The convenience of handling covid as a common flu divides primary school physicians

Two years after the coronavirus began to spread around the world, more and more voices are asking to turn the page. The Spanish Society of Family and Community Medicine (Semfyc) has published a long editorial this weekend entitled

, in which it advocates returning to the "old normality", stop counting each case of covid and treat the disease as is done, for example, with the flu. This transition is, however, too premature for other voices consulted: from epidemiologists to other societies of family doctors.

The horizon, both for specialists and for the Government itself, is to move towards that goal.

As EL PAÍS announced this Monday, Health technicians and communities are finalizing a plan to change the surveillance system for covid and move towards one more similar to that of influenza.

The President of the Government himself, Pedro Sánchez, confirmed on Cadena SER that it is time to think about a new paradigm: "We have to evaluate the evolution of the covid towards an endemic disease."

What is not so clear is how and when, although in no case is it raised before the end of this sixth wave.

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WHO sees it premature to consider covid-19 endemic

Samples are taken from a child at the entrance to the Montessori center in Munich, Germany.Photo: EUROPA PRESS |

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The moment, for the Semfyc doctors, is now.

His thesis is based on the fact that the lethality of the virus is decreasing and that counting and tracking each case is an unrealistic strategy.

"Governments should focus their efforts on protecting the most vulnerable people rather than trying to curb, probably with little success, the circulation of the virus at the population level," the editorial reads.

More information

Spain finalizes a system to monitor covid as the common flu

“We must recover the old normality as soon as possible, that is, life as we knew it before March 2020: without masks or limitations of social interaction [...]. Let's stop visiting and testing healthy people with minor symptoms, let's stop tracking and testing their contacts, let's stop isolations and quarantines. All these activities, which made sense in the past, have been overcome with acquired immunity (both by infection and vaccination) and the arrival of the omicron. The objective should be to treat covid as we do with the flu: clinical diagnosis and general recommendations on self-care and prevention of infections to vulnerable people, reserving health care for people who need it due to their symptoms or vulnerability.Only then can we properly attend to those who really need it, due to covid or any other ailment, "the text concludes.

Until now, no prestigious medical society in Spain has been so adamant when it comes to calling for a paradigm shift regarding the pandemic. It is no coincidence that the one who does it is one of family doctors in a sixth explosive wave that has saturated health centers with mostly mild or asymptomatic cases.

Their position is far from unanimous. The other two large societies of family doctors, the SEMG and the Semergen, believe that it is too early to change the scene. "We don't like the tone," says Vicente Martín Sánchez, from the Semergen National Board of Directors. “They are very enthusiastic and very optimistic, but there is still no information to be so optimistic and so enthusiastic. There is no certainty that the omicron variant is less virulent; what there is is more vaccinated people. The death toll is high and it is foreseeable that it will continue to rise in the coming weeks ”, he adds.

SEMG spokesperson Lorenzo Armenteros expresses himself in very similar terms: “We cannot trivialize the pandemic.

We are in a situation of exponential growth that overloads primary care and any decision that changes the criteria that is followed must be based on scientific evidence.

It creates a great uncertainty for us that the huge number of those affected could become persistent covid over time ”.

What is clear is that today the individual risk of each person infected by the coronavirus is much lower than it was a year ago, when the vaccination plan was beginning.

A mixture of exposure of citizens and their immune systems to the virus, injections and mutations of SARS-CoV-2 has caused its lethality now to be much lower than that of the first waves of the pandemic.

The problem is that the explosion of infections is such that, in absolute terms, the number of hospitalizations, people in ICU and deaths is growing.

And the risk of a hospital collapse is real.

The levels that it can reach are not yet known, as the sixth wave has not reached its peak.

This Monday there were 16,496 people with covid in Spanish hospitals, approximately 60% more than in the fourth and fifth waves;

2,200 of them were in intensive care, more than in the fifth (2,031), and gradually approaching the figure of the fourth (2,356), when there were still many people in the ICUs from the previous wave.

Premature conclusions

Several epidemiologists consulted by this newspaper believe that the scenario drawn by the Semfyc doctors does not correspond to what we know about the virus today. “They assume that the omicron infection has a flu-like severity and, therefore, it has to be managed as such. I think that is not the case, but in any case in a couple of weeks we will have a little more discretion in this regard ”, says Fernando Rodríguez Artalejo, professor of Public Health at the Autonomous University of Madrid.

Pedro Gullón, from the Spanish Society of Epidemiology, thinks that some points of the document give the key, but others are premature: “I am not sure that we are at that moment. They point to a change in the surveillance system towards a flu sentinel; With the sixth wave near its peak and a very great hospital pressure in the coming weeks, it seems a bit early to say: 'We are going to live with it and see what it causes'. We are not sure what will happen ”.

What Gullón does agree on is that the collapse of primary care should receive "agile solutions", but without externalizing all responsibility to patients in the form of self-management. José Martínez Olmos, professor at the Andalusian School of Public Health and former Secretary General of Health, has a similar opinion: “Part of the work that prevents primary school from doing another task can be organized in a different way. But let's look for alternatives: working with the pharmaceutical sector, with the military health, reviewing the nursing roles, pharmacists and veterinarians who are in charge of vaccines ... There are alternatives, but the covid cannot be treated as an endemic because it is not " .

Albert Planes, director of the editorial committee of Semfyc, responds that the exact moment to turn the page "nobody knows." “We do not have any certainties. What we know is what is happening: the restrictions and the workload in health centers and in public health are unbearable. We are not capable of controlling chains of contagions; we know that. That is not to say to be deniers. The pandemic has been serious and mortality has been four times higher than expected. Now it is in the upper part, but on the margins of what is expected. Some cases are going to reach the ICU, but it would be good to consider prudently withdrawing some measures ”, Planes ditch.

The Ministry of Health has no intention at the moment to give a steering wheel to the management of the pandemic.

The strategy, in principle, is to reach the peak of infections this month and from there, work to implement new surveillance systems.

But this will not come overnight and has to be agreed with international organizations such as the European Center for Disease Control and the World Health Organization itself.