Barcelona hospital chief: ‘The situation in Lleida has clearly gotten out of hand’

Magda Campins, 63, is an epidemiologist who is in charge of Catalonia’s biggest hospital. During the coronavirus pandemic, Barcelona’s Vall d’Hebron had the most Covid-19 patients in the region and it also handled the highest volume of intensive care patients.

From her experienced vantage point, this expert says that things are not looking good in Catalonia. A series of recent uncontrolled outbreaks, most notably in Lleida province, have led the regional government to try to reintroduce home confinement in a bid to prevent a second big wave of infections, even as people and businesses struggle to recover from the effects of a three-month nationwide lockdown that ended in June.

Campins points at the shortcomings that have made the current situation possible: a lack of foresight, and an underfunded public healthcare system.

Question. What happened in Lleida?

Answer. Most likely, nobody foresaw that there would be a number of people coming from abroad to pick fruit in unfavorable conditions, and that they might be infected. This was not foreseen. No preventive measure was adopted, either from a health or from a social point of view. And when the infections began to be detected, it was hard to keep tabs on the cases and their contacts because some of them, although they should have been in isolation, got away because they needed to earn money. It’s been difficult both in terms of early detection and in case follow-up. And Lleida’s public healthcare resources are insufficient.

Q. The Catalan government insists that they took steps and that everything had been thought of.

A. I don’t know what it is that they did, but the situation right now has clearly gotten out of hand. They should have done PCR tests from the beginning, and been able to keep cases located.

Q. Why did the tracing system fail?

A. In Lleida it failed because they were very difficult cases to follow and because healthcare professionals needed support from social workers and mediators to explain the situation to these individuals. Also, the public healthcare’s tracing capacity has failed. There are nine staffers assigned to the job, a wholly insufficient number for the magnitude of the problem.

Catalonia is not ready in terms of epidemiological monitoring: the resources are absolutely insufficient

Q. Is the tracking system failing in Barcelona as well?

A. Right now, with outbreaks on the rise, it is going to prove absolutely insufficient. Germany has calculated its contact-tracing staff needs very well. It has figured out that it needs around 25 tracers for every 100,000 inhabitants. Catalonia would need between 1,500 and 2,000.

Q. Is Catalonia prepared for a second wave of coronavirus?

A. It is ready in terms of primary healthcare ability to perform early diagnosis, of labs’ capacity to do PCR tests, and of hospitals’ resources to deal with incoming patients. But we shouldn’t have to come to this point. Catalonia is not ready in terms of epidemiological monitoring: the resources are absolutely insufficient and that is the most important thing during the containment phase. In order to do proper containment, it is essential to have a strong epidemiological monitoring system in place.

Q. Will the second wave take place in the summer instead of the fall?

A. It is hard to say. If we manage to contain the community outbreaks, there won’t be a second wave. If this ability does not exist and we start to see community transmission in numerous areas, there could be a second wave sooner than we thought. Now we are also seeing that the hot weather is not a factor that reduces transmission.

Q. Is home confinement the only way to contain the situation in Lleida?

A. I don’t know if it is the only one, but given the situation, it is the most efficient measure to stop transmission quickly.

There should have been massive PCR testing on seasonal laborers and on the community in general

Q. Is confinement a failure in terms of pandemic management?

A. It means that the previous measures are not working. In Lleida, the milder measures have not been enforced 100%. Defining a perimeter for confinement aims to prevent the virus from extending to other nearby comarcas [territorial divisions encompassing several municipalities], yet we are still seeing transmission there. There should have been some good contact tracing. There should have been massive PCR testing on seasonal laborers and on the community in general. All of those things have only been partially done.

Q. Could the legal wrangle over the Lleida home-confinement order take a toll on public health?

A. Losing one day means a lot. The rise in cases is exponential right now. I would like to know what arguments the judges used to say that this measure cannot be adopted. We’re playing with people’s health here.

Q. Barcelona registered 257 cases on Friday alone, which is significantly above the week’s average. Are you concerned?

A. Yes, I fear for Barcelona. I find it hard to believe that the Friday figures will be a one-off thing, because during the week we have seen a rise in cases in nearly every city district. I fear for Barcelona because I am scared that Barcelona may not have the contact-tracing capacity, and the public health system could be overwhelmed.

Q. What does it take to pull out of this?

A. We need to communicate better with the population, to convey transparent and understandable information every day on what is happening, so that people are aware that the problem is not just in Lleida. Information is essential, and we are seeing a more complacent citizen attitude toward protection measures. There is also a pressing need to increase the number of contact tracers, otherwise we will be unable to do this job or we will come late to it. The main thing is information and public health resources.

Q. Are you afraid of what’s coming?

A. I am not so much scared as concerned. I am concerned about all of Spain, and especially about Lleida, because besides the outbreak, there is a social issue there that needs to be addressed. And I am also worried about the big cities, because of the population density. The situation in Spain is not reassuring.

English version by Susana Urra.