You don’t just die from Covid-19

Two consensuses: the first, that the coronavirus pandemic has caused a multitude of collateral victims; the second, that the figure will never be known with scientific exactitude.

A look at the figures suggests that since the Covid-19 began to spread silently among us, the number of deaths from its cause has a disturbing derivative: until September 21 they had died in Spain 54,811 more people than in the same period of 2019, and until that date, the deaths officially attributed to Covid-19 were 30,663. Thus, there is an unexplained excess of 24,148. An abyss.

Possibly a good part of them are also due to the virus, but numerous medical and professional societies warn of the immense collateral damage that there have been in all kinds of pathologies.

“It is impossible to measure how many people have died during Covid from heart attack, stroke or cancer, it is impossible to know exactly its consequences. We will never know “, assesses the cardiologist Oriol Rodríguez Leor, of the Germans Trias i Pujol Hospital in Badalona and member of the Association of Interventional Cardiology of the Spanish Society of Cardiology.

“The records are like this in Spain: we do not know what thousands of people have died of”

Germán Peces-Barba, vice president pulmonologist of the Spanish Society of Pneumology, has the hypothesis that among those more than 24,000 deceased “some may be sick with Covid-19 that were not diagnosed, but others may be deaths attributable to diseases that were not treated.”

“The registries in Spain work that badly, we do not know for sure what thousands of people have died of,” he complains Ramon Garcia Sanz, president of the Spanish Society of Hematology and Hemotherapy and doctor in the University of Salamanca.

The case of heart attacks is paradigmatic. They plummeted 40% the first week of state of alarm, beginning March 14. Didn’t people suffer from them …? The figure – similar in the United States, Italy or the United Kingdom – puzzles specialists. Of course there were, but between the collapse of telephone and emergency services and the general fear of stepping on a hospital, it is suspected that the mild cases remained at home.

Some deaths may be attributable to diseases that were not treated ”

In Spain, this number of deaths stabilized in the following weeks in a 28% reduction in cases. But they registered a higher mortality. The cause is also a mystery, because although they arrived later than in normal circumstances and there was Covid, the treatment has been the standard, explains Rodríguez Leor: “We do not know the exact cause. Perhaps due to certain health intangibles that cannot be measured ”. So, the mortality rate has multiplied by 1.88 from 2019 to 2020, although there are no absolute figures. Attention to less serious processes, adds the cardiologist, fell by 80% those days.

In kidney diseases and hematology, Covid has generated severe complications. “Many kidney patients have to go to the hospital yes or yes three times a week, with hospital transport to go and return and they cannot do confinement. They are very vulnerable ”, he details Jose Emilio Sanchez, from Spanish Society of Nephrology and head of service in the hospital
Cabueñes de Gijón. Some 2,200 of the 61,000 kidney patients in Spain were infected with Covid, and a 27% of them died. “It is true that many patients in confinement did not want to come to the hospital, we only stayed with dialysis users. And dialysis has to be done: either you do it or you die ”, Sánchez remarks.

With around 70,000 new cases of hematology annually (those who suffer from leukemia, for example) there is no statistical basis to know what effects the healthcare distortion caused by the pandemic has had. “Sure it has had an effect, but given the rate of development of these pathologies it is difficult to go further.” It is known that up to 36% of those who have also been infected with Covid have died, according to data from García Sanz.

“There are delays in diagnoses and that will certainly have an effect”

The rate of the disease makes it difficult to determine what effects it has had on other types of cancer, such as lung or colon. “What we do know for sure is that in the months of the pandemic, the number of new cases fell by 20%, but the exact impact on mortality cannot be known. There are delays in diagnoses, and that will certainly have an effect ”, he considers. Mariano Provencio, president of Spanish Lung Cancer Group, which brings together more than 500 specialists from 177 hospitals. A study published in the journal The Lancet states that lung cancer mortality may have increased by 30% because of the pandemic. The lung disease is the most frequent in Spain, and in 2018 it caused the death of 22,153 people, according to data from the National Institute of Statistics.

“Quantifying the impact is difficult. One of our estimates is that 500,000 surgeries, 10 million consultations and 2 million diagnostic tests have been stopped, ”he says. Marciano Sánchez Bayle, from Federation of Associations in Defense of Public Health, “Some damages produced by this situation are difficult to recover. For example, the incidence is high in strokes or heart attacks, which have decreased or have not been diagnosed ”.

Health professionals have seen all sorts of illnesses get worse, from gastroenteritis to torn menisci. “The patients did not come and then came more seriously, for example a urine infection is almost always mild in the case of a young and healthy woman, and in these months it has been self-medicated in the pharmacy. It shouldn’t be like that but it is like that ”, he says. Jesús Casado, internist at the Getafe hospital.

In the middle of this jungle, what happened to organ transplants? In the two months of greatest virulence, between March 13 and May 19, they were able to execute 274 transplants, from 127 donors: that means an average of 1.9 donors and four transplants per day, far below average daily, which is 7.2 donors and 16.1 transplants daily. Until September, the National Transplant Organization estimates that we have suffered a 26% decrease in donations and 22% decrease in transplants. There are no cases of infection through transplantation.

“We have the precedent of 2008, when we saw an increase in anxiety pathology and the risk of suicide”

There was, of course, a fish biting its tail. On the one hand, the severe decree of the state of alarm in March flatly prohibited leaving the house and the images of the collapsed hospitals invited not to visit them. On the other hand, the entire non-urgent system collapsed, and a good part of the services turned to Covid-19. Many non-excruciating symptoms or pain kept potential patients at home. Many days the telephone service was impractical. “The first wave brought a lot of tension to the hospital system and it was necessary to prioritize the urgent and the emergent”, explains Xènia Acebes, director of the Catsalut Healthcare Area.

The patients disappeared from outpatient clinics and day centers. In the Parc Sanitari Sant Boi, which serves the mental health out of a population of 150,000 people, the first visits fell by 80%, and 80% of the assistance began to be made virtually. “Some risk pathologies are evolving uncontrollably, emergencies have decreased and now those we see are more serious, most of those who arrive have direct admission criteria,” he warns Ignasi Riera, its director of Assistance Operations. “We have the precedent of 2008, when we saw an increase in anxiety pathology and the risk of suicide. Now we have this fear in the face of the effects on the general population ”.

And now, with the second wave about to submerge us? The internist Casado believes that “we are not so overwhelmed and we have learned to live with the virus.”

“You have to choose any route,” he says. Maria del Carme Sabater, from the Users Coordinator– If we are not treated at our assistance center we must call the emergency room. Can’t give up on right to health”.

Without revisions, self-medication is imposed

Pharmacies have played a key role in this crisis. And they offer to play the imminent second part of the game again.

Faced with closed outpatient clinics, hospitals limited to emergencies and health care telephones in continuous collapse, they have been a key factor: they have detected problems with the treatments and monitoring of patients, the risks of self-medication, fear among users and also the deterioration of health, especially of the elderly.

This is the proof
Vicente J. Baixauli, Vice President of the Spanish Society of Family and Community Pharmacy
, for whom the health system does not give more of itself. “The most important problem that we are observing is that the follow-up of chronically ill patients has been reduced. Blood pressure, sugar, heart rate … The basic health system regularly attended to these people but now it does not happen. The treatments are not reviewed and there are people who have been taking the same thing for a year when nobody knows if it is still convenient for them or not ”.

“The treatments are not reviewed and there are people who have been taking the same thing for a year when nobody knows if it is still convenient or not”

“It will take time to find out what really happened but I am convinced that these situations have increased the number of deaths,” he warns.

Another derivative of the overflow of the system is self-medication linked to two parallel phenomena: “The fear of users to go to the medical center, especially among older people” and, in younger people, “the conviction that it will take time to be treated and that the ailment they suppose they suffer from is not worth the wait they will have to pass through ”.

The closure of day centers has also had a devastating “do-it-yourself” effect on people with dependents. “The caregivers estimate that they have increased their daily care hours by 4 hours on average and the patients have suffered the loss of routines with the confinement and closure of certain services, which has precipitated the symptoms of the disease, “he explains.
Nina Agramunt
, technical director of the social area of ​​the
Pasqual Maragall Foundation
specialized in the disease of the Alzheimer.

“Caregivers estimate that their daily care hours have increased by four hours on average”

The deficiencies that the system already dragged, he affirms, have worsened. However, they do not have data on whether this worsening of the conditions of caregivers and the patients themselves has led to an increase in fatality.

A survey by this entity reveals 65% of the users, non-professional caregivers, essentially direct relatives of the patients, claim to have missed the support of the medical and care services in this crisis.

In the field of mental health, thousands of patients have been left without their daily routines and therapies. Have these enforced restraints been harmful in one’s home? For
Ignasi Riera, Director of Healthcare Operations at the Sant Boi Health Park
and member of the Catalan Union of Hospitals, “Patients with social phobia can feel protected, but our model and our idea is the opposite: asylums consisted of losing sight of the problem, but modern mental health seeks the opposite, that people know how to integrate and manage themselves socially, and the pandemic it has not helped us. In the medium term, comprehensive care is necessary, with the involvement of all levels ”.

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