Vaccination against covid reaches the over 80s and dependents

The primary care will assume the organisation of a complex campaign no knowing the number of doses that will be available

4 min
The first person vaccinated against covid in Catalonia, Josefa Perez, 89 years old, receiving this Monday the second vaccine from Pfizer

BarcelonaSlowly, the vaccination campaign against covid-19 advances in Catalonia and this week the doses will begin to arrive to the over-80s and dependents who have lost their physical and/or mental autonomy. These two groups are part of the priority groups of the first stage of the vaccination strategy, along with care home residents and staff working in health centres, but their immunisation was temporarily postponed due to a lack of adequate doses. From this week, however, the Department of Health expects to reach 31,000 vulnerable people, although the number of people who form the group of over-80s and dependents is much higher, 34,000 and 400,000 people, respectively.

The Secretary General of Health, Marc Ramentol, acknowledged that this phase has a "great organisational complexity" and that it will be the primary care teams (EAP) which will take over the vaccination of these groups. In fact, they will be the ones who can decide where to administer the doses, whether in the elderly people's homes, in day centres or similar facilities or in healthcare centres. Virtually all the logistics of vaccination, then, will be responsibility of primary care teams and specifically nurses, who had demanded such a move since the first vaccines arrived in late December.

"We believe it is a very wise decision considering that primary care nurses plan all vaccination campaigns every year and we know our population. We have the experience and expertise to do so," says Glòria Jodar, director of the EAP Sant Andreu de la Barca (Baix Llobregat), who says nurses are "ready and excited" about vaccination. For now, however, the health centres are awaiting specific information from the Department of Health to start preparing for vaccination, but Jodar notes that the foundations of the vaccination campaign are very solid. "It will not be difficult for us to organise ourselves, because we already have the assigned population, we have access to their medical history and we have classified them according to their risks, such as age, chronic pathologies, whether they live alone or have caregivers," explains the nurse

Jodar admits that, taking into account the fragility of these two groups, a large emphasis must be placed on vaccination at home or in the places where the groups spend more time, such as day care centres. She also believes that healthcare workers moving around will be more common than patients going to their healthcare centre or vaccination point in the neighbourhood. "We are used to moving around, but if we have to do it in a more intense way, it is clear that we will have to plan routes" to be as efficient as possible, says Jodar, who points out that they will also have to prioritise the criterion of opportunity. That is, if the nurse has to go to the home of a frail patient to check up on them, the patient or family will be informed to know in advance if they want to be administered the vaccine.

However, Jodar highlights that, in order to plan the campaign, they will need to know how many vaccines are available and when new deliveries will arrive. "It is key to know if we will be able to accelerate vaccinations or not. The easiest part of the campaign is the jab," stresses the nurse. And, in fact, this new phase of the Catalan vaccination campaign will start in a week in which the deliveries of pharmaceutical companies have failed again: although 116,360 doses have arrived -79,560 from Pfizer and 36,800 from AstraZeneca-, Moderna has not delivered any.

This means that, although primary care teams "are already organising" to vaccinate this new age group, according to Ramentol, the available doses are scarce. Older people can get the Pfizer or Moderna vaccine (in Spain, AstraZeneca can only be administered to the under-55s) and these two doses have to be prioritised among the users of nursing homes users of old people's homes - 79% of whom have already received the second dose - and health professionals - 57% of whom have already received the second dose..

A slow recovery

While the vaccination campaign progresses, the epidemiological situation in Catalonia continues to decline with fewer than 2,000 cases per day and a rate of positive tests below 5%, which is the threshold set by the World Health Organization (WHO) to consider that the spread of the virus is controlled. The coordinator of the monitoring unit of covid-19, Jacobo Mendioroz, explained that the only outbreaks detected that have a more worrying percentages of incidence are in the Osona region, especially in Manlleu. Although Mendioroz has recognized that 25% of infections in Catalonia already correspond to the British variant, he has clarified that the outbreaks have a large social component linked to the vulnerability of the affected population, since not all people can stay isolate or stop working.

Despite the improvement in epidemiological indicators, the most relevant data for health authorities, hospital pressure, remains very high: there are 2,359 patients admitted, 632 of whom are in critical condition. "The average stay in the ICU is close to 20 days. Recovery is much slower," explained Ramentol, who has appealed to "not lower our guard" despite the fact that the peak of the third wave is behind us. "We are not in a situation of low risk," he insisted. Mendioroz has attributed this slow decline in hospital admissions to the fact that the third wave also rose more slowly than the second. "The decline is very progressive. The time in which it will return to normal will be long," he predicted

This evolution will impact, in fact, in the decision that the departments of Health and Interior, through Procicat, will have to take this week on the extension of the restrictions. Although Ramentol has not wanted to venture if some restrictions may be eased after next Monday, he has warned that we "should not expect an absolute or very remarkable de-escalation" due to the pressure of care. In fact, he assured that the department has "identified very clearly" the actions that affect the epidemiological evolution, although he did not specify which sectors he was referring to.