The flu already rages in a good part of the Spanish territory. The majority of the autonomous communities have exceeded the baseline level of influenza syndromes (55.5 cases per 100,000 inhabitants) and are already in the epidemic phase. In the last week, the global incidence rate is 109.4 cases per 100,000 inhabitants and maintains its upward trend. The autonomous communities have deployed their contingency plans to deal with the avalanche of people affected by the virus but theThe emergencies of some hospitals are already beginning to show saturation of services. Elderly frail, with cardiovascular or respiratory problems, and children under one year are the most affected groups.
It has taken two or three weeks more than last year, but the flu epidemic has not failed to the appointment. "At the national level, a level of intensity of low influenza activity is indicated, a level of epidemic spread and an increasing evolution", points out in his last weekly report the Flu Surveillance System of the National Network of Epidemiological Surveillance.
"Every year we have an influenza epidemic. Nothing unusual is happening. The virus that circulates most is type A and, generally, there is a higher notification in younger children and the most serious cases are in elderly people and at risk groups. It is very important to launch the recommendation that people over 65 and those belonging to at-risk groups should be vaccinated, "explains Aurora Limia, a technician from the General Directorate of Public Health of the Ministry of Health.
The rate of hospitalization of patients with influenza is 5.3 cases per 100,000 inhabitants. 53% of them are over 64 years old. "Severe cases always go to both extremes: babies and those over 65 with risk factors, especially heart and lung diseases," says Dr. Toni Trilla, head of epidemiology at the Hospital Clínic de Barcelona. Among the serious cases admitted (1.71 per 100,000 inhabitants), half were over 65 and three out of four had associated risk factors. Mortality among the most serious cases is 10%. "The vaccine is not perfect but it is the best tool we have to prevent severe cases and mortality"Warns Limia.
It is still early to test the effectiveness of the vaccine this year. The flu virus is very changeable and therefore the vaccine has to be renewed each season according to the strains (usually type A, B or C) that have circulated most the previous season. Last year, for example, a variant of subgroup B (the Yamagata) that was not in the vaccine circulated which is administered to risk groups (now elderly, pregnant, chronically ill, immunocompromised, hemophiliac and celiac, among others). This course, however, experts suspect that the vaccine matches circulating viruses. "It's early to venture how it's working. We do not have the first analysis of concordance but we hope that there is between the vaccine and the one that circulates. Last year, laboratory studies pointed out that the vaccine virus was not exactly the same, but later studies showed that the vaccine was effective, "clarifies Limia.
According to Trilla, this year "seems to predominate in a very majority" type A virus, of which there are two strains that includes the vaccine. "65% seems to be strain A (H1N1) and 35% A (H3N2). If the H1N1 circulates better, because the vaccine is very effective. H3N2 is harder, especially for people with risk factors and, in addition, last year this strain gave us problems of effectiveness in the vaccine, "adds the epidemiologist, who cites the effectiveness of the vaccine last year in something more than 40%.
The autonomous communities keep the devices and contingency measures active to face the flu peak. But the epidemic has already begun to take its toll on the emergency services of many hospitals.
Catalonia. The Generalitat declared on Thursday the flu epidemic. The sentinel hospital network, which monitors the flows of influenza syndromes, registered in the last week 18 serious cases that required hospital admission. So far this flu season, the number of serious cases amounts to 129. Seven out of ten were not vaccinated.
The Government has injected 19.7 million to strengthen emergency care and primary care centers during the peak of influenza. However, this has not prevented the emergencies of large hospitals from becoming saturated again. CC OO denounced the accumulation of patients in the corridors and demanded more resources and planning. In the last week there were 69,651 visits to the emergency room and the activity in primary care increased by 74% in seven days, although the Generalitat attributed part of this increase to the fact that at the end of the year the health centers were closed.
Galicia. The Xunta confirmed Friday "the beginning of the epidemic wave" and the "activation of contingency plans" before "the increase in the demand for hospitalization." Since the beginning of the season, 152 flu-related admissions have been registered in the public or subsidized hospital network. Of these, 69 have already been discharged, 17 required assistance in the ICU and, of the 136 that had indicated the vaccine, 86 had not been put. According to an official spokeswoman of the Servicio Galego de Saúde (Sergas), two people died "with influenza" confirmed, but "only one of them died from this disease." The other patient infected by the virus died of another illness that he suffered. Neither of these two cases had been vaccinated "even though they were part of the population at risk". Since the beginning of the season, 558,468 people have received the vaccine (28,247 more than last year) out of a total population of 2,699,299 inhabitants.
The Sergas ensures that its "contingency plans" imply that "the emergency staffing is maintained at 100%," although the nursing union Satse warned on Friday that the flu is already overflowing the staff. The union denounces the "marked increase in the pressure of care", as the staffs do not increase "in a convenient manner", which continue to be "at a minimum", he points out. Satse talks about "patients on stretchers and wheelchairs in the corridors instead of being admitted, waiting for results over 48 hours, spaces without curtains or screens that offer some privacy" or "companions sitting on the floor."
Basque Country. In Euskadi, the rate of flu cases per 100,000 inhabitants was 362 per week from January 7 to 13, according to the latest report from the Osakidetza Medical Surveillance Network. The return to class and work after the Christmas holidays has led to a greater number of infections, which in Euskadi has caused 211 hospitalizations and nine deaths -in this second week-. Above all, due to the complications that the influenza virus has caused in other pathologies that patients who have died have already had. Since the beginning of the flu season there have been 19 deaths among serious cases hospitalized with confirmed influenza. I was vaccinated 57.9%.
However, Osakidetza warns that in all likelihood, deaths are many more since the cases computed are patients treated in one of the eight Basque hospitals that participate in the surveillance network. That is, the list does not include those killed by complications of influenza in the rest of the hospital network and those treated in private clinics. Since the start of the flu season, and according to the Basque Health Service Surveillance Network, 500 people have needed to be hospitalized, 165 of them in serious condition.
Valencian Community. The flu has not yet reached the level of epidemic. The incidence rate is 52 cases per 100,000 inhabitants. The spread of the disease is "sporadic", the second of the four stages of spread. Last year, in the same week, there were more than 200 cases per 100,000 inhabitants. The lower incidence in 2019 is attributed, above all, to the fact that it has done better time. The rate of serious cases is 0.91 per 100,000 inhabitants and these are patients who had not been vaccinated. The rate of vaccination against influenza has increased: until last week it had been 728,095 people, 21,000 more than last season.
Mercedes Bel, a family doctor in Paterna, a municipality of 68,000 inhabitants of the metropolitan area of Valencia, says that the incidence of influenza is low, but outpatient clinics are saturated by the increase in viral conditions such as bronchitis, constipation and pharyngitis. At their health center they are seeing between 40 and 50 patients a day, and almost half of them go urgently – without appointment. Given the flood of work, primary care doctors have begun to concentrate for 10 minutes on Wednesdays at the doors of the centers and have threatened to go on strike in March if the Generalitat does not increase the workforce and covers casualties.
Only one Valencian hospital, La Fe de Valencia, has reached the point of saturation, says Rosa Atienza, Secretary of Health of CC OO-PV: it is 100% and this Friday 35 people were waiting to be admitted. The Generalitat has approved a contingency plan in anticipation of the increase in demand for assistance. The plan includes hiring a maximum of 172 health-15 of them doctors and their budget is 800,000 euros.
With information from Silvia Rodríguez Pontevedra, Pedro Gorospe and Ignacio Zafra.