The flu epidemic collapses health centers: “The emergencies are completely saturated”

Health centers cannot cope with the seasonal epidemic of respiratory viruses. At the end of 2023, the flu has returned with a vengeance after several seasons of anomalous behavior due to the coronavirus. And it has joined the covid that, with less impact and virulence, is also present in consultations collapsed due to high patient demand and staff depleted by the Christmas holidays. “Out-of-hospital emergencies [las de los ambulatorios] “They are completely saturated,” summarizes Lorenzo Armenteros, spokesperson for the Spanish Society of General and Family Physicians (semFYC).

The latest epidemiological data published by the Carlos III Health Institute They are from the week before Christmas Eve. By then, there had already been an increase of more than 100 points compared to the previous one in the notification of acute respiratory infections in primary care: from 806 cases per 100,000 inhabitants to 916. And everything indicates that in the later dates, with celebrations and family gatherings in between, has continued to rise strongly. The new data will be published this Thursday, but experts expect that infections will continue to increase in the coming weeks and that the peak will arrive in the second half of January.

Doctor shortage

Despite the predictability of these winter waves, history repeats itself with more or less impact every year in health centers, in a chronic deficit of professionals that the pandemic exposed and that has no signs of being solved. The Ministry of Health itself recognized in a report from a year ago that there were a thousand fewer family doctors than in 2018. And in May, semFYC presented another that assured that it would allow 10,000 professionals to join in the next four years to replace upcoming retirements, something that seems very difficult, since the conditions and salaries offered by the autonomous communities in health centers are pushing many professionals to work in hospitals or abroad.

In Malaga, where Leovigildo Ginel, a member of the Spanish Society of Primary Care Physicians (Semergen), serves, this Christmas they have broken a record of patients arriving without an appointment: 178 in a single day. The four doctors who were working joined those already on their agendas. “More than 60% or 70% come for the same thing: respiratory symptoms,” says Ginel. Most are flu, the incidence of which is double that of covid. Both join other pathogens with similar symptoms that are not usually identified.

In most health centers, tests are not performed to discriminate which virus it is, something that is reserved for the so-called “sentinels,” who serve to measure the impact of the epidemic in the country. Treatments, regardless of the virus, also do not vary for people without underlying diseases. Good hydration and paracetamol to relieve discomfort. This is what doctors usually recommend, in addition to taking precautions to avoid infecting vulnerable people.

For this reason, Armenteros calls for people who are not at risk to not go to the health center at the first symptoms: those over 80 years of age, or those who have comorbidities or are immunosuppressed. “There is no need to be scared, you have to give a margin of 48 hours to see how the symptoms evolve, take an antipyretic or anti-inflammatory at low doses and see what the situation is. If beyond this time it has not improved, medical assistance is not necessary either; “It should be left for more serious symptoms, such as dyspnea (suffocating sensation), fever lasting more than four days, worsening of the respiratory disease, change in the color of the mucus…”, lists Armenteros.

One of the problems for many patients is that they need a medical certificate to prove their sick leave. “Here we have a very strong services sector in which teleworking cannot be done. The ideal would be something like what other countries do and that we have been demanding for some time: the responsible declaration of the patients themselves for sick leave that does not last more than three or four days. This would partly prevent the saturation of health centers,” Ginel claims.

In Armenteros' opinion, this flu wave could have been softened with higher vaccination rates and with more monitoring of the safety measures that society applied during the pandemic, such as the use of masks and air filtration systems. The data on the vaccination campaign for all of Spain is not known yet; the Ministry of Health will make it public when the season ends. But Armenteros' perception is that coverage has been “low”, also in children, who report the most cases, despite the fact that in 2023 a massive immunization campaign was launched for the first time for children under five years of age.

This is supported by data such as that given this Tuesday by Catalonia, where only 46% of the population over 60 years of age has received the injection, when the objective was to reach 75%. In the Valencian Community, the Minister of Health, Marciano Gómez, has called on the population to receive their dose, in addition to announcing that they are considering returning to mandatory masks in health centers in the face of the rise in infections.

Are we facing a more virulent epidemic than other years?

The majority virus circulating this season is influenza A, which usually leaves stronger symptoms than other variants. But it is still a well-known pathogen. With the data that has been published so far, Spain is not facing an extraordinary situation.

José María Eiros Bouza, director of the National Influenza Center of Valladolid, explained last week that “we are witnessing a common situation” in the northern hemisphere at this time of year. “The flu is an infectious disease that occurs in the autumn-winter months, associated with weather conditions and overcrowding. As a message to people who can be infected, it is not the same whether it is someone who is healthy, without underlying pathologies, who can endure without going to the health system, than people who are in fragile health or who are elderly.”

It is the latter who generally require hospital care due to respiratory viruses. Income is growing, but the situation of hospitals is far from that of health centers. Antoni Torres, member of the respiratory infections area of ​​the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), emphasizes that the collapse is occurring in primary care, since the vast majority of patients are not serious. “There is already some income, but still little. We will see the data at the end of the epidemic. There are still dates of great overcrowding and infections,” he concludes.

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