress and 60% have symptoms of burnout syndrome, which occurs in the form of personal, professional and relational exhaustion. In fact, a third have considered leaving the profession, although most admit that they will not.