Madrid has yet to “consolidate” a system that allows it to detect new cases of covid-19 and track contacts for contagion. That is one of the arguments that the Ministry of Health gives to reject its passage to phase one, a position that goes beyond the available beds in the ICU or the number of hospitalizations to focus on one of the areas that has suffered the most from the coronavirus. : primary care. As the curve flattens, eyes shift from hospitals to health centers, and the health workers who work there ask to reinforce the teams to face the work of tracking. “We are the spearhead“, summarizes Ignacio Sevilla, member of primary care of the Madrid College of Physicians and doctor at the Los Alpes health center.
The primary care mission in the face of de-escalation passes through detect any new outbreaks of coronavirus: “The work of tracking will mean that every patient who comes with respiratory symptoms and is suspected of covid will undergo a PCR at the time,” explains Seville. “If it is positive, then the study of contacts will be started in order to isolate them and see if they are infected: from primary care we will make family contacts and from Public Health, work contacts or other characteristics “. In the absence of polishing the protocols, the objective is clear, but the ability to carry it out not so much:”We have been mistreated for years. We lack professionals and we have an increasing workload, “criticizes the vocal.
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Of the primary care doctors with whom El Confidencial has spoken, Seville is the most cautious when evaluating the tracking of new cases. The rest, who also work in Madrid health centers, is concerned:
– Carolina Pérez de la Campa, primary care physician at the Rosa Luxemburg health center and delegate for the prevention of occupational risks of the Amyts union: “It is an absolute disaster that they have provided us to carry out population tracking. We are outraged. We have received little amount of PCR in each center and the quick tests they have provided us are not practical: they do not distinguish between antibodies and, therefore, they do not give us valid information.The professionals are not doing the most reliable tests either, but rather ones with a very low sensitivity. It is an absolute disaster“
– Alfonso Lopez, family doctor at the Benita de Ávila Health Center: “Is primary care going to be essential now? No, sorry, we are a bit screwed up by this. Primary care has been essential from day one, which is where Ifema is Tracing is a role that has been nailed to us and we have to see how we do it, because we have not had staff since before this crisis and now those who have fallen ill are milk. Who is going to do all those PCRs? in no time we will even have queues at health centers to do the test. The future is devastating“
– Eduardo Diaz, family doctor at the Mendiguchia Carriche health center and secretary of the primary care sector of the AMYTS union: “Now that the world opens in de-escalation, there will be contacts beyond your own home and that for primary care it is unaffordable. On television it is said that primary care is being strengthened, but in my health center we are the same as before the pandemic. They have not reinforced us with anything. We have the same job and they put all this detecting early cases on us, so until now that does not imply too high a burden, but if there is a rebound, it will be very conflictive to bear it. “
– Paula Chao School, primary care doctor at the Griñón health center and member of rural doctors at the Madrid College of Doctors: “This comes to overload a system that is already saturated. The number of doctors has not increased and we are assuming more and more competences, and now comes another that will suppose an incredible workload when patients begin to return to the consultations for their usual pathologies. There have been a few weeks that we have been focused on the covid and that postponement has been postponed care for regular patients, and all that work is going to join us not only with the detection of new cases, but also with tracking. “
– Vicente Baos, family doctor at the Collado Villalba health center (Pueblo): “In primary care what we need is to know well what we have to do and the protocol changes every week. I have to do clinical care, I have to identify patients, I have to assess their risk, I have to decide … Obviously, we cannot do more. We are going to put things in place, see the scale of the problem, see the resources and act accordingly. Let’s stop heroes and great wordsWe now say that primary care is the best thing in the world when before it was shit. “
When talking about the tracking of infections, everyone underlines the lack of personnel and, although the Community of Madrid has announced new hires, the answer is repeated over and over again: for the moment, nobody has come to their centers. This situation is aggravated by the coronavirus crisis, which has particularly affected health centers: of the 3,620 primary care workers in Madrid who had undergone the coronavirus test as of May 10, 1,668 had tested positive. Among them are Baos, Chao or Pérez de la Campa, who were admitted due to the disease and point to the unreliability of the tests that have been carried out on the toilets. “We do not know if the data is real. I myself have had a positive that is probably false because the PCR later turned negative,” admits Seville.
They stress that misinformation about how tracking works doesn’t help either. “People are not understanding anything. Everyone who believes they have passed it now wants proof. That cannot be and must be explained,” criticizes Baos. “We do not test anyone who comes with a symptom. We are only going to do a PCR test on those we suspect, but the one who has to suspect is the professional, not the patient“explains the member of the Madrid College of Physicians. This trickle of people asking for tests complicates their work, especially when the number of PCR and protective material is limited:” We only have PPE to see patients in the wards of respiratory and other centers are having to recycle, “says Pérez de la Campa.
Madrid breaks the bridges with Health after being left behind by the delay in detection
The Community openly speaks of “arbitrary decision” and opposes the Health decision, which believes it essential to consolidate early detection in primary care to move forward
Despite the scenario drawn by the consulted doctors, the Health Minister of the Community of Madrid, Enrique Ruiz Escudero, defended this Saturday at a press conference to go to phase 1. According to what he explained, the network they have set up is capable of monitoring 20,000 new positives, and primary care is in a “transformation process” that allows Madrid make the leap as other communities have already done. Asked by the health workers who raise their voices asking for caution, the counselor took away the criticism and charged the College of Doctors: “It is surprising that he says that there are no reinforcements when it has already been approved at the Sectorial Table. Sometimes we see the College of Doctors doing the work unions do “.
The position of the counselor clashes with that of the Ministry of Health, which when justifying this Friday that Madrid did not go to phase one, focused on primary care: “A procedure has begun to be effective in the early detection of covid-19 based on the taking of samples in 306 primary care centers, which should be observed in the coming days and see how it adapts, “he explained in his report. “At the time of carrying out this analysis, information is provided on the two days that the procedure has been implemented, which, although it indicates effort, must be consolidated in a complex territorial area in mobility“
Primary care has ended up jumping into the political arena, a battle in which the health workers ask the authorities to leave behind partisan interests to provide the necessary resources. “We lack professionals and we have an increasing workload. We must not enter the fights of the Government or the communities, which it misrepresents everything with some blaming others. It is much more beautiful to take a photo in a new hospital than in a new health center, or to buy a machine than to hire a family doctor, but if we consider that primary care is the axis of the system, we have to stop mistreating it “, Seville concludes.