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?
Es fundamental aprender a convivir con el uso de equipos de protección y a reducir los contactos de riesgo efectivo.
— Salud Pública (@SaludPublicaEs) April 3, 2020
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.