Santiago Moreno: “We have already seen this a few months ago and we are tired and angry”

The doctor Santiago Moreno knows very well how the coronavirus spends them. Not in vain he was in the ICU during the first wave for a week and, fortunately, he is now in charge of the infectious diseases service at the Ramón y Cajal Hospital in Madrid. During this month he intervenes in the I National Congress Covid19.

– At what point in the pandemic are we?

We are not, at the moment, like the beginning of March. The epidemiological situation is very different, although I don’t quite understand why. Now there are many more PCRs. Could it be that what we are seeing now was the same as what happened in March and that it preceded the great wave? It is unlikely, because now, for example, in my center there are 230 hospitalized patients (evolution from July 31 to September 16), while on March 12 we had 80 patients, which became 200 in two days. In other words, it is unlikely that the slow curve we are having is similar to what occurred in March. In my opinion, there are two different epidemiological situations.

The problem is that the situation is maddening; We are already in the middle of September and, when we expected that the cases would have to be testimonial, in my hospital there are already more than 20% of the beds with people with covid-19. And there are other hospitals in the Community of Madrid (Doce de Octubre or Gregorio Marañón) in which 40 or 50% of the beds are already covid-19.

Although it is not as explosive as it was in March, it is not what we expected. In Madrid, 11% of people with covid are in intensive care, a very high number, although, fortunately, mortality is much lower.

-What have we not learned in this time?

In these months we have learned a lot, and this time we have reacted better and more agilely. We have made progress in clinical management, what should we do and what not, and when. However, we keep making some mistakes. Possibly our lifestyle and the character of our expansive and meeting-loving society is a determining factor that favors not strictly contemplating prevention measures; But it is also true that the fact of not rigorously monitoring the contacts of people with covid has had an influence.

We started with the initial outbreaks, but something has happened to make those outbreaks get out of control and we have reached the current situation. Those are the two factors, from my point of view that explain the current epidemiological situation, but surely there are more because, for example, are Italians less expansive than us and have such a different lifestyle? Certainly not. Are they tracking better than us? Probably not either. So what happened?

I do not think that Spain has done worse in the de-escalation than other countries. What we are sure of is that contact tracing has been done poorly in most of the country.

From the experience of the influenza pandemic, it was learned that the number of patients in the second wave, and the number of deaths, was related to the implementation and duration of the confinement and de-escalation measures. Countries that did worse in the de-escalation fared worse in the second wave.

I do not think that Spain has done worse in the de-escalation than other countries. What we are sure of is that contact tracing has been done poorly in most of the country.

-How are the health professionals?

We are tired and a little angry. We have the feeling of ‘deja vu’, of having lived it a few months ago despite all the effort made during that period. But it is all very different. We are tired, even though we have made sure that we all have our rest. But the mood is bad. And I’m not talking about a material problem (masks, PPE …). It’s more of a demotivation problem. De, we are back in the same position as a few months ago! We have a lot of physical, mental and mood fatigue. You realize that not everyone has done their homework.

-What do you expect in the coming weeks in the Community of Madrid?

The situation looks bad, bad, very bad. At the rate we are going, patients are going to flood hospitals. If something does not come up, like the vaccine or a medicine, we are going to have a very complicated winter with many patients and many deaths.

We have the feeling of ‘deja vu’, of having lived it a few months ago despite all the effort made during that period

-What should be done done?

I think we have missed the opportunity to have limited the extent of the second wave. Contact studies are now impossible due to the number of infected people. We need more trackers, many more. It is possible that radarcovid app help, I don’t know.

-Are you afraid of reinfection?

So far we have lived without fear of reinfections. We protect ourselves with the appropriate measures and we understand that we have developed defense mechanisms but, after the 4 cases that have been reported in Catalonia, we are a little more pending.

I do not completely rule out that a person who has suffered from the infection can be reinfected, but is probably asymptomatic and does not have a clinical picture. That is, the immunity generated does not prevent infection, but we believe that it is asymptomatic.

The problem is that we do not know whether or not a reinfected person can infect. Vaccines may do something like this. That is, they do not prevent the infection so much, but the severity of the disease. This would be consistent with the cases of reinfection that have been described in the world, except for the serious case in Barcelona. I do not rule out that scenario: that someone who has been infected cannot be infected, and the cases are exceptional. But the other is also possible.

I do not completely rule out that a person who has suffered from the infection can be reinfected, but is probably asymptomatic and does not have a clinical pictureWe must bear in mind that the virus is not going to be eradicated, that is something that we are beginning to understand.

-Are we protected by the cross immunity created by other coronaviruses?

The hypothesis that the infection of other previous coronaviruses protects us against this virus is related to this issue. This cross-immunity may not protect us from a new infection, but it does make it asymptomatic.

Keep in mind that the virus is not going to be eradicated, that is something that we are beginning to understand. It is very likely that it becomes a seasonal virus and that it will be controlled by herd immunity or vaccines. There will be fewer cases. But we have viruses for a long time.

-The only approved treatment for covid-19 is remdesivir. Is there for all patients?

The only specific drug for COVID-19 is remdesivir. At the moment, we have been informed that there are stocks available and can be requested following certain criteria. Trump [Donald] You have not kept all the doses. Of course, it is indicated for patients with moderate infection, in mild it does not work

– Vaccines, for December as the Government says?

It is highly unlikely that this year there will be a vaccine with a sufficient guarantee of safety and efficacy. They will arrive over the next year, but the prototypes that do arrive probably won’t be the most efficient.

It is highly unlikely that this year there will be a vaccine with a sufficient guarantee of safety and efficacy

– Do you recommend getting a flu shot?

Yes, it is good to get vaccinated. Not to prevent covid, but to avoid catching the flu and to go systematically to Primary Care or Emergency to rule out covid.

-What impact can reopening schools have?

It is likely that little, although it will have. It is a very difficult decision. We think that children are infected and transmit less. Health must be combined with the consequences of having teaching paralyzed or telematically. I would not like to have to make that decision.

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