Jos Antonio Iribarren is the head of the Infectious Diseases Unit of the OSI Donostialdea, so there are few more qualified voices than his to talk about the covid: both the last year and a half and what we can expect
Donostia – The doctor Iribarren He is very clear about it and transmits it that way. If at the time it was confinement that “saved many lives”, now the improvement in the pandemic is due to the vaccination. Recognizes that health was not prepared for a pandemic “as explosive” as that of the covid.
It has been a year and a half since the start of the pandemic. How are those beginnings in the hospital? When did they realize that it was going to be a serious matter?
-At the beginning of January (2020) we already had news of what was beginning to happen in China and since the end of that month, as a unit and hospital, we have already been preparing for what could come, but we did not think it would have the explosive characteristics it has had. Since the flu of 1918, there had not been a pandemic of these characteristics and the severity of influenza A a few years ago was very low, and this was a factor that had us, in some way, untrained. In addition, we found a silent infection, which was transmitted by asymptomatic people. The first patient with covid is admitted here on March 3, the second on March 9, the third on the 12th, on the 17th there were already six and then it was something absolutely explosive until reaching 213 hospitalized on March 29. It was the confinement that saved many lives, because from March 14 to March 29, income was increasing, and after those two weeks at home the figure was decreasing.
Can a hospital be prepared for that? Were you overwhelmed at some point?
–Once it happened, the hospital did know how to respond. Many services are dedicated to that, 80% of our staff was dedicated to covid, also an important part of internal medicine and doctors of other specialties. I fondly keep a list of many surgeons from other hospital specialties who volunteered to help if the number of cases increased. Knowing that it was something unexpected, the hospital knew how to respond. The intensive care unit, which has the capacity it has, was more problematic. There the anesthesia and resuscitation unit helped. My impression is that the hospital knew how to respond very professionally.
And on a personal level, as head of the Unit, how do you handle it? Many eyes were on public health.
– There were mainly three bad moments. The first was when a colleague had to enter. The second was around March 18, when we found that there were no masks or suitable material. Fortunately, we have a room here prepared, high-level isolation, for other situations, and we had some equipment. There was a risk of running out of protective equipment. It was fixed, but we had a bad time. And the third was that uncertainty that you saw 30 or 40 income a day and you thought: When is this going to stop? But I keep that professionalism of all my colleagues.
Was such a pandemic to be expected?
– A pandemic was expected, what was not known was when it might arrive. Also, it looked like it was going to be more related to a serious bird flu. In the background something similar arrived, a respiratory virus, with an advantage, if you can say something like this: that the mortality is lower than that of an avian flu. At the time, fifteen years ago, a work approach was made in case an avian flu pandemic arrived, and something helped us. On the other hand, there is one important thing. And it is that between 8 and 10% of those infected with covid needed to enter, and that collapses any health system. Confinement was essential because revenues would have continued to increase and saturation would have been absolute.
Can another pandemic come?
–This virus has put us on our site in some way, it shows us that we are vulnerable. The world of viruses is vast. There are two large families of viruses. One is that of RNA viruses, which when they divide have a great capacity to mutate and adapt. And it coincides with the fact that man has increasingly entered forests, jungles … and has brought out some viruses. With the capacity they have to change, it is logical to think that there could be a pandemic again. In two, five or fifty years, we do not know that, but at that risk we are safe. One of the things to learn is that we need to prepare, we need good public health systems. When you look at Southeast Asia, countries like South Korea or Taiwan were able to give a very quick response. These countries were trained because a few years ago they had the SARS COV 1 pandemic, which spread to many places in Southeast Asia and stopped. Europe in general has to take note of this and strengthen public health, epidemiology … and without forgetting that what we have is not over.
¿What is the current situation and what can we expect from these next few weeks?
– The vaccine has been salvation. We are as we are thanks to the vaccine, but this has not ended and we must encourage people who have not been vaccinated, either due to neglect or fear, to do so. The message has permeated the majority, but there is a group of people who have not been vaccinated. The vaccine is safe. It is not 100% effective, but it reduces the risk of hospitalization by 90%, that is very important and what has made the situation improve. And at the same time, a certain prudence is still necessary, because what happens six months after receiving the vaccine has been analyzed and the protection for hospitalization is still 90%, but in the face of infection it drops from 70-something percent to 40 and so many. So we have to remain prudent and get vaccinated with the third dose when it comes time. Masks, hygiene and ventilation have been and will continue to be important, but vaccination has gotten us out of this. It is true that vaccinated people still enter, but this number has dropped drastically.
Last year there was almost no flu, what can we expect this fall?
–It is difficult to make predictions with the flu, even though it is a common disease. Last year there was practically no flu. An important reason was the use of the mask, it is something that this situation has taught us. Historically, after a year with little flu, it is a bad year, but this time we have the variable of the mask, ventilation and hygiene. If we continue to be careful, we can probably limit the number of cases. If there is something good about covid, it is that it has taught us that when you speak, sneeze or sing, you drop drops of all kinds of sizes and some remain in the environment. And this is going to be true for most respiratory infections. We are going to see, for example, that in health centers and hospitals, at least in autumn, which is the time of respiratory infections, both we and the patients will have a mask on to protect. There is no reason to continue to have respiratory infections continuously, the health professional will have to wear a mask because it protects from infecting and acquiring.
And would that spread it to the entire population indoors?
–In autumn and winter it would be very reasonable, even if we are not in a pandemic. You should have the civility of, who has a cold, put on a mask to protect others, as we have seen in Asian countries. These kinds of things have to come to stay.
To put it in context, in a bad flu year, how much income can they have?
-I do not have the number. There are usually three or four complicated months, but if in covid the need for admission is 8-10% of those infected, this in influenza is much lower. You can have a large infected population and the impact on hospitalization is less.
In addition to vaccines, do you think we will be able to have a treatment against COVID soon?
–The fundamental treatment when there is a hospital admission is oxygen. Putting corticosteroids was also seen to improve survival. And there are drugs and an antiviral, remdesivir, which helps in cases that you catch very early. In addition, there are drugs that are being tested if they can be effective before the patient is admitted, that somehow put antibodies that fight against the virus, but it would have to be a very early use and the effectiveness is not 100%. They would be used on very specific people at high risk and are awaiting approval. But still, to avoid an admission you have to treat 20 patients, so they are not the panacea. This issue is still in an early stage.
There are persistent covid cases. How is it treated? What evolution does it have?
“That is at an even earlier stage.” The cause is not known. It is a painting that has a certain similarity to a virus in which you then drag yourself tired. It also does not have a treatment. The first thing is to rule out that the patient does not have other things, this is important. Many of these people are gradually improving, the good news is that an important part of those with post-covid symptoms are improving.
Will we always have to live with the covid or will it be milder in a while?
–It’s a bit fictional. It is not over, it is clearer than water. The natural evolution of the virus is to survive, the natural thing is to become kinder and infect more people to continue surviving. Some virologists say it will mutate, become less severe and be like a cold, but it is not known. For now we have this virus, some very effective vaccines and measures not to get infected. And so we must continue. And if it changes and is more friendly, then magnificent.