The arrival of covid-19 turned the world upside down. In Spain, too; the healthcare system had to be restructured within a few weeks and the pandemic changed both the healthcare system and the way patients were cared for.
Telemedicine -online care- became necessary and was introduced in some areas as a pilot. Consequently, the number of health workers and the budget for research had to be increased. Additionally, public health had to be improved.
Covid-19 revealed both the shortcomings of the system and relevant questions for the future. One year after the declaration of the state of alert, there are not yet all the answers. However, experts believe they are needed in order to avoid having to go back into quarantine in the event of a new pandemic. The five challenges are:
1. Restructure the health system
Covid-19 led to overcrowded hospitals that had to postpone operations, resulting in longer waiting times. According to pre-pandemic estimates, waiting lists for an operation in Spain were around 170 days. Moreover, health care representatives said, this was ‘a typical example of the fragility of a system that had already crashed’.
Also it became clear that many people did not dare go to a hospital for fear of infection. As a result, this led to an increase in the number of heart attacks or complications of serious diseases. For example, cancer cases that were ‘diagnosed too late’. Additionally although the covid-19 mortality rate is under control, it is feared the virus will continue as ‘a new flu’. Consequently, this could lead to an excessive burden on primary care.
2. Healthcare workers
The second challenge concerns healthcare workers. Trade unions have been denouncing for years that the health sector is one of the public sectors with many temporary and precarious contracts and poor working conditions. Among other things, ‘the low wages and poorer working conditions than in some other countries’, have made many doctors and nurses decide to work outside Spain and emigrate. Currently, the Spanish Congress is debating a civil legislative initiative to hire 130,000 additional nurses.
3. Investment in science
Among the professionals who emigrate, there are many scientists. And they are precisely the ones who are so essential in the fight against a totally unknown virus. However, they continue to work with the pharmaceutical industry on the use of innovative techniques for the treatment of diseases and on research into medicines or vaccines. Covid-19 has led to innovations in Spanish hospitals. For example, the use of hyperimmune plasma, a proprietary therapy based on human blood plasma, to cure covid-19. This project was carried out under the direction of the Foundation for Biomedical Research at the University Hospital Puerta de Hierro Majadahonda in Madrid. According to the Spanish newspaper ElEspañol, as of 31 January, more than 7,000 therapeutic doses of plasma were available for both randomised clinical trials and observational research, where no intervention or experimental treatment is tested.
Furthermore, the Instituto de Salud Carlos III, the Spanish public health research institute, has funded 129 research projects on covid, three of which involve vaccines using RNA technology: two in Catalonia and a third in Santiago de Compostela in Galicia.
4. Public health
The key player in the covid-19 pandemic is the health sector. Make the sector stronger’ was both the promise of governments and the plea of those working in the health sector. President of the Spanish Society for Preventive Medicine, Public Health and Hygiene (SEMPSPH) Rafael Ortí affirms that if the government had ‘powerful’ tools for preventive medicine and public health, this would have led to the ‘more efficient’ detection of infections, resulting in fewer people in quarantine.
Ortí wants to see 20 people working on prevention in all health regions. They could, he claims, be engaged in ‘contact investigations, analysing risk factors, checking that people really do stay in quarantine, keeping up to date with vaccinations or improving information systems’. He also states that ‘a well-coordinated and equipped public health system would have enabled Spain to be prepared for a pandemic like the one we are currently facing’. The Ministry of Health has since created the State Health Agency (la Agencia Estatal de Salud Pública). For this project, the department of Health Minister Carolina Darias has allocated €5million.
5. Healthcare technology
Telemedicine has become an important tool for many citizens, either out of fear of infection or to protect those at risk.
In Spain, outside the private health sector (where it is pioneered), this practice is not fully developed. This must change. The Ministry of Health has appointed Alfredo González as Secretary General of Digital Health, Information and Innovation. Little is known about his projects. However, he does want to set up a data network in the cloud and modernise primary care. Likewise, he will also be responsible for projects such as the analysis of health data and the development of digital health systems.