Public Health: Who are the workforce behind the management of Spain’s coronavirus crisis?

As Covid-19 continues to make its way around the globe everyone on social media seems to have suddenly become a public health specialist. Admirable as this maybe, there are people who are experts in this field. Public health doctors are trained doctors that specialise in the investigation of health and disease conditions in human populations.

Public Health: Who are the workforce behind the management of Spain's coronavirus crisis?
Photo: AFP

By Alan McGuire and Laura del Nido Varo

Before the crisis happened, public health was seen as a ‘geeky’ medical speciality. Epidemiology, the science behind the speciality, is very academic as it includes the study of health in populations and the science behind the causes and management of infectious diseases. The work within public health is often seen as less than glamorous. Its more  graphsand databases than running down corridors or being stood in an operating theatre.

However, with the outbreak of Covid-19 it has been pushed to the forefront of the medical world. Now the database managing, infection control inspecting doctors are working to help form national policy. With even Fernando Simon becoming a national celebrity and more recognisable than the Minister of Health, public health has become gain a level of fame that it wasn’t expecting.

Having to deal with the world’s biggest pandemic in recent history, whilst also trying to answer the politicians and fellow medical professional’s questions, cannot be easy. But also, the question comes up, what do they do? Surgeons pull out ruptured spleens and dermatologists look at people’s skin conditions. So, what does an epidemiologist do?

The Local spoke to Carlos Fernández Escobar, a resident doctor of Preventive Medicine and Public Health, to find out what he has been doing during this pandemic. He is working at the CNE (National Centre of Epidemiology) on the analysis of Covid-19, and publication of reports on the situation in Spain. 

What is the CNE?

It is the centre in charge of the surveillance of many diseases in Spain, those that are considered of special interest, such as vaccine-preventable illnesses (measles, polio, meningitis, seasonal flu…) and, now, COVID-19. We keep track of the number and evolution of infected cases, to inform the public and other government agencies. We conduct a great deal of epidemiological research as well, both in the field of infectious diseases and in other health topics such as cancer, air pollution or cardiovascular health.

How is the data collected?

​The data is first collected in hospitals and primary healthcare centres from all over Spain. For every case of COVID-19 there are a standard set of questions called “epidemiological survey”, which includes demographic data (sex, age) and clinical variables (when symptoms started, whether the patient suffer from more diseases or not, whether they need intensive care or not, etc.). Those surveys are then transferred to an information system, where they are completed and/or corrected by the health administrations of each Spanish Autonomous Region. They in turn send their data to the CNE.

How is it related to the healthcare system and the management of Covid-19?

It goes both ways. The healthcare system provides us with the data, and the managers of the system use this processed information to guide their actions.

How does it relate to the ministry and Fernando Simón?

We are in everyday contact with the National Coordination Centre for Health Emergencies (CCAES), the agency of the Ministry that Simón leads. We exchange data and insights with them, as they receive other complementary data from the Autonomous Regions: aggregated or accumulated cases, which are more quickly reported but lack data on many variables that we do have at CNE. Both institutions are part of a larger National Epidemiological Surveillance Network (RENAVE).

What are the main findings of your analysis so far?

With all the necessary caveats, given that our figures are still preliminary and change day by day, we can replicate some of the findings of other countries facing the epidemic. COVID-19 seems to be more aggressive with older people, especially men, who suffer from previous diseases. The number of confirmed cases, severe or critically ill patients, and deaths continues to growth, although the epidemic appears to be slowing down. There are big geographic differences between areas as well, being Madrid and Catalonia the Regions with the largest numbers of confirmed cases in total.

Have you found any unexpected results? 

In our latest reports, we found that over a quarter of COVID-19 cases were healthcare workers. That is a fairly large number. We know that health workers are at a higher risk of becoming infected, but we also suspect that they are being tested much more frequently than the general population, so the actual percentage may be significantly lower.

How will these results help manage the covid-19 crisis ?

One way these reports, and many others published by CNE, can guide action is by showing how the epidemic is evolving day by day. Although data is far from perfect, it can detect if new cases are appearing more or less quickly and where, so that the health authorities can act accordingly. They show as well a wide picture of some demographic and clinical variables that could predict the risk of severity or death in patients. They can also point out surprising or unexpected results, such as the high infection of health workers, or possible delays in hospital admissions or notifications, that may be corrected using the appropriate measures.

What is MOMO? How is it going to help with the current crisis?​

​MOMO stands for 'monitoring of mortality', and it is a surveillance system shared by European countries which counts the daily or weekly deaths in each country. In Spain, it gets its information from the civil registries where every birth and death is recorded. It is useful in the sense that it shows when 'mortality peaks' occur. Those are periods when the recorded deaths are much higher than the 'expected deaths', i.e. the 'normal' number of deaths that usually happen in that week of the year. Mortality peaks normally signal extreme weather events, such as hotwaves or coldwaves, or the seasonal epidemic of flu. What we can see in the latest MOMO reports is a remarkably high peak of mortality at the same time as the COVID-19 epidemic reaches thousands of cases in Spain. MOMO counts all deaths, no matter their cause, so we cannot tell apart which ones are due to COVID-19 and which not, but we can get an overall picture of the impact of the epidemic, and the associated healthcare system's collapse, in the population.

Alan McGuire is a British writer living in Madrid, Spain. He is currently working on a book on Spanish society. You can follow him on Twitter and see his writing here.

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Spain rules out EU’s advice on compulsory Covid-19 vaccination 

Spain’s Health Ministry said Thursday there will be no mandatory vaccination in the country following the European Commission’s advice to Member States to “think about it” and Germany’s announcement that it will make vaccines compulsory in February.

Spain rules out EU's advice on compulsory Covid-19 vaccination 
A Spanish man being vaccinated poses with a custom-made T-shirt showing Spain's chief epidimiologist Fernando Simón striking a 'Dirty Harry/Clint Eastwood' pose over the words "What part of keep a two-metre distance don't you understand?' Photo: José Jordan

Spain’s Health Minister Carolina Darias on Thursday told journalists Covid-19 vaccines will continue to be voluntary in Spain given the “very high awareness of the population” with regard to the benefits of vaccination.

This follows the words of European Commission chief Ursula von der Leyen on Thursday, urging Member States to “think about mandatory vaccination” as more cases of the Omicron variant are detected across Europe. 

READ ALSO: Is Spain proving facts rather than force can convince the unvaccinated?

“I can understand that countries with low vaccine coverage are contemplating this and that Von der Leyen is considering opening up a debate, but in our country the situation is absolutely different,” Darias said at the press conference following her meeting with Spain’s Interterritorial Health Council.

According to the national health minister,  this was also “the general belief” of regional health leaders of each of Spain’s 17 autonomous communities she had just been in discussion with over Christmas Covid measures. 

READ MORE: Spain rules out new restrictions against Omicron variant

Almost 80 percent of Spain’s total population is fully vaccinated against Covid-19, a figure which is around 10 percent higher if looking at those who are eligible for the vaccine (over 12s). 

It has the highest vaccination rate among Europe’s most populous countries.

Germany announced tough new restrictions on Thursday in a bid to contain its fourth wave of Covid-19 aimed largely at the country’s unvaccinated people, with outgoing Chancellor Angela Merkel speaking in favour of compulsory vaccinations, which the German parliament is due to vote on soon.

Austria has also already said it will make Covid-19 vaccines compulsory next February, Belgium is also considering it and Greece on Tuesday said it will make vaccination obligatory for those over 60.

But for Spain, strict Covid-19 vaccination rules have never been on the table, having said from the start that getting the Covid-19 jabs was voluntary. 

There’s also a huge legal implication to imposing such a rule which Spanish courts are unlikely to look on favourably. 

Stricter Covid restrictions and the country’s two states of alarm, the first resulting in a full national lockdown from March to May 2020, have both been deemed unconstitutional by Spain’s Constitutional Court. 

READ ALSO: Could Spain lock down its unvaccinated or make Covid vaccines compulsory?

The Covid-19 health pass to access indoor public spaces was also until recently consistently rejected by regional high courts for breaching fundamental rights, although judges have changed their stance favouring this Covid certificate over old Covid-19 restrictions that affect the whole population.

MAP: Which regions in Spain now require a Covid health pass for daily affairs?

“In Spain what we have to do is to continue vaccinating as we have done until now” Darias added. 

“Spaniards understand that vaccines are not only a right, they are an obligation because we protect others with them”.

What Spanish health authorities are still considering is whether to vaccinate their 5 to 11 year olds after the go-ahead from the European Medicines Agency, with regions such as Madrid claiming they will start vaccinating their young children in December despite there being no official confirmation from Spain’s Vaccine Committee yet.

READ MORE: Will Spain soon vaccinate its children under 12?

Spain’s infection rate continues to rise day by day, jumping 17 points up to 234 cases per 100,000 people on Thursday. There are now also five confirmed cases of the Omicron variant in the country, one through community transmission.

Hospital bed occupancy with Covid patients has also risen slightly nationwide to 3.3 percent, as has ICU Covid occupancy which now stands at 8.4 percent, but the Spanish government insists these figures are “almost three times lower” than during previous waves of the coronavirus pandemic.