Primary healthcare has been overexerted in order to absorb the Covid-19 pressure during the last eight months, whilst trying to maintain regular activity. However, health professionals cannot multiply in two, and the erosion has reached the point that medical visits related to the virus have been prioritized over other pathologies, according to data which spans up to October. Ordinary visits for diseases other than Covid-19 have fallen by 12% compared to last year - mainly as a result of months of home quarantine -, but if one adds to these numbers the work generated by Covid-19, especially throughout this second wave, work in primary healthcare centres has increased by 6.8% compared to 2019. "Primary care is the line of assistance that has suffered the most during the pandemic, and it has not always been perceived as such" says the director of CatSalut, Adrià Comella.
The second wave is generating much higher demands in primary care than the first one did. This is partly because, between March and April, the battle was mostly fought in hospitals. The usual activities of outpatient clinics was reduced by almost half. However, in the second wave, nearly 97% of the regular activities has been maintained and, at the same time, an extra number of medical consultations have been assumed, both face-to-face and virtual, in order to mostly address confirmed or possible Covid infections. The month of October stands as proof of this: if last year there were 4,879,000 consultations, this year there have been almost two million visits more, adding up to a total of 6,654,360. Additionally, almost a third of last month's activity was due to Covid.
Primary healthcare has not always been able to keep up with the onslaught. "Between March and June occupation fell greatly, especially where face-to-face care is concerned", explains Comella. In March, healthcare centres stopped making 20% of medical visits, compared to last year; in April, the occupation unrelated to Covid sank 44%, and in May, 33%. In fact, it is not until June that the data recovers, and until August that this recovery is consolidated. That being said, the increasing demands of Covid were already being felt by then. "This is what causes the feeling of great tiredness which professionals are currently living with", admits the director of CatSalut.
More than half of the visits are virtual
It is possible to trace the before and after of the coronavirus pandemic effects in primary healthcare by looking at presential consultations data. If in January 80% of visits were face-to-face, in April they plummeted to 25%. During this period, the Government asked the population to avoid going to healthcare centres as much as possible, and to communicate with their doctors or nurses by video call or telephone. Little by little, the data has been compensated for, and since October, during the epidemic's accelerated period, 43% of consultations are face-to-face.
"Covid has made us rethink the healthcare we give in primary centres: we have to try to make 60% of the consultations face-to-face, and the remaining 40% telematically", says Comella. In this sense, Salut proposes incorporating 8,000 webcams, 3,000 portable computers, half a thousand telephones, and the deployment of its own SMS platform to promote telematic assistance.
Throughout summer, hospitals were less crowded. However, primary healthcare was facing its toughest period, since it took over the care and monitoring of infections, which were increasing throughout the country as the weeks went by. Since then, these centres have led the way in PCR testing and mass screening, assisting 80% of patients and preventing many of them from suffering complications. They have also entered nursing homes and private homes, and have become the link between Salut and schools. But the lack of working hands, the closure of local clinics during the summer - 30% of which have not yet reopened -, and their crucial role in epidemiological surveillance have pushed centres with a chronic lack of resources to the limit.
Salut is proud to have hired 3,258 professionals to strengthen primary healthcare, 2,089 of which are administrative staff (mainly Covid managers, who work with schools or take samples for diagnostic tests). With regard to health professionals, 1,169 have been hired: 249 physicians -family doctors, psychologists, pediatricians and dentists-; 494 graduates in nursing and social work; and 426 nursing assistants.
A dozen new primary healthcare centres
Considering that the 568 civic centers, retirement centers, and municipal pavilions transferred by the municipal governments for the flu vaccination campaign will sooner or later be reclaimed for their conventional uses, Salut will make available a total of 60 primary healthcare centres in order to take triage and care of people with respiratory problems (and symptoms compatible with Covid) out of the centers.
These spaces will be similar to the five satellite hospital buildings already under construction, although they will be smaller (between 40 and 60 meters) and will have a useful life of three to five years. According to Comella, the number of benefited healthcare centres could be increased to reach a hundred, but for now only about sixty are expected to come into operation in January.
CatSalut also foresees a dozen larger constructions through the emergency contract route for other centres that have become too small and need better structural solutions. For example, this is the case for a centre in Mollerussa, another in Torredembarra, and several in the Barcelona metropolitan area. However, these steps will not be carried out until next year.