The perfect storm: Winter, flu and Covid-19

Sore throat and muscle pain, fever, fatigue … Flu and coronavirus share symptoms that will increase the confusion of the medical opinion. And locked in by the cold, contagions will shoot up

It was said this week by a doctor as recognized and prestigious as Rafael Bengoa, namely: public health expert, director of Health Systems in the World Health Organization (WHO) For 14 years, he was an advisor to former US President Barack Obama in his two terms and a former Health Minister of the Basque Government. In your opinion, there is “an excess of optimism and a lack of preparation” in the face of the pandemic, and attributes that responsibility to the Government and health authorities, who are “trying to convince the population that things are going better than they are. It is necessary to treat civil society in a mature way, “he added.

But the Executive of Pedro Sánchez is not aware and seems to look the other way, exhibiting an imposing optimism, for example, transferring to the population the inconsistent prediction of an immediate commercialization of the vaccine, while the coronavirus once again rides wild and the health services begin to be overwhelmed again by this new onslaught of Covid-19.

As if that were not enough, the arrival of autumn and winter does not bode well because it can lead to a perfect storm: an uncontrolled coronavirus and a flu that affects about 800,000 people each year and claims more than 15,000 lives. As the REASON says immunologist and virologist María Montoya, “We are behind the virus instead of anticipating its transmission.”

For its part, Salvador Tranche, president of the Spanish Society of Family and Community Medicine, point out that «It is clinically impossible to distinguish a flu picture from a coronavirus infection because the symptoms are very similar, so that all patients who present symptoms of fever, sore throat, fatigue, muscle aches, nausea, vomiting or diarrhea will have to undergo PCR. And that supposes many, with which we can find ourselves with a situation in which there is a lack of diagnostic tests or whose results take a long time, between eight and 10 days, with which the usefulness of the diagnostic test is minimal.

In June there was a general consensus on the part of health economists, epidemiologists, specialists, managers and even politicians, that it was necessary to bet on primary care and public health. But since then the necessary resources have not been incorporated. We need more resources to face this pandemic and this situation that looms in the autumn and winter, in which flu, respiratory infections and coronavirus will coincide, “concludes Salvador Tranche.

Another relevant statement is that of Ildefonso Hernández, Professor of Public Health at the Miguel Hernández University of Elche (Alicante) and member of the Spanish Society of Public Health and Health Administration. “The optimism, or rather irresponsibility, of some regional governments has contributed to us reaching the gates of autumn in a delicate situation. It is not fully understood that they did not reinforce in time and form the health resources of public health facilities (epidemiology, trackers, etc.) and of primary care personnel to be able to truly contain outbreaks. It is not so much about how the virus will behave, which, fortunately, has shown that it is not prone to many mutations, but what we will do and what the competent administrations will do. Although again it is late, there is time to make the correct decisions despite the fact that it gives the impression that some highest regional authority is not concerned about the situation, “he adds.

In his opinion, “the fact that in any community there is more than 20% of income due to Covid-19 is already bad news. This indicates that the essential health care for other health problems will be delayed, or not provided, and the population will have to use its resources, whoever has them, to face the situation. Furthermore, the reality in some primary care centers is already collapsing. We do not know to what degree of intensity of demand for health care and mortality we will reach in winter, but we do know that the solution is not based on more hospitals, but on doing everything possible, absolutely everything, to avoid infections and to control the transmission of the cases detected. If the necessary measures are not taken quickly and forcefully, the outlook is not optimistic. Even if the spring collapse is not reached, the functioning of the health system can be seriously altered.

And apostille: «There is a lack of health personnel on the front line to control the pandemic with the three known measures: diagnosis, follow-up or contact tracing and isolation. There is also a lack of resources to reduce the serious social inequalities that are being aggravated by the pandemic and whose existence contributes to its spread. If we do not attend to social conditions and apply the criterion of equity in all policies we will have difficulties.

Maria Montoya, head of the Viral Immunology group of the Margarita Salas Biological Research Center, attached to the Higher Council for Scientific Research (CSIC), warns that in winter we spend more time indoors, which represents an added risk for the transmission of the virus. “From a scientific point of view, Covid continues to behave in the same way. It is a very transmissible virus and therefore infects people as soon as there is any possibility. We are the ones who change habits or circumstances that favor or not the transmission of the virus.

For example, in summer we have spent more time in airy places, outside the houses, where transmission is not so easy; but on the other hand we tend to increase our social contacts. Right now, On the eve of fall and winter, we face another change in habits: we stay longer in closed places (houses, offices …), which favors the transmission of the virus. Ventilation of closed places where we spend long hours is going to become more necessary than ever, ”says Montoya.

“The virus has shown in Spain and in the world that it continues with its high contagion capacity, taking advantage of all its opportunities,” says Juan Jorge González Armengol, head of the Emergency Unit of the San Carlos Clinical Hospital in Madrid and president of the Society Spanish of Emergency and Emergency Medicine.

“If we relax distance, masks and hygiene, and there are crowds outside the recommendations, in the context of geographic mobility that exists, together with the variability in individual behaviors and population density, infections may continue to increase.” And he adds: «We are going to live with figures that should be acceptable for the care management of these patients. Probably with ups and downs. But if there is a lack of reasonable epidemiological control, we can have saturation problems. Emergency care, hospitalization, ICU admissions and deaths will be in proportion to the number of infections; differently from March, but they will happen.

Javier Urra, Doctor in Psychology and Health Sciences and a full member of the Spanish Academy of Psychology, warns: «We have to live with the pandemic, otherwise, we will collapse. From reality you have to transfer hope and illusion. We are more prepared than in the first wave. But I worry about the emotional damage of many people that is not explicit, including health personnel. It is necessary to have an important checkpoint of sanitary before the risk of infection of the holders of the different services. And it is necessary to agree with the General Council of Psychology so that clinical psychologists and psychiatrists emotionally support health workers. I am concerned that anger against others and against oneself will increase exponentially, giving way to aggressions, assaults … ». The perfect Storm.

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