Editorial is in Spanish, that´s a mainstream group, and the info has been relayed in mainstream newspapers. In light of high level of immunity (through vaccine and previous infections) and the high contagiousness plus low severity of Omicron, which goes along the way viruses are likely to evolve, they are asking for Covid to be treated as a regular seasonal respiratory disease, all covid linked restrictions lifted, including mask mandate. they also ask asymptomatic or people with weak symptoms to stop being tested and quarantined, else they overwhelm the health care system and cripple the economy. Well shared in the news are also suicide numbers in 2020, they raised sharply, and there were more deaths by suicide than by covid in Sain in the below 50 y o population. Good to see mainstream media changing their tune, it´s probably associated with political will to deescalate. Spain has been moderate by european standards after the first lockdown when it came to covid restrictions btw, and Madrid has been one of the most open provinces in Western Europe (we still don´t have a covid pass, not sure there´s another place like this in Western Europe at the moment, besides our 2 neighbourhing provinces) https://amf-semfyc.com/web/article/3063
Oh an obviously very important set of authors this AMF 'drafting committee' with their seven published and barely reacted to opinion pieces and look at all the votes and comments. So it's basically an entirely unimportant piece. The one(the only) article comment does make some good sense though. "To think that Omicrón will be the end of the road and, even more, to think that Omicrón is something slight is more a wish than a reality. We have just learned about this variant and we are still suffering the first infections to be able to say how it will be and what it will do. And the example of South Africa is not worth us, given that its population is far from being comparable to ours. On the other hand, and with the flu we know it, a disease with a high contagion (although it has a low mortality), depletes health resources that we cannot give to other patients. Assuming that people, that the general population, will take seriously a disease in which successive waves have shown us that there is everything, is also a risky bet. The article talks about communication "to adults" and "abandoning fear messages". I agree, but the problem is that we can fall into the opposite, in transmitting a false assurance of "this is going to be one more flu" and diminish the importance it has. It is not about saying, for example, to women, you are going to have breast cancer yes or yes. No, it is about, as is done with women, to warn that there is a real risk of something. It is difficult not to fall into alarmism, but, sometimes, to avoid falling into alarmism, we can fall into a trivialization that does not help. Finally, it is clear that the new situation that Omicrón presents us with a shot in the contagions, makes it impossible, by material means, to diagnose all the cases and it is impossible to follow up on the cases. This should be addressed by the health authorities offering mechanisms to help this task (if we consider it important) and I think it is. It is evident that the number of infections that we have does not put in the dilemma of prioritizing health (the disease and its possible contagion to others, which may not carry it as well as the asymptomatic or paucisymptomatic) or prioritizing the economy (so many casualties would paralyze business and the economy, with its social consequences). But, will taking quick casualties and thereby putting people who can infect to work, will it not cause more casualties and, in the end, will it continue to affect the economy? Last but not least, we are talking about a new disease, the long-term consequences of which we do not know."
Towards the end of exceptionality AMF DRAFTING COMMITTEE The turn of the year is marked by the sixth epidemic period of COVID-19 in Spain. This wave has been different from all the others: the arrival of omicron is leaving a large number of infections with maximum levels of incidence, but with few serious cases in relative terms. According to data from the Carlos III Health Institute, currently half of the infections detected are asymptomatic and the indicators of hospitalization and death are at historical lows 1 . This is due in part to the lower intrinsic pathogenicity of omicron compared to previous variants, and also to its greater ease in infecting people with previous immunity (by infection or by vaccine) and who, therefore, present a low risk of serious disease . The low frequency of serious illness, together with the saturation of both Primary Care and Public Health due to mild cases, should lead us to rethink how to face the pandemic from now on. From the AMF Drafting Committee we want to contribute to this debate based on five key ideas. The virus will not go away The most likely scenario is that SARS-CoV-2 will live with us for many years. So far it has presented in the form of epidemic periods with a high concentration of infections for a short period of time (8-10 weeks). We do not know if these types of waves will continue to exist in the future or with what cadence (for example, influenza or respiratory syncytial virus (RSV) occur in a single annual epidemic) or if it will enter a seasonal endemic with a more or less circulation. less constant during cold months (as do many other respiratory viruses, including the four catarrhal coronaviruses that affect humans). It is also not ruled out, although it is unlikely, that it will end up disappearing as happened with SARS-CoV-1, which circulated between 2002 and 2004. There are four factors that determine the level of circulation of a respiratory virus at each moment: factors of the microorganism itself (appearance of mutations that make it more contagious, for example), the immunity developed by the population (either due to previous infection or vaccination ), seasonality (each virus has its favorite months) and human behavior (not only individual, but also social and cultural factors). The future of the epidemic will depend on the balance of these factors. Viruses constantly mutate and natural selection favors those mutations that lead to greater contagion (and, to a lesser extent, those that cause less severity). The omicron variant meets both conditions, and could represent a step in the evolution of SARS-CoV-2 towards a catarrhal coronavirus; Only time will tell if it is so. Conversely, humans become infected (or more recently vaccinated) and in this process we develop an immune response that protects us from new infections and especially from becoming seriously ill in the future. In this way, a balance or implication is reached between viruses and humans: mild and repeated infections during childhood and youth build a good immunity that protects us from potentially serious infections in advanced age. The sudden appearance of a new organism temporarily breaks this balance, since many people without previous immunity have their first contact with the virus at an age with greater risk of serious disease; This fact, together with the great synchronization of many initial cases because the entire population is susceptible, can lead to the collapse of the health system. Fortunately, we live in an age where vaccines can simulate those initial mild infections and build immunity in older people without the risks that a natural infection would pose. The expectation would be that, once vulnerable people are vaccinated, we all become infected multiple times in our repeated contacts with the virus, and that this fact will improve our individual and collective immunity. Vaccination based on evidence and equity Since the beginning of the pandemic, we have known that the risk of serious disease is not homogeneous, with advanced age being the main risk factor for hospitalization and death. Since the end of 2020 we have several vaccines that have proven to be very effective in preventing serious disease. Initial clinical trials have been corroborated by real-world usage data, which has yielded an effectiveness few of us would have imagined a few months ago. However, although vaccines are still very effective against severe disease, they are not as effective against infection and mild disease, especially with omicron 2 . While protection against infection, mediated by humoral immunity, tends to decrease with time and the appearance of new variants, protection against severe disease is maintained by cellular immunity. As health professionals, we must try to convince all people at risk to get vaccinated, especially those who have not yet been infected, because we are sure of the benefit of vaccines. Young and healthy people should be offered the vaccine, but vaccinating them should not be a priority of the health system; in this case, benefit-risk assessments and the number of people to be vaccinated must be introduced to avoid hospitalization or death. In the particular case of the child population, vaccination should be evaluated on a case-by-case basis between the family and their health team. The role of booster doses should be studied in more detail to analyze in which population groups they may contribute to a further reduction in the risk of severe disease. We need more studies to clarify to whom they should be administered, how often, and if it would be convenient to do it with vaccines adapted to the new variants. In any case, it seems clear that booster doses should be reserved for the most vulnerable populations. The decrease in protection against infection and mild illness, especially with omicron, has important implications for vaccination policy 2 . Vaccinating the entire population, including the very low-risk population and children, will not prevent the virus from circulating. To get vaccinated or not is an individual decision, and no one should be pressured to get vaccinated for the sake of a collective benefit that we do not know to what extent it exists and how long it could last. We have never done it before and we should not do it now. The vaccination certificates to access certain services, beyond the ethical doubts about their implementation, lack scientific evidence about their usefulness in reducing infections and serious cases. The vaccination situation worldwide is deeply inequitable. While rich countries are vaccinating boys and girls or giving booster doses to young people, some poor countries have not yet been able to complete the vaccination of the elderly or health professionals; in Africa only 10% of the population has completed vaccination 3 . Since vaccines are a finite asset, we all have a duty to rationalize their use based on the expected benefit of each dose administered. Communication for an adult society Some governments, COVID "experts" and the media continue to use fear as a communication strategy. The worst scenarios and the most catastrophic forecasts always enjoy more space for communication. To err by excess of alarm always penalizes less than to err by defect. In general, alarmism is unnecessary and analysis and context are lacking. Record numbers of infections are broadcast live without clarifying that half are asymptomatic and that the immunity achieved and the arrival of omicron have completely broken the relationship between infections, sick people, income and deaths. Never before has there been so much confusion between the number of people infected, detected, contagious and sick. We have to stop counting and reporting the number of daily infections, which are no longer of any interest: the sixth wave may have infected more than 10% of the population in a few weeks, while severe cases have remained relatively low. 1 . The important thing should always have been deaths, and in this sense we will never return to the catastrophic situation of March and April 2020. In the communication of deaths it is important to introduce concepts such as excess over expected mortality, potential years of life lost , and distinguish if the deaths are due to COVID or COVID. On the other hand, we will have to admit as a society (as we do with the flu, smoking, suicides or accidents, among many other causes) that in the coming years there will be a number of deaths from or with COVID that will be inevitable. The pandemic will not end when there are no deaths, but when the media and governments give them the same treatment as other causes. The fear of a possible hospital collapse that forces us to delay care for other pathologies has also been used, as happened during the first wave. This situation has not recurred or has occurred in a very specific way, although it remains true that a very small proportion of serious cases in a context of a very large number of simultaneous infections can end up causing a significant number of hospitalizations. It will be necessary to homogenize admission protocols, both conventional and critical care units, as well as distinguish between admissions due to COVID (severe infection symptoms), with COVID (decompensation of other pathologies), accidental findings (for example in admission tests for other processes) or nosocomial infections. Knowing the mean stay and the percentage of patients requiring mechanical ventilation would also help to better understand the dimension of the problem, as well as the overall hospital occupation (not just the number of patients with a positive test). Be that as it may, there has been enough time to draw up contingency plans that allow the hospital capacity of the public system to be expanded quickly if necessary; We cannot collapse Primary Care indefinitely and continue mortgaging the social and economic life of the country to avoid a hypothetical hospital collapse in the future. there has been enough time to prepare contingency plans that allow the hospital capacity of the public system to be expanded quickly if necessary; We cannot collapse Primary Care indefinitely and continue mortgaging the social and economic life of the country to avoid a hypothetical hospital collapse in the future. there has been enough time to prepare contingency plans that allow the hospital capacity of the public system to be expanded quickly if necessary; We cannot collapse Primary Care indefinitely and continue mortgaging the social and economic life of the country to avoid a hypothetical hospital collapse in the future. Fear is often joined by guilt. Getting or spreading a respiratory virus is no one's fault. If the cases go up, it is not because "we have relaxed" or because we "behave badly." As has been seen, the dynamics of an epidemic is much more complex and is influenced by a multitude of factors. Furthermore, the social determinants that contribute to the infection cannot be ignored: the impossibility of teleworking, the need to travel by public transport, overcrowding or the impossibility of isolating oneself in the home, labor difficulties to isolate and quarantine, etc. Governments cannot hand over their responsibilities in these areas to citizens. Recovery of the (old) normality During 2020 and 2021, a multitude of population measures have been tried to try to reduce social interaction, with the assumption that this would reduce the circulation of the virus and therefore the serious forms of COVID-19. These measures include from initial home confinement to perimeter confinement, capacity limitation or business closures, curfews, mandatory use of masks, non-face-to-face higher education or limitation of meetings. Different countries and autonomous communities have tried several of these measures at different times, without so far we have a clear and rigorous evaluation of how effective each one is in terms of hospitalizations and deaths, and what their potential effects are. harmful: economic and job losses, violation of fundamental rights (movement, assembly, self-image, education), increase in mental health disorders, etc. In short, a correct evaluation of the benefit-risk ratio of each of the measures adopted and a true social debate on their implementation has been lacking. At the present time it no longer makes sense to maintain them and their elimination must be planned, starting with the absurd recovery of the mandatory nature of the mask in outdoor spaces4 . Governments should focus their efforts on protecting the most vulnerable people rather than trying to curb, probably with little success, the population-level circulation of the virus, a circulation that, on the other hand, we know improves our immunity. This focused protection can be achieved from three axes: vaccination of people at risk, specific recommendations for vulnerable people (minimize close contact with people with respiratory symptoms, assess the use of FFP2 masks in situations of high risk of contagion at times of high incidence) and specific actions in areas such as geriatric residences, which in some autonomous communities have concentrated more than half of all deaths from COVID-19. We must recover as soon as possible the "old" normality, that is, life as we knew it before March 2020: without masks or limitations of social interaction. Quaternary prevention must also apply to public health, and it is especially urgent in the school environment. We know that children do not suffer from severe forms of the disease nor are they particularly effective transmitters 5But despite this, we had schools closed for months, and then we imposed the most severe measures on them: use of a mask throughout the day, prohibition of mixing between groups and tests and quarantines every time a positive is detected. These measures cause difficulties in learning and socialization, in addition to making family reconciliation difficult as there is no help to maintain child quarantines. The benefit-risk balance is unfavorable and in these cases prudence is not doing many things, but rather, as we know in Primary Care, often the prudent thing is to do nothing. Stop doing to be able to do Most countries, including Spain, have implemented an individual contagion control system based on the testing of suspected cases and their home isolation if they are positive, along with home tracking and quarantine of their contacts. This system is time-consuming and resource-consuming and, as has been demonstrated again in the sixth wave, when the number of cases increases significantly, it is no longer viable and rapidly collapses. In Spain, the system pivots on Primary Care. The detection of cases, the study of the closest contacts, the prescription of the corresponding leave and care for COVID-19 patients, added to the usual care, have often been an unbearable burden for health centers. This overload, added to an already very precarious previous situation, has made it impossible to maintain our hallmarks: accessibility, longitudinality, presence and equity. Maintaining the testing and tracking system, managing positive cases by self-diagnosis in asymptomatic patients, assuming vaccination and facing the consequences of the pandemic have displaced preventive activities, the diagnosis of new serious diseases or the control of chronic diseases 6. The negative consequences of all this will be seen in the immediate future. As Juan Simó pointed out in an excellent entry on his blog 7 , the time has come to stop doing to be able to do: let's stop visiting and testing healthy people with minor symptoms, let's stop tracking and testing their contacts, let's abandon isolations and quarantines. All these activities, which made sense in the past, have been overcome with acquired immunity (both by infection and vaccination) and the arrival of omicron. The objective should be to treat COVID as we do with the flu: clinical diagnosis and general recommendations on self-care and prevention of infections to vulnerable people, reserving health care for people who need it due to their symptoms or vulnerability. Only then can we properly care for those who really need it, for COVID or any other ailment. The sixth wave and the collapse it has produced in Primary Care and Public Health in many parts of the country have made us move in this direction. The Interterritorial Council has proposed measures 8 such as establishing prioritization criteria for testing based on symptoms or vulnerability, limiting screening to vulnerable areas, shortening isolates or eliminating quarantines in vaccinated people. These measures must be consolidated and maintained beyond the current situation of collapse, in addition to establishing a realistic calendar for the progressive cessation of the contagion control system. A strong and coordinated message from all institutions is necessary to reverse the need we have created for an etiological diagnosis of mild respiratory infections, either in health centers or with a self-diagnostic test; the etiological diagnosis should be reserved only for sentinel epidemiological surveillance systems. Neither the health system nor society as a whole can afford to continue testing asymptomatic people or people with mild symptoms and isolating all the positive ones, with the consequences that this entails at a social and economic level due to the massive sick leave of healthy people. We must end the exceptionality: COVID-19 must be treated like other diseases. Acquired immunity and the arrival of omicron allow this. In short, 2022 should be the year of recovery not only of Primary Care, but of our old normality. Happy New Year to everyone.
"AMF (Family Medicine Update) is semFYC’s distance learning programme. Its objective is to provide family doctors with a continuous training tool, based on the speciality programme, designed and prepared by specialists in Family and Community Medicine. AMF is governed by a Steering Committee. The content of the programme is compiled by the Drafting Committee, which is advised by the Editorial Committee, and the collaboration of a group of people in charge of its revision. The technical work is carried out by semFYC Editions. This group of professionals acts in line with the mission, values and commitments of AMF. " So you see the drafting committee writes up some shit that goes through revisions by highers. So it's not an official statement. Every LuisHK post reminds me of a libertarian who talks our his ass saying stuff without regards to truth because he just wants to feel good. And this song, the libertarian anthem, comes into my head, which thankfully is catchy.
Bugen, wtf u on about ?? It´s a statement from the Sociedad Española de Medicina de Familia y Comunitaria, and has been deemed important (and mainstream) enough to be relayed in mainstream papers here. But by all means, feel free to read more about mass executions in WW2 and harrass maids on your way to a 4th jab and 8th lockdown.
It's actually the main title in El Mundo today´s covid related news, one of the top papers in Spain It´s also in other papers, though I´m not gonna look them all up just to please the bunch of panicky little virgins we have roaming this forum
Draft Committee little man. (sorry Drafting) 1. If you read it you will see its a pile of crap. The comment made after it explains why pretty well. 2. I don't know how regarded El Mundo is in Spain it could be their Daily Mail or The Times (I have an idea El Mundo is reputable enough) but they are quoting authors who's thoughts would normally be behind a membership login if this was a serious organisation. I posted the hierarchy above, if this was an official publication it should be by a higher entity.
The draft commitee you should care about is the one formed by your Mom and Dad, time they give birth to a finished version of yourself is long overdue.
Right.. So you get my thrust there on why the fuck do we care about brain farts going by the quality of the drafting committee of the distance learning program wing of the Sociedad Española de Medicina de Familia y Comunitaria in Spain. The only thing worthwhile about that is the one comment afterwards, pasted above, which is quite sensible. The fact that there is so little comment or interaction with their few posts is a bit of a concern for me.
I'll ask my brother in law to have a look, he is also in Madrid and in medicine. Just to be completely fair. Also, my dad would have given a shit-streak like you a cracked rib to help you recover from your lying ways.