The Spanish Government maintains an order on its health workers that does not comply with a directive set by the WHO on January 31, when proclaiming the coronavirus pandemic. The Ministry of Health requires its professionals “not to actively follow up on the direct contacts” of those infected and “not to carry out diagnostic tests”. This has led to two terrible problems: failure to follow up on contacts has prevented the real expansion of coronavirus from being known and, at the same time, limited its effects.
Currently, due to the shortage of tests and saturation Hospital, Health can only know the approximate dimension of the problem by the death toll or by those who have come to the clinic or have been admitted, but it does not know what active mass of the virus is in the Spanish population. And here comes the dance of approximations.
If a standard lethality of around 1% is accepted, Spain, with 10,000 dead It must be around a million infected, although there are studies that multiply that number because the deceased do not stop growing.
But there is something more serious than not knowing how many infected: ignore who have been contacts direct from the sick or positive. Because if you had followed up on such people who related to the infected, you could have prevented or known their subsequent direct contacts and, therefore, infections.
This work, in addition, having been done from the beginningWhen the numbers were only a few tens or hundreds, it would have been much more manageable than when the 100,000 infected officials were exceeded. This would have stopped this deadly snowball where each infected person infects four others, and those four, in turn, 16 others, and so on.
This is the technical successes followed in Korea, among other countries, where an iron follow-up of the contacts, for which they multiplied the tests that were carried out in Spain, managed to dominate the epidemic. The follow-up of the contacts, aside from the toilet, on their face restriction of movements or interrogations, does not even need medical means because they require more useful police facets than mere street control: telephone monitoring, card movement, etc.
There was a direct order
Spain has not done any of this. He could have ordered it and then, in practice, it was impossible for him due to lack of means. It is not the case. Has not by express order. The text of the aforementioned Health instruction, which has been accessed ESdiario, it goes like this:
“Contacts will not be actively tracked, they will only be instructed to carry out a home quarantine for 14 days from the last contact with the case if they are not living with each other or from the end of the symptoms of the case, if they are living together. Health authorities may assess individual situations that require another type of recommendation. If during the 14 days after exposure contact develops symptoms and the clinical situation allows it, you should do self-isolation immediately domicile and contact the primary care services as established in the protocols of each CCAA “.
And he added: “The prevention services of occupational hazards they will be in charge of establishing the mechanisms for the investigation and follow-up of close contacts within the scope of their powers, in coordination with the public health authorities. ”
Finally, in case there were doubts: “The management and follow-up of health professionals who have been close contacts is established in a specific procedure. No tests will be performed diagnostic for coronavirus routine in contacts ”.
And what did the WHO say had to be done on January 31st regarding direct contacts?
– Contacts must be monitored during 14 days afterThe last contact without protection.
– The contacts they should travel and move as little as possible.
– Public health authorities can carry out the surveillance through home or virtual visits to check the symptoms.
– Any Contact If you become ill and fit one of the case definitions, it will be considered a test case.
– We will have to locate and observe contacts of all new probable or confirmed cases. ” Already then, the WHO pointed out the convenience of carrying out tests on “all suspected cases”.
WHO gave another warning
On February 10, the WHO He insisted: “Daily data will be provided to all direct contacts, who must complete them for a minimum of 14 days.” But he emphasized yet another point: all contacts had to be analyzed direct from each confirmed coronavirus case.
To do this, they had to be tested for serology and virology at the beginning to know their possible contagion (as direct contact) and repeat them two weeks later. If with either of these two filters direct contact was positive, it went to the confirmed case category. And again it was time to check, research, monitor, and test all your direct contacts. The WHO urged to fill out forms where the patient or infected will detail your direct contacts.
What is a direct contact? “Anyone who had contact (within one meter) with a confirmed case during the symptomatic period, including four days of the onset of symptoms ”. But also those who have lived with the infected or whoever has given personal attention.
To get to know the direct contacts, the WHO detailed a task quasi-police: “Information on primary cases and their direct contacts should be collected through a combination of interviews personal or phone calls to the case (or family members if the case is too ill to be interviewed) and other members of the home, his own statements, interviews with health workers and review of medical records when necessary. “
The Spanish Government can argue today that this measure is not viable: to know, control, and test the direct contacts of 100,000 Spaniards. But when the WHO demanded such surveillance on January 31 in Spain there was still no infected known.
When the WHO reiterated such a measure the February 10, in Spain there were two cases. But they were the beginning of a ball that showed his most disturbing face after the weekend of 8M, when the contagion and mortality charts shot up.