Every day, tens of thousands of people test positive for covid in Spain. They have to start a period of isolation and, where appropriate, leave work for a minimum of seven days since the symptoms began (or tested positive, in the case of asymptomatic patients). With the collapsed health centers, the autonomous communities are betting on shortening the procedures: they are opting to issue the discharge and discharge in a single procedure, a period of seven days that can be reviewed if the patient continues to have symptoms or is worse. But what if the symptoms continue? Is it necessary to give a negative test to return to normal life?
The isolation strategy changed in Spain at Christmas. The Public Health Commission, formed by the directors of this area in the Ministry of Health and the autonomous communities, decided to shorten the isolation from 10 days from the onset of symptoms to the current seven, in the face of an avalanche of cases that threatened to paralyze the country. But not everyone can leave isolation (or return to work) after a week: they must have had at least three days without symptoms and until the tenth they must “extreme precautions and reduce social interactions as much as possible, constantly using the face mask”, according to protocol.
If the person continues with symptoms on the seventh day, they will have to finish the isolation period until the tenth day, after which they can lead a normal life. In Spain a negative test is not required for this, it is enough to comply with the mentioned times.
This regulation was put in place without the endorsement of the Warning Report, the technicians of the communities and the ministry that are in charge of drafting the protocols and recommending measures, which then have to be assumed (or not) at a political level. They asked for more time to evaluate the evidence after countries like the United States shortened isolation to five days as long as there were no symptoms.
The reason why this country changed the protocol – which also partly explains the new Spanish strategy – is that with omicron the largest window of contagion seems to be between two days before symptoms start and three days after. According to this logic, in most cases, five days would be enough to stop infecting; and, after seven, the odds would be very low.
The United States is not the only country that has reduced the days of isolation to five. In Europe, for example, Greece or the United Kingdom have done it. In the latter, however, two negative tests are required on the sixth day after the symptoms to be able to lead a normal life.
This is what experts such as molecular biologist María I. Tapia ask for Spain. He warns that after a week, even after three without symptoms, there is no guarantee that the person is not infectious. To avoid this, he believes that for discharge or the end of isolation, antigen tests should be used and only return to social life when the patient tests negative. This can happen after five or seven days, but it can also take 10 or 11 days in some cases.
The Spanish protocols produce, in Tapia’s opinion, that many patients end their isolation prematurely and can infect other people with whom they are in contact. In this he agrees with José Jiménez, a researcher at the Department of Infectious Diseases at King’s College London: “Although it is true that automatic discharge after seven days will help relieve primary care centers of work, there are people who will return to work without knowing if you can still spread the virus. It is a measure that is fine in people who have not presented symptoms during isolation. However, for those that do, it would be better to carry out an antigen test beforehand to see if it is still positive.”
How they process cancellations in each community
The low system is not exactly the same in all communities. In Madrid, for example, from this Monday it is allowed to automate the procedure, but in principle only for asymptomatic patients. To prove contagion, a self-diagnostic test is enough, which can be notified by phone. The process has also been streamlined in other communities, which give automatic discharges and discharges for seven days, generally whether or not they have symptoms, and the discharge can always be reviewed by a doctor depending on the patient’s health status. This is the case of Andalusia, where a test done at home is enough and contagion can be communicated through an application on the mobile or computer. Catalonia, Aragon, Murcia, Galicia and Cantabria have resorted to a similar system. The Valencian Community and Extremadura have also unified the procedures, but the diagnostic tests have to be carried out in principle in the places authorized by those communities. In the case of continuing with symptoms, it is necessary to request that the sick leave be extended.
In Navarra, where doctors also process discharges and discharges in a single act conditioned to clinical evolution, starting this Monday all situations that require discharge have begun to be validated with their own diagnostic tests, including infections that until now they were reported through a pharmacy self-test. In the Basque Country the situation is similar, automatic withdrawals that can be processed electronically and in principle the test has to be endorsed by the public health system. Similarly, in Castilla-La Mancha it is possible to process discharge and discharge at the same time, but to prove contagion it is necessary that the test (PCR or antigens) be carried out by the health personnel of the Health Service.
On the other hand, Castilla y León has chosen not to authorize, for the time being, the issuance of sick leave and discharge from work in the same medical act. The discharge can be requested in an application (a confirmation PCR will be necessary), while an automatic telephone appointment is generated after seven days to assess whether the discharge is processed.
Asturias has set up a telephone service system to manage cancellations, but registration is not automatically given. A system similar to that of the Balearic Islands, which has not yet decided to automate registrations.
Vicente Baos, a primary care doctor in the Community of Madrid, explains that this system can ease the workload for cases of asymptomatic positives, but that in most of those who do show signs of the disease, after just one week, some tend to persist. signs, which the doctor will have to examine to assess whether to extend the leave. Baos complains that a fundamental problem that drowns primary care consultations in bureaucracy is not addressed: “The permanent and continuous medical implication of any absence from work through sick leave.”
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