Health centres collapse under avalanche of mild cases and sick leave certifications

Health centres visited nearly 100,000 patients per day for covid, the highest number since the pandemic began

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A mother and daughter entering a CABEZA in Barcelona.

Santa Coloma de GramenetThe workload generated by covid in primary care is unsustainable: on Monday 97,081 consultations related to the virus were made, the highest figure of the entire pandemic. However, and unlike other waves, most of the patients who arrive suffer mild symptoms and many want to confirm their positive result with a diagnostic test or process their sick leave, which always has to be validated by a doctor. The professionals consulted by ARA warn that they are exhausted and that the trickle of these patients makes the ordinary functioning of the centres impossible, since it prevents access to medical care for people with other urgent illnesses.

"Despite the request not to visit health centres if it is not necessary, people come because they want to take a test or get a sick leave, and we have neither the staff nor the infrastructure to respond without compromising access for people who really need it," explains the vice president of the Catalan Forum of Primary Care (Focap) and nurse at the Raval Nord health centre, Antonia Raya. In fact, the volume of minor cases is so high that the professionals' agendas become clogged. "We make 300 visits a day just for covid. Fortunately, the vast majority are mild infections, but they require sick leave and medication management, and this conditions teams a lot," summarises the delegate of Doctors of Catalonia and family physician at the Rambla de Terrassa health centre Pau Roman.

Although the processing of online sick leave has been enabled to minimise the saturation of health centres, the vice-president of the Catalan Society of Family and Community Medicine (CAMFiC) and physician at the health centre in Rambla de Sant Feliu de Llobregat, Jordi Mestres, is committed to eliminating it to "remove a huge volume of work" from the centres. "It makes no sense that a doctor has to act as a notary and certify whether the person is on sick leave or not. After two years of pandemic, we thought that this would be solved with a declaration of self-responsibility for periods of less than seven days, but it isn't," he regrets.

This exceptional formula is already applied in other countries, such as the United Kingdom, where the agreement is signed between the employer and the worker. Catalan Health minister Josep Maria Argimon has admitted that these bureaucratic procedures collapse the system, and has defended that it would be a good alternative. "Since the beginning of the pandemic, we have been demanding from Social Security that sick leave due to covid be exceptional and that a declaration of self-responsibility to not go to work can be made," he said in an interview on Tv3.

Covid: a priority?

The Spanish Society of Family and Community Medicine (SemFYC) estimates that most of the infections detected now are mild or asymptomatic because the Omicron variant is less serious and because of the increase in the population's immunity thanks to vaccines and contagions. For this reason, it believes it is necessary to rethink the suitability of the strategy based on testing all cases and contacts to indicate isolation, which has primary care at its centre and "consumes a lot of time and resources". SemFYC calls for steps to be taken towards the normalisation of covid as a disease: self-care for mild cases, follow-up of people with risk factors and only using health care for the most vulnerable and those with severe symptoms.

For the time being, however, visits to health centres continue to rise, and this paradigm shift does not seem close. "For two days now we can fill the Camp Nou with the number patients we see," says Mestres, who warns that it is an unsustainable trend, as it halts the diagnosis or follow-up of serious or chronic diseases. "For weeks we are focused on counting cases of runny noses and we have stopped visiting patients who need us. Maybe it's time to test only the people who might have complications," he adds. However, the physician points out that it is important to keep in mind that antigen tests are not accessible to everyone and that up until now health authorities have asked people to contact health centres in case of suspicion of covid. "We cannot blame the population, because they have not been given the option of accessing us without saturating an already deficient system," he laments.

Raya believes we must also begin to consider a change of perspective and a reorganisation of the tasks that primary care has to perform so as not to compromise access to healthcare for people who "really need it." "We will not deny care to anyone, but testing all cases with the current volume of infections is madness," she says.

Roman agrees, and assures that the current prioritisation of covid is "excessive", given that serious cases and deaths are low and that it seems that "a new phase thanks to vaccination" is underway. "Our staff is dedicated to seeing covid patients and very few professionals are seeing patients who really need to be visited, diagnosed and treated. And we will soon see the consequences," he denounces, in relation to the underdetection of serious and chronic diseases.

Peak number of infections in ten days

After 440,000 people became infected in the last eight days, the Health minister has assured that there are already signs of "clear deceleration" of contagions and has predicted that the peak of the sixth wave will be reached in a maximum of ten days. This Tuesday the Government announced that the scientific advisory committee on covid is already working on a report on coexistence with the virus in the medium and long term, beyond the strategies that can be agreed with the Ministry of Health and other regional governments.

Catalonia sees it as "essential to do its own evaluation of the scenarios" for the future, according to executive spokesperson Patrícia Plaja, now that the Omicron variant, due to its high contagious potential and its lower virulence "could have brought the pandemic into a new paradigm". However, Argimon defended that "it is still premature" to compare covid to influenza, as Spanish president Pedro Sanchez did, and said that the pandemic will eventually pass "when everyone has had contact with the virus", either through vaccines or contagion.