Spanish hospitals anticipate the arrival of the coronavirus | Society
Train emergency personnel and provide tools for rapid diagnosis of patients who may enter with the Wuhan coronavirus. This is how the great Spanish hospitals are prepared before the outbreak that stalks China and that has reached nine other countries aboard international flights. This is not the case in Spain for now: the Ministry of Health reported Friday that two suspected cases under study, people with respiratory ailments recently arrived from Wuhan, have given negative tests. But late at night the Basque Country notified that they had a patient with some suspicious symptoms who was under surveillance and who had recently visited Wuhan.
“We are following everything with great interest, but also with peace of mind. It is very unlikely that the new virus will become a relevant problem in Spain, ”says Santiago Moreno, head of the infectious diseases department at Ramón y Cajal Hospital (Madrid). This position coincides with that maintained by the ministry: “The population must have a very low level of risk perception,” said Fernando Simón, director of the Center for Coordination of Health Alerts and Emergencies, in the presentation of the measures agreed by Health and the autonomous communities.
Three ideas are the most repeated by the specialists consulted by this newspaper. The first is that what is known about the virus is still little. “We don't know the transmissibility rate, which tells us how many people infect each case. Nor do we know if there are asymptomatic cases or with very mild symptoms, ”explains Jesús Rodríguez Baño, head of the infectious diseases department of the Virgen Macarena Hospital (Seville).
The second is that, with the available data, Wuhan's seems less virulent than the other coronaviruses that have caused epidemic outbreaks since 2002. "Mortality does not reach 5%, while with SARS and MERS they were much higher" - 10% and 35%, respectively—, says Juan Carlos Galán, spokesman for the Spanish Society of Infectious Diseases and Microbiology (Seimc). In addition, "although the transmission from person to person has been demonstrated, it does not seem very high, lower than with SARS," adds Magda Campins, head of Preventive Medicine at Vall d’Hebron Hospital (Barcelona).
Pathogens that lose virulence
Experts consulted highlight that past episodes show that the virulence and expansion of viruses tend to reduce as time goes by. "This occurs due to the generation of immunity from asymptomatic or mild cases, which are presumably also occurring on this occasion," says Juan Carlos Galán.
"This means that the virus is finding less and less ways to circulate ... All individuals who have passed the infection, even asymptomatically, end up being barriers that contribute to slowing down the circulation. We are still in the initial stages, but the expectation is that this is what will happen. This natural process and the control measures adopted must allow limiting the virus, ”he concludes.
As a third important idea, the experts conclude that until the investigations progress and the international organizations establish more precise recommendations, it is advisable to “adopt here the necessary measures to be prepared if there is a case,” says José Miguel Cisneros, head of the service department. Infectious diseases of the Virgen del Rocío Hospital. "And be calm, because our public health system and our hospitals are well prepared to face an episode like this," he adds.
The first measures taken by hospitals are to “prepare protocols for emergency personnel, which is the gateway to the hospital,” says Campins. "The objective is to determine if the patient suffers symptoms compatible with the virus and if he has recently traveled to Wuhan," he adds. If both facts coincide, “the patient must be admitted in isolation and the health personnel adopt the usual precautionary measures until it is ruled out or confirms that the condition is caused by the virus,” says Rodríguez Baño. These measures go through "hand protection and respiratory barriers, such as masks with a high degree of protection just in case there is airborne transmission," he adds.
The instructions finalized by the Ministry of Health and the autonomous communities establish that the samples of all the suspicious patients will be sent to the National Center for Microbiology (CNM), which will be the reference and will have the results in approximately one day. But large hospitals have a technology, called PCR, which allows the diagnosis to be advanced in a few hours. “We are acquiring the specific kits to identify genetically the Wuhan virus with PCR, ”says Campins. "We have ordered the purchase and they will arrive on Monday," they explain from Ramón and Cajal.
Fernando Simón explained yesterday that if a positive case is detected, contacts will be tracked, even if the virus does not have “much transmissibility”. On a flight, for example, the evolution of the two passengers sitting next to them would follow. The objective is that the public network has the sensitivity to detect cases without blocking the health system. Health is not considering taking exceptional measures at airports for now, since there are no direct flights from Wuhan and it is a measure "that has not proven useful," according to Simon. He explained that it is very common that passengers who come from long flights suffer respiratory symptoms, more in winter, so applying controls to arrivals "would not bring enough benefit."
Health concludes that "it is not very likely, but it may happen" that the virus reaches Spain. "That is why we are prepared to act," said Simon, who recalled that the most important thing in these outbreaks are the actions at origin and that he considers that quarantines in China reduce the risk.