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Covid 19

Reflections of an ICU nurse: “The coronavirus is won with medical and social reasons”

“Faced with such an infectious virus, with hardly any pharmacological treatment and with a vaccine still to come, we must join all our forces to fight the pandemic without fissures, as if we were a rocky and invincible team; in which society as a whole, critical but at the same time supportive and committed, pulls the sanitary car to overcome the fierce attacks of the covid ”, says Alejandro Blanco Aoiz, emergency nurse at the Complutense University of Madrid

In an interview with EFEsalud , Alejandro Blanco reflects on the social consequences of the coronavirus, the undisputed protagonist of our daily lives since China communicated to the world its great destructive capacity by mercilessly infecting the vast majority of the population, in a special way to the elderly who suffer from other previous pathologies, such as hypertension, diabetes or heart failure.

Nursing lessons learned “piecemeal” in the Intensive Care Unit

Alejandro Blanco reinforced the ICU of the Hospital Clínico Universitario San Carlos de Madrid during the hardest phase of the coronavirus in Spain, between March and June 2020. Alejandro, who has returned to his daily work as an out-of-hospital emergency nurse at the UCM, responds to our questions, sometimes excited, about a disease “very difficult from a clinical point of view”.

“It is a pathology that basically attacks our lungs, causing  bilateral pneumonia , for which there are no specific medications and which kills quickly,” he emphasizes.

“And under this double medical-pharmacological condition, very stressful, the key to success was in teamwork , as always. All of us, in multidisciplinary communion, achieved the objective that was sought in the face of the coronavirus; that it was none other than to minimize the number of deaths caused by the infection, especially among patients with their health or immune system already damaged ”, says Alejandro.

The nurse Alejandro Blanco dressed in his PPE in the ICU area“We have learned together,” he emphasizes. One of the wonderful things that happened at those times in hospitals is that each and every one of us brought out our best qualities, even when we shared work with other professionals who weren’t to our liking. So to speak, we all work together against the virus ”.

“Personally, being one of the new ones to the UCI, I felt absolutely supported and very well guided from the first moment by the people who had been there for many years and who knew a lot. I never felt alone with a patient, even less when I did not know how to perform a nursing technique well. Even the intensive care technicians corrected some procedures for me. It was a pleasure learning from such experienced people, ”he says.

“During my second night of work – he signed up for that shift to reconcile his family life, he tells us – I arrived at my post, an ICU with six beds, recently assembled. My colleagues were two other nurses and two care technicians. The four of us were new and not only did we not know how to use the special PPE – personal protective equipment – but we also could not find the material and did not know the action protocols ”.
“ Luckily, ” he continues, “ Alicia , a nurse with more than 20 years of experience in the ICU, arrived . Very calm, she began to organize, teach us and direct us. When the shift change came at 08.00 the next day we realized that we had not even rested for a few minutes. I knew then that we would be able to face any situation of the pandemic, no matter how tough it was at first sight.

Alejandro Blanco, Emergency Nurse-efeWhat else has this pandemic revealed?

“How badly structured we have the order of values ​​in our head, that is, the priority of what really matters in life. Right now, we are afraid of the coronavirus, practically confined at home, on the edge of the precipice of the economic crisis, with pending jobs by a thread, but you realize that above all that there are other essential things such as health and people’s health; our physical and mental well-being ”, he estimates.

And does society take into account all health professionals equally?

“As the months go by, my reflection is that society in Spain does not adequately respect certain jobs, such as firefighters, true heroes in other countries, on which the idea weighs that they risk their lives putting out fires day and night goes to the salary … as happens in hospitals, where we take care of the sick to the limit of their possibilities . This scale of social values ​​cannot continue like this ”.

“Especially when a person who decides to study nursing or an auxiliary technician is surely not looking to get rich, but rather his goal will be to help people -reason-.

“These professions or others related to the public good must have the social recognition they deserve; And I do not mean that people come out to applaud on the balconies, that we have thanked it and are grateful from the heart, but that, for example, when someone tells you … ‘ I’m a nurse ‘ … you come to think: shit, she’s a nurse ! and he spends many hours of his life caring for hospitalized people. My profession is not paid by far .

Perhaps, Alejandro, your training and dedication are not appreciated enough?

“You can be the basis of why and perhaps it is also related to the fact that today we have an excess of information via the Internet with sources of all kinds, safe and reliable or manipulated and biased. If a person has a headache, it is not uncommon for them to self-medicate without the intervention of a professional, who is the one who can find out the cause of the pain in their head … it is like the health structure in Spain, which is partly based in pharmacology, ”he says.

“What would people think if we built a building without the intervention of an architect!… Surely someone would dare by following a tutorial on the web and applying a design app. In theory we could build a skyscraper, but no one with two fingers of a brain would think of putting that idea into practice ”, he says.

The Emergency Nurse, Alejandro Blanco
Alejandro Blanco : “I think that you have to make an effort and teach people how important it is to have a healthy health system, with its correct ratios, and that health is prioritized over certain economic aspects.”

So, the National Health System should base its action on prevention?

“We cannot have a health system in which drugs cure your disease, as happens many times, for example, in the case of cholesterol. If you have a bad diet, you run the risk of suffering from bad cholesterol or LDL, which in turn will affect the cardiovascular system, especially the coronary arteries and their consequent acute myocardial infarctions. The usual solution is a daily pill ”, he puts on the table.

“From the nursing point of view it is nonsense, since the medicine should be for acute cases. If you think about it, the solution is prevention; modify eating and nutritional habits, the way you eat, your hygienic-sanitary habits, do physical exercise, etc. It is not possible to neglect your health and take the pill so as not to suffer a heart attack. It’s sad to think about it.

And prevention measures are the key against COVID infections?

“Yes, everyone has to prevent the spread of the coronavirus by giving up portions of their personal interest for the interest of the common good. But it seems, once the origin of this second wave has been verified, that at present we pride ourselves on not having a social conscience… and it should be the other way around ”, he points out.

“In this sense, there are two types of people, those who are at risk of dying and those who do not. The disease is attacked in many ways and one of them is the vaccine, in which we have all placed great hopes, but the most important now have to be focused on the correct application of the set of personal and social prevention measures constantly and proportionate ”, he highlights.

“Just because we wash our hands every five minutes, like crazy, it doesn’t free you from contagion. Wearing a mask in a closed room, crowded with people, will not free you from the infection, since the air you breathe is stale and the immense variety of masks do not serve 100%, far from it, to avoid the virus. They are not hermetic and with filters ”, he highlights.

“Even so, there are people who should not do prevention because what we have to achieve is that they have zero risk of contagion, that is, people who have a greater risk of dying if their body is infected by the virus,” he clarifies.

In either case, Alejandro, as an experienced nurse, cannot stop thinking about the nearest future.

The Emergency Nurse, Alejandro Blanco“From the point of view of immunology, which is based on exposure to the pathogenic microorganism, when we obtain a vaccine, not everyone can be vaccinated, and those who do not get vaccinated will have to be exposed to the coronavirus; two situations that will lead to the general control of the disease, as is already the case with the influenza virus or flu ”, he explains.

“It should be remembered, he adds, that we give flu a relative importance, despite the fact that every year it causes many deaths among the population at risk. At the moment, the flu cannot be controlled or eradicated, although there is a seasonal vaccine every year ”.

“What we do have to take into account, as it could also happen with the flu, is that we cannot get everyone and everyone at the same time , the crux of the matter, since it would be catastrophic for a country like Spain to register millions of infections in few weeks. If 10% of these infected people suffered moderate or severe symptoms, all the hospitals would completely collapse ”, he remarks.

And what do you expect from this second wave of coronavirus, more pronounced in Madrid?

“It reassures me to know that today we have everything under control, given the experience of the hard phase of the coronavirus during the spring. Then – he recalls – decisions were made on the fly … beds were opened and closed … plants were opened and closed … even so, the level of response capacity was very high “.

“Now, we would know where to locate the ICU, UCRI or hospital recovery beds and how to better treat patients with the drugs and available technology, as it was possible to verify in the hospitals or in the Ifema – Madrid facility for congresses converted into a center sanitary- “, he assures.

“At this time, too, we must bear in mind that other illnesses or accidents continue to exist . We cannot stop attending heart attacks, diagnoses of malignant tumors, traumatic injuries or suicides because 60, 70 or 80% of the hospital infrastructure is dedicated to the coronavirus. We would be undermining the health system, which has to continue to function with surgical precision ”, he emphasizes.

The EFE journalist, Gregorio del Rosario, interviews the nurse Alejandro Blanco
Alejandro Blanco concludes the EFEsalud interview with advice to the entire population, especially dedicated to youth: “Prevention measures are essential to prevent infections, which are not only avoided by washing hands and putting on masks. Help to prevent infection is carried out with a set of hygienic-sanitary measures focused on diet, exercise, rest or avoiding unnecessary stress. I know it is a difficult social balance, but we must try with all our might … we must pay attention to reason and health professionals . Photographs by Antonio Herrera.
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Covid 19

Experts expose COVID uncertainty and value what they learned in the first wave

Health and medicine experts expose the uncertainties in the situation and evolution of COVID-19 in Spain and value everything learned in the first wave of the coronavirus that is serving to combat the current second wave

Family photo of those attending the innovation conference / Facilitated by the IDIS Foundation

This was explained at the Innovation Seminar “The health that comes: Challenges and trends in the COVID-19 era”, organized by the IDIS Foundation, in collaboration with Farmaindustria and FENIN, last Thursday, in which the report was also presented “The future of the health sector.”

The day had initial speeches by the president of the IDIS Foundation, Juan Abarca ; the general secretary of the Spanish Federation of Health Technology Companies (FENIN), Margarita Alfonsel ; and the CEO of Farmaindustria, Humberto Arnés .

The debate was attended by doctors Ricardo Cubedo , Assistant of the Medical Oncology Service of the Puerta de Hierro University Hospital in Madrid; Ángel Gil de Miguel , Professor of Preventive Medicine and Public Health at the Rey Juan Carlos University; Santiago Moreno , Head of the Infectious Diseases Service of the Ramón y Cajal University Hospital; and the general director of the IDIS Foundation, Marta Villanueva .

Villanueva was the one who presented the report, which makes a diagnosis of the future of health from different angles, such as the disruption of health, the user experience, liquid hospitals, the E-Doctor, digital management, hyper-personalization and preventive technology.

marta villanueva
Marta Villanueva, general director of IDIS / Photo provided by IDIS

“Behind all this is the data and the algorithm that is made with the data, and the ethics of the algorithm, for a more precise, personalized, better and easier healthcare”, emphasized Marta Villanueva.

The debate with the doctors focused on COVID-19

Doctor Cubero highlighted: “You have to be critical, I am not proud of the control of the pandemic, the results are not good. There is much to analyze and improve to see why our results are not as good as in other countries ”.

Dr. Gil pointed out that in a worldwide comparison “we are not so bad, but our health system has shown shortcomings to respond to a situation like the one we have experienced. Here is the limitation ”.

Dr. Moreno stated: “We cannot pass for being optimistic. The number of infected people is tremendously high and we have not been able to prevent transmission. At the beginning of October we thought that the cases would be few, and we have the expectation of what will happen with the seasonal viral infections ”.

“We can see if the lessons learned help us to effectively control the continuity of the second wave of the virus,” added the doctor from the Ramón y Cajal hospital, one of the health workers who had to overcome COVID-19.

Doctor Cubero emphasized: “We have learned a lot in these months about what to do with sick patients and in hospitals, but we have not learned something well to avoid contagion; and I’m afraid that communication with the population has left a lot to be desired and it worries me a lot ”.

Dr. Santiago Moreno during his speech at the V Anniversary of EFEsalud / EFE / Juanjo Martín

For Santiago Moreno, “we hoped that there would be no second wave and it has happened because the virus does not go away. The sanitary and the non-sanitary have done wrong things. There was no control of the de-escalation even in the summer ”.

Dr. Gil asked the politicians for a pact for health “without ideological conditions; this is the moment, if there is not with the pandemic, when will there be ”, he questioned.

The speakers launched an appeal to the responsibility of the population in complying with the rules, and to the media in transmitting messages with clarity and scientific evidence.

They also asked the population to get vaccinated against the flu this year, more than ever, to mitigate the effects of this disease and reduce the cases of doubts that may arise regarding whether what you have is the flu or covid.

IDIS Foundation, FENIN, FARMAINDUSTRIA

In the initial interventions, Juan Abarca stressed that “the most important lesson is that we have to innovate in the health system and work together, in a structural and stable way, for the benefit of patients’ health.”

Juan Abarca
Dr. Juan Abarca, president of the Institute for the Development and Integration of Health (IDIS Foundation) / Photo courtesy of IDIS

“We are all very concerned with the second wave; in Spain things are not being done as well as they should be from the management, ”added the president of the IDIS Foundation .

From Fenin, Margarita Alfonsel raised three keys to the future of health and against the pandemic: coordination with the creation of a State Public Health Agency; knowledge with a forum of experts who provide capacity and experience; and co-responsibility of all health agents, including citizens.

Humberto Arnés summarized the two most important lessons learned from his point of view: the need to have a public and private research fabric to provide solutions to health problems; and a powerful business fabric that “does not make us depend on third countries”, as has happened in COVID-19 with Asian countries.

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Covid 19

The arduous search for drugs to combat COVID-19

The pandemic has caused more than a million deaths and there is still no truly curative treatment, an arduous task to which more than a thousand projects are dedicated around the world, in parallel with research to achieve a vaccine

coronavirus drug research

Researchers work in a laboratory to combat Covid. EFE / Welcome Velasco / Archive

Remdesivir, dexamettosan, hydroxychloriquine or lopinavir are some drugs that we have become used to hearing about during these eight months of pandemic, linked to the treatment of COVID-19, but with mixed results.

At the moment, there is no drug that is effective, although some have been identified that can help in the treatment and others that “do not attack the virus, but help improve the clinical situation” of the patient, says Adrián Velázquez-Campoy, researcher at the Spanish Aragonese Agency for Research and Development Foundation (Araid).

But in these months many things have changed in the treatment, now the disease and its clinical behavior are better known, which, says Miguel Górgolas, from the Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (Madrid), allows them to anticipate “possible complications ”.

In any case, it is essential to find an effective treatment, either through the repositioning of drugs that are used for other ailments and that are shown to have effects against covid-19 or through the investigation of specific drugs.

A war on two fronts

The disease is fought from two fronts, explains Velázquez-Campoy: attacking the virus when it invades the body and preventing our immune system from overflowing, generating a cytokine storm, caused by an excessive reaction of the immune system, which ends up attacking the body.

lung health targets
Brussels authorizes the use of Remdesivir to treat the coronavirus / EFE

At present, drugs such as antiretrovirals, chloroquine and others have stopped being used, which – says Górgolas – “have proven to be useless.” “And I would dare to say,” he adds, “they have caused more harm than good”; furthermore, the protocols have been simplified to include only those drugs that have been shown to be effective.

Among them, the antiviral remdesivir, which shortens hospitalization for seriously ill patients, or corticosteroids, such as dexamethasone, which act on tissue inflammation and reduce mortality in seriously and very seriously ill patients, although, in both cases, “ the effectiveness is limited ”.

The doctor does not believe that “soon” a medication will be available that will “significantly reduce mortality.” Currently there are hundreds of trials with different molecules, monoclonal antibodies, immunomodulators and, it is “very likely” that several of them demonstrate efficacy compared to placebo, but he doubts that “this efficacy appears in a large majority of cases”.

In this sense, he points out that there are risk factors and possibly other genetic factors that “significantly influence the evolution of the disease and this will not be able to be solved with a ‘miracle’ drug, it has not been the case in any similar viral infection” this.

Reposition drugs

The fastest method of finding a drug is to try to reposition those that are already used for other pathologies. Chemist Nuria Campillo, from the Margarita Salas Center for Biological Research (CIB-CSIC), is working on this using computational design.

SEMERGEN Primary Care
A pharmacist shows two containers of dexamethasone in his pharmacy in Santiago de Compostela / EFE / Xoán Rey

“In order not to spend more time than necessary, we use the computer and specific programs” to confront different proteins of the virus or of the human cell to a drug library, thus we can see which drugs are capable of binding these proteins in a virtual way.

They are then evaluated against SARS-CoV-2 in order to verify that those drugs identified with computational techniques have antiviral activity.

So far, “there are some quite interesting” and they are thinking of going to clinical trials, says Campillo, who is confident that, through repositioning, an effective drug can be found.

This search for drugs that already exist works on multiple fronts, from preventing the virus from entering the cell, to preventing its replication, controlling inflammation or minimizing lung damage.

Also at the CIB-CSIC, Eduardo Rial’s team analyzes anticancer drugs that slow down the replication of SARS-CoV-2 in cells.

The approach is not accidental, he explains, since tumor cells reprogram the cell’s metabolism to grow and the virus does the same, but so that more viruses are produced.

The research is still on cell lines of the bronchi and lungs, explains Rial, who has “great hope that some of these antitumor drugs will work,” although he warns that these processes take time.

Formulation from scratch

The other way to find drugs is specific formulation from scratch, a process that can take more than a decade.

The Velázquez-Campoy team has identified quercetin, a falvonoid found in foods such as grapes, apples, fennel or capers, in a project that, for now, -stands out- is being financed entirely by the NHA foundation.

Although the works are in an incipient phase, they have discovered that quercithin has an inhibitory effect “in vitro” on two virus proteins, 3CLPRO and PLPRO, which “are essential for its replication”.

They came to this compound through a screening project of hundreds of molecules, but Velázquez-Campoy warns that taking food where it is found naturally or with dietary supplements does not work against the disease.

In this search for medicines, the world scientific community has mobilized in an “impressive way, each one from its own particular approach”, highlights Rial, who considers: “If many of us look for one, we will find the right one”.

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Covid 19

Coronavirus Spain: 12,788 new infections and 241 deaths

On the day that the Government has decided to declare the state of alarm in much of the Community of Madrid, including the capital, the data on the evolution of the pandemic are similar to those of yesterday in infections, 12,788. Deaths rise, today 241, yesterday 126

Infographic of the evolution of the pandemic in Spain on October 9 / EFE

The data of cases and deaths from COVID-19 in Spain continue to rise.

Today there are 241 deceased (126 yesterday) reaching almost 33,000, exactly 32,929, according to these official figures from the Ministry of Health. In seven days 541 people have died, 134 in Madrid.

Today there have been 12,788 new cases (yesterday 12,423) up to a total of 848,324 since the pandemic began.

Madrid represents 2,995 of these new cases, approximately 25 percent.

The cases notified in the last 24 hours are 5,986 (yesterday 5,585) with Madrid adding 2,256. about 40 percent.

The cases at 14 days are 121,535 and at 7 days, 57,247.

The cumulative incidence (AI), number of cases per 100,000 inhabitants, is today 258.44 (yesterday 256.79); and in Madrid of 540.64 (yesterday 563.86). Only Navarra is ahead of Madrid, with more than 600.

Hospital admissions in seven days have been 2,764, they continue to rise, 2,452 yesterday, and in this period of time 199 patients have been admitted to ICUs, a figure that was 172 yesterday.

However, the total number of hospitalized patients is lower today, 10,554 (yesterday 10,645) with a percentage of beds occupied by COVID-19 patients of the total hospital beds of 8.66% (yesterday 8.95%).

This data in Madrid jumps to 20.61 percent, slightly lower than yesterday, of 21.10 percent.

In the Intensive Care Units there are 1,590 affected by the virus, five more than yesterday, with a percentage of the total number of ICU beds due to coronavirus of 17.91 (yesterday 18.04) of the national average.

In Madrid, this data has been declining tenths this week and today is 39.33 percent compared to 39.81 percent yesterday, a very high figure, since four out of 10 patients who are in the ICU are due to coronavirus.

The income registered in the last 24 hours is 1,303, compared to 1,165 high.

coronavirus test health
The health workers collect samples from volunteers who agree to undergo two tests (one normal PCR and another the rapid test) during the rapid diagnostic test for COVID-19 to validate its operation at the COVID-EXPRES facilities in the Palacio de Congresos de Palma de Mallorca this Friday. EFE / Cati Cladera
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Covid 19

Do I have the flu or COVID?

You have woken up with a fever and a sore throat. A year ago you would have taken painkillers and you would not have given it more importance, but today the alarms are going off: is it the flu … or COVID? Information from the EFE VERIFY team

With the cold come colds and flu, with symptoms that can be confused with those of COVID-19, so in a health system highly saturated by the pandemic, diagnosis is crucial.

This year, the advancement of the flu vaccination campaign and PCR tests are the only way to take pressure off hospitals and health centers.

What symptoms do they share?

The influenza virus (flu) and SARS-CoV-2 (COVID-19) cause respiratory diseases and some of their most characteristic symptoms are similar: fever, cough, fatigue, shortness of breath, sore throat, runny nose, muscle and headache pain.

Loss of taste and smell, rashes, diarrhea: COVID-19

There are other signs of COVID-19 that flu sufferers do not have, such as loss of taste or smell, skin rashes, or color changes in the fingers or toes.

These are mild symptoms that begin gradually, while fever and cough are usually the first thing the person infected with the new coronavirus experiences.

People with COVID-19 can also have diarrhea, something that children who catch the flu can also get.

Unlike the latter, the infection caused by the coronavirus can rapidly evolve “to serious respiratory problems”, which forces patients to be evaluated from time to time, José Ignacio Peis, of the Spanish Society of Primary Care Physicians, tells EFE (SEMERGEN).

In fact, people who have a fever or cough and also breathe with difficulty, feel pain or tightness in the chest or find it difficult to speak or move have to “call the doctor immediately,” warns the WHO.

And the cold?

A person with a cold has a stuffy nose, sneezing and may have a low fever and cough, says Peis, who coordinates the SEMERGEN Preventive Activities and Public Health working group .

Symptoms of the common cold, usually caused by rhinovirus, are easily distinguished because they are much milder than those of the flu and COVID-19 and begin more gradually.

COVID-19: longer incubation time and more contagious

Flu and COVID-19 are transmitted in the same way: through droplets and small particles expelled by coughing or sneezing, as well as by direct contact and with surfaces.

However, this disease is more contagious among certain populations and age groups than the influenza virus and generates many more cases of “super-spreaders”.

After infection, the signs of the disease appear earlier in a person with the flu (one to four days after contracting the infection) than in one with COVID-19.

In the latter case, the disease is revealed around the fifth day after contact with an infected person, but this period of time can vary from two days after contracting the virus to 14.

Recovery and complications

Both the flu and the coronavirus can cause serious complications, especially in older people, with previous pathologies and pregnant women.

In children, however, the flu can cause more serious conditions than COVID-19.

Both diseases can progress with complications such as pneumonia, respiratory failure or heart injury, multi-organ failure, inflammation of the heart, brain, and muscle tissues, and secondary bacterial infections.

The flu usually affects mainly the nose, throat, bronchial tubes, and occasionally the lungs.

But COVID-19 is a disease that not only attacks the respiratory system, but also the immune and cardiovascular system, Peis emphasizes.

In fact, some of these patients develop blood clots in the lungs, heart, legs, or brain; and, in the case of children, there have been cases of multisystemic inflammatory syndrome.

Flu sufferers recover in one to two weeks without the need for medical treatment, usually. In the case of COVID-19, one in five people end up with a serious illness and experience breathing difficulties.

Only the flu has a vaccine

Finally, a key difference between the two diseases is that the flu has a vaccine and COVID-19 does not yet.

Antivirals for influenza reduce the risk of contracting the disease by between 32 and 43%, according to a European study.

In addition to preventing contagion, the vaccine will have a much-needed collateral effect this year: lower healthcare and hospital pressure in the middle of the second wave of coronavirus.

In 2019, these antivirals already prevented 26% of hospitalizations, 40% of ICU admissions and 37% of deaths attributable to the flu, according to the Ministry of Health.

Thus, in order not to compromise more health resources and face the coronavirus pandemic with more guarantees, the 2020-2021 flu vaccination campaign was advanced at the beginning of October.

“In the coming months, SARS-Cov 2 and the flu will coexist and this could especially stress our health system,” said the Secretary of State for Health, Silvia Calzón, at the end of September.

Also the president of the Spanish Association of Vaccination, Amós García Rojas, emphasizes that vaccination “is always important, but there are contexts in which it increases, as in the current pandemic.”

The current pandemic requires that vulnerable groups, such as those over 60, pregnant women, health workers and people with an associated pathology, get vaccinated against the flu to avoid complications in case they contract COVID-19.

Likewise, the Spanish Society of Out-of-hospital Pediatrics and Primary Care (SEPEAP) recommends universal flu vaccination from six months to refine the diagnosis of COVID-19.