CORONAVIRUS

No protocols, no guidelines: 71% of Spain’s health workers lacked means to fight coronavirus, poll shows

According to the survey, most professionals had neither adequate personal protective equipment nor proper instructions on how to manage Covid-19 patients

Medical staff from Fundacion Jimenez Diaz hospital embrace each other in Madrid on May 17.
Medical staff from Fundacion Jimenez Diaz hospital embrace each other in Madrid on May 17.SERGIO PEREZ / Reuters

When the coronavirus hit hospitals in Spain, most health workers did not have the means to face the virus. Not only were they exposed to Covid-19 due to the lack of personal protective equipment (PPE), they were also not given basic protocols on how to manage coronavirus patients and to avoid contagion. That’s according to the results of a survey of 2,500 health professionals published Tuesday by the Institute for Better Healthcare, also known as the IMAS Foundation.

In total, 71.5% of healthcare workers replied that they did not have enough resources (tests, PPE) to protect themselves from the coronavirus. Only one third said that they were given protocols on how to avoid contagion at the beginning of the crisis. This percentage doubled two weeks after the state of alarm, which was declared on March 14 in a bid to control the spread of the virus. What’s more, few health workers were provided with guidelines on how to treat suspected coronavirus patients. According to the survey, fewer than half had such instructions at the beginning of the pandemic, and an additional 33% by the end of March. But 12% said that they never received patient guidelines.

More than 90% of those surveyed believed that the government acted too late

It is likely that this contributed to the high rates of coronavirus infection among Spanish healthcare workers. According to the third and final round of a coronavirus prevalence study, 10% of healthcare workers tested positive for coronavirus antibodies – nearly double the national average of 5.1%. Of those surveyed, 85% said that they had been in direct contact with Covid-19 patients – 56.5% on an ongoing basis. A total of 15% of doctors and 14% of other health workers (not including nurses) said they had contracted the coronavirus. This figure rose to 23% among nurses.

The conclusions of the in-depth survey are highly critical of Spain’s healthcare system. “The response of the National Health System to the crisis caused by the pandemic has been notably inadequate and fragmented. The focus has been overly centered on hospitals, instead of on public and community health. The coordination between hospitals and primary healthcare, as well between social and health resources, has been very poor,” said Javier Elola, the head of the IMAS Foundation and the director of the survey. “The system must reorientate itself towards health and establish mechanisms for better integration of available resources.”

The survey also revealed health workers’ dissatisfaction with different government administrations, including the management teams sent to hospitals, who were often seen as “political instruments,” according to the survey. One health worker complained: “It was perverse for hospital managers to be politicians. They reacted late, listening to their leaders instead of to their workers. The lack of professionalism in the managing teams has been seen in the failure to make important decisions to involve all professionals and doctors.”

According to the survey, administrations were viewed more negatively the further up they were on the chain of command. The central Health Ministry was the worst-rated institution during the crisis, followed by regional governments, the respondents’ medical center and their department. More than 90% believed that the government acted too late, while 81% replied the same of their respective regional health departments.

The response of the National Health System to the crisis caused by the pandemic has been notably inadequate and fragmented
Javier Elola, head of the IMAS Foundation

But some health departments fared better than others. The region of La Rioja is on the top of the list, with an average score of seven out of 10, followed by Murcia, Galicia and Asturias, which scored six. The worst-ranked regional health departments were Castilla-La Mancha with two, followed by Valencia, Madrid and Aragón, with three points.

“There was a slogan: our health system is the best, or one of the best. Both the IMAS and different scientific associations have been reporting structural, organizational and management problems that must be resolved,” said Elola. According to Elola, as expressed in the survey conclusions, the healthcare system must be reformed at all levels to become more cohesive and to depoliticize management so that decisions are based on scientific evidence.

Health workers also replied that prevention is key to fighting the pandemic. To achieve this, the survey concludes that the primary healthcare system needs to be strengthened so that it can react faster to situations like the coronavirus crisis. This would increase the number of cases detected and lower the number of hospital and intensive care transfers.

While the survey highlighted the shortcomings of the healthcare system, there were also some positive findings, such as the response of autonomously run hospitals and phone assistance programs.

Triage

A total of 44% of those surveyed said that the medical centers they worked at had established explicit criteria to limit medical care based on a patient’s characteristics and the available resources. While this is standard procedure, 60% of respondents said the criteria was not passed by an ethics committee.

In Madrid, the regional government has been heavily criticized over allegations it recommended against admitting elderly patients and those with dependencies into hospital.

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