"We do not know what happens in nursing homes"

Science

By CAPosts 03 December, 2020 - 05:30pm 47 views

The world went blind during the first wave of the pandemic, not knowing how deadly the new coronavirus was that, unstoppably, infecting millions of people. The National Epidemiology Center, in Madrid, has finally put exact figures on the tragedy : outside the nursing homes, the virus killed around 1% of those infected in Spain, reaching a shocking lethality of over 12% in men over 80 years of age, more than double that of women. Last year, the epidemiologist Marina Pollán took the reins of this scientific institution, mistreated during the previous economic crisis. In 2008, around one hundred people worked at the National Epidemiology Center. When the coronavirus broke out this January, there were only 64. “The crisis was terrible. And that has been very noticeable when the pandemic has arrived, ”laments Pollán, born in 1960 in the Leonese town of La Bañeza, where her grandfather had a chocolate factory.

Question. What would you say to someone who sees the fatality figure of 0.8% and thinks that it is not so bad either? There are even respected scientists - such as epidemiologist John Ioannidis of Stanford University (USA) - who argue that fatality figures are not enough to justify measures such as lockdowns.

Response. Taking action requires many factors to take into account. That 1% of the infected population dies is not little. In the first epidemic wave, this virus infected about 2.3 million Spaniards . 1% of deaths are not few. And, of course, from the point of view of public health, the ideal to cut transmission is to make confinements. They have economic repercussions and when taking action, both things must be taken into account. In addition, although the 1% seems small, it must be taken into account that in those over 80 years of age, especially in men, the fatality reaches between 12% and 16%. Those figures are very important. And in Spain most of the elderly live with their family, or live alone but receive visits from their relatives or caregivers. The strategies of isolating only the elderly in this country are very difficult

P. You have left out the more than 300,000 elderly people who live in residences in Spain, where more than 19,000 died infected by the coronavirus, as calculated in your study. If they were included, the fatality rate in those over 80 would be even higher .

R. Residences have been particularly terrible places in Spain - as in the United Kingdom, Canada or the United States - because there have been large outbreaks, many deaths and, sometimes even difficult access to hospitals. Mortality in nursing homes has nothing to do with it, it is much higher, if we make calculations with the number of deaths in nursing homes that we have been able to extract from different sources, including EL PAÍS . That is a pending issue in Spain: we do not have good information about what happens in the residences nor do we have the exact number of people who live in the residences. We have made an estimate, but we do not know.

"In those over 80 years of age, especially in men, the fatality rate reaches between 12% and 16%"

Q. Is there no centralized information on nursing homes in Spain?

R. No, we have consulted the autonomous communities and some had more information than others. There are some reports, but above all of places of residences, rather than of actual occupation. The major limitation of our study is that not study those groups where everyone knows that the lethality has been much higher .

Q. exclude half the deaths that occur in the home almost, it sweetens the imagen.

R . we are offering a true picture of what happened to people living in households, which is what we can do. The situation of the residences has been dramatic . We cannot make an average, because we do not know the infection rate in the residences. It is not a question of sweetening, what we want is to know how many people this virus kills among those infected, since it is the first time that we are exposed to it. And, in people who are not confined to a site that may be susceptible to large outbreaks, we have seen this lethality.

Q. Someone might think that, if a person dies in Spain, that data is entered into a computer program and all the centralized information reaches the director of the National Epidemiology Center, the Minister of Health and the President of the Government in real time in an application on your mobile, but the reality is nothing like this

R. It doesn't look like that at all, no

"Sometimes they ask me for specific information and I say: I want them too"

P. In the worst of the pandemic, in some hospitals there was talk of nurses going room by room and pointing with sticks on a paper

R. There are autonomous communities that are quite well computerized and can have this information relatively quickly, such as Navarra and the Valencian Community. In the Community of Madrid, for example, it is complicated, because the electronic medical record is not unique for all hospitals. They have different information systems

P. Not even hospitals in Madrid share the same computer system

R. Several hospitals in Madrid can share the same system, but there is no single electronic medical record. Several were developed. One good thing about the pandemic is that it has highlighted the need to improve information systems. Sometimes they ask me for specific information and I say: "I want it too." But to have these data, you have to invest in information systems.

Q. Has decentralized healthcare in 17 autonomous communities hindered the management of the pandemic?

R. This is a political question. I think it would have been easier if instead of having 17 information systems we had one, but I suppose that there are certain aspects of the pandemic, such as the issue of trackers and the organization of clinical care, which are done more efficiently in a decentralized manner. In the end, each of the communities did what seemed best to them, not only in health, in everything, but when a problem of these arises, we realize that it is better to face it together and agree on common criteria.

"It would have been easier if instead of having 17 information systems we had had one"

Q. Have you taken into account only the direct deaths from covid or all the dead people who were infected with coronavirus?

R. That is a good question. In the death certificate the doctor says what is the basic cause of death and what are the contributing causes. That has to be coded and it takes a while. At this time we do not have the death certificates, we could not do that study. Not us or anyone. All the estimates that have been made are similar to ours, with deaths in infected patients and without being able to take into account the basic cause of death. As of today, as long as we do not have death certificates, we can only speak of deaths among those infected, assuming they are deaths from covid. We think that the coronavirus accelerates other processes in people who already had other diseases. Having a comorbidity is having more ballots to die.

P. The Ministry of Science itself affirms that the budget of the Carlos III Health Institute - to which the National Epidemiology Center belongs - suffered a cut of more than 25% in the previous decade to the last approved budget, in 2018. During that time, the Institute lost more than 300 researchers and technicians, 27% of its staff. How have these cuts affected the management of the pandemic?

R. I do not know the big data of the Carlos III Health Institute, but it is true that here, at the National Epidemiology Center, we lost many researchers: people who retired and not we were able to replenish. The crisis was terrible. And especially in the department of communicable diseases. And that has been noticed a lot when the pandemic has arrived. I hope they strengthen us now, because Minister Pedro Duque has promised to strengthen the Carlos III Health Institute.

P. 77 people currently work at the National Epidemiology Center [13 more than in January, but still 23 less than in 2008 ]. Is this a lot or a little?

R. For a National Epidemiology Center, little

Q. How many staff would you like to have?

R. In the area of communicable diseases, the department and all existing units should be strengthened: influenza and respiratory viruses, vaccinated, HIV, zoonoses, food-borne infectious diseases, vector-borne infectious diseases, sexually transmitted diseases and diseases related to healthcare and antibiotic resistance . In the area of chronic diseases, we currently have researchers working on cancer, cardiovascular disease, and neurodegenerative diseases, as well as a group dedicated to social and behavioral determinants. We should have staff investigating chronic respiratory diseases, diabetes, aging and comorbidity, as well as reinforce the research we have underway on the main modifiable risk factors: tobacco, diet, physical exercise. In addition, and in collaboration with other centers of the Carlos III Health Institute, we would like to reinforce the environmental epidemiology part , since the possible effects of contamination are of great importance.

Q. In your study on the lethality of covid Is there any data that leads to optimism?

R. What moves me to optimism is that, surely, if we could do this same study after this second wave, the fatality will probably be lower. We don't have the data yet, but a lot has been learned about how to treat patients and save lives

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Source: Elpais

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