Infectious diseases: how to deal with them?

Aware of the bleak picture that Covid-19 drew and now the War in Ukraine and the consequent economic and energy crises that the planet is going through, The Network against Tuberculosis and for Solidarity (TBS Stop Epidemics Network) has carried out the 1st Joint Conference of Prisons, Social Health Centers and Humanitarian Organizationsaimed at the different professionals involved in dealing with tuberculosis and other infectious diseases, and paying special attention to groups at risk.

“Alone we are dreamers but together we can be a tool”, he argued in the presentation of this meeting Julio Ancochea, president of the Scientific Committee of the TBS Stop Epidemics Network, who added that “not only does collaborating enrich us, but learning about different experiences is undoubtedly an opportunity for everyone.” And so it materialized after more than two and a half hours of an online day that has revealed the ravages of a situation, as defined by the moderator of the meeting, in which the conflict has been placed as something of every day. A daily life in which for the members of this entity, Solidarity, with capital letters, is increasingly necessary to deal with diseases whose common denominator is making a greater dent in the most disadvantaged populations: Covid-19 and Tuberculosis not They only share the image of the lung that they destroy, but also the fact that they are both examples of what an epidemic of injustice is. And in the different areas it has been lived in a similar way, in some with more fortune than in others:

Great job of control in penitentiary centers

Enrique Acín, Head of the Public Health Area of ​​the General Subdirectorate of Prison Health of the Ministry of the Interiorspoke about the situation of the most prevalent infectious diseases in prisons. The known prevalence of HIV in prisons has fallen from 32% in 1989 to 3.8% in 2021. And the cases of tuberculosis in prisons, 24 cases in 2021, mostly young men, and with the important fact that 100% of cases in directly observed treatment. The prevalence of Hepatitis C virus in prisons is in some ways a story to be proud of: 48.6% from 98 to 9% in 2021 and only 0.9% with positive viral load. With regard to SARS-CoV-2 infection, the mortality rate in prisons has been much lower than that of the general population, and a striking fact: 0 deaths from Omicron.

For its part, Susana Catalán, doctor at the Madrid V Penitentiary Center, of the General Secretariat of Penitentiary Institutions, described the situation in Soto del Real: Between 1,000 and 2,000 inmates with a very high turnover, they are fundamentally preventive prisoners. For the management of infectious diseases, the doctor explains that they have an established health protocol in which the search for synergies with the support of the Gregorio Marañón Hospital Microbiology Service stands out. Examples of the collaborative activity are the 418 cases of COVID-19 but no deaths and in terms of tuberculosis cases: 7 cases in the last five years, an example of why the protocol must be insisted on: screening, clinical history, chest x-ray , serial smear microscopy, Mantoux… The importance of doing things right.

Invest, act… and evaluate: a program that is not evaluated does not exist

So he defended Joan Caylà, president of the Barcelona Tuberculosis Research Unit Foundation, who revealed that all notifiable diseases have been affected by the pandemicleaving a serious setback in the entire population, “we can no longer speak of immigrants or natives”, argued this expert, although he recalled that traditionally the approach to tuberculosis has been marked by migration as one of the problems (such as HIV /AIDS, drugs, the few pharmacological innovations or structural poverty, all of them great allies of this epidemic of injustice that is now a syndemic together with COVID-19).

In fact, according to data from the Barcelona Tuberculosis Control Program, “an exemplary and model program for all” as defined by Dr. Ancochea, 67% of cases in 2021 correspond to people born in other countries, an example of what It happens in big cities, where the disease is concentrated in certain areas.

Joan Caylà recalled the classic recipes for imported tuberculosis care, highlighting the pillars: improving the study of contacts, public health nursing professionals, health agents and facilitating the health card and screening in the first contact with the health system with PPD and chest x-ray since many patients may not return when scheduled for another test.
In short, for this expert, the key goes through invest, act… and evaluatebecause according to what he states, “a program that is not evaluated is as if it did not exist”.

The detection of tuberculosis decreases, also in Spain

Specifically, the “covidcentrism”, as this speaker defined it, has meant that since 2019 the notification of tuberculosis cases has fallen by 23% in Spain, going from 4,400 cases in 2019 to about 3,400 in 2021. Javier García Pérez, president of NeumoMadrid and general secretary of the Red TBS – Stop Epidemics did not tire of exemplifying how striking the impact of COVID-19 has been on tuberculosis control, which has forced professionals to change approaches and objectives. “In 2021”, he argued with data from the World Health Organization, “the detection and treatment of cases will be interrupted in 42% of the countries of the world, with 6.3 million more cases and 1.4 millions more deaths… which would be added to those that would have occurred without the pandemic.” The also head of the tuberculosis unit of the University Hospital of La Princesa recalled the disastrous association “low detection, less treatment, higher mortality.” But it seems that the course is changing, and to illustrate it, he shared the “non-epidemiological but descriptive” data of his hospital: 16 cases in 2017, 16 in 2018, only 8 in 2020 and 6 in 2021 and it seems that in 2022 He begins to diagnose more, and in these nine months they have already been 11. For Dr. García Pérez, uncertainty is what will mark the immediate future.

The Importance of Directly Observed Treatment

Especially in vulnerable population, as ratified Xavier Casas, medical director of Serveis Clínics, who explained the experience in health and social care in a referral center for tuberculosis, where hospitalization is combined with outpatient treatment. Dr. Casas placed great emphasis on the multidisciplinarity and comprehensive care, emphasizing the important role of Social Work and highlighted the great work done in prisons. He also spoke of the progressive increase in the immigrant population.

The gist? Trust and commitment

So he defended Joaquín Rodrigo, president of the Spanish Association of Biosimilar Medicines and CEO of Sandozin a presentation that praised the benefits of generics and biosimilars as a tool for improving access to medicines, a great challenge in the not-so-distant future and an aspect in which, for Julio Ancochea, “we should all go further together” .

Coordination, coordination and more coordination

And if it is always paramount, it becomes essential in the care of vulnerable patients. This was claimed by Francesca Sánchez Martínez, assistant doctor of the Infectious Diseases Service of the Hospital del Mar in Barcelona. Dr. Sánchez Martínez emphasized the importance of caring for risk groups and those situations of social vulnerability and emphasized again the bureaucratic difficulties and difficulties of access to the health system that immigrants have. To highlight, according to this doctor, the importance of each professional in the essential comprehensive approach: from case management to social work through health agents and mediators

In Spain we call it Soledad

Because, beyond musical references, it is the great pandemic that the pandemic has faced us. This was claimed by Fátima Cabello, director of the Spanish Red Cross Health Area, who spoke about health and social determinants after COVID-19, emphasizing the great importance of these social determinants. for the director the great current pandemic is lonelinessof the elderly and also of caregivers.

This is evidenced by the vulnerability reports that the Red Cross carries out among its users. Some reports that, according to Cabello, have shown that the profile of the population they serve has rejuvenated: almost 65% are women of about 55 years of age on average.

The head of the Red Cross confirmed that COVID-19 has had an impact on the increase in poverty, global and mental health and even the environment. And there are already 17% of its users who recognize pandemic fatigue, 25% if it is limited to the group of people over 65 years of age.

Along with the loneliness of the elderly, Fátima Cabello highlighted the possible fragility in the young population, especially in terms of mental health, since frustration and demotivation are widespread given the uncertainty with which they face a future in which they point to the lack of opportunities. .

The head of the Red Cross wanted to highlight the verification of the intergenerational transmission of poverty and reiterated the emphasis on the importance of the employment situation, housing, energy poverty, the underground economy… and even the digital divide that has affected a large number of schoolchildren.

A poverty that means that, according to Cabello, the Spanish Red Cross has seen a 30% increase in the demand for help to cover basic needs.

A poverty that according to the TBS-Stop Epidemics Network is synonymous with injustice, and even more so in the 21st century. That is why it continues to work hard to defeat infectious diseases by spreading commitment and solidarity with actions such as this 1st Joint Conference of Prisons, Social Health Centers and Humanitarian Organizations.

Because, as Dr. Julio Ancochea concluded: “Solidarity is not giving what is left over, it is sharing what you have, because together we can go further, fly higher and even, why not, be dreamers and look the moon in the eye”.
And the Red-TBS Stop Epidemics has been joining entities and professionals for more than a decade in an increasingly real dream.

Although it may contain statements, data or notes from health institutions or professionals, the information contained in Medical Writing is edited and prepared by journalists. We recommend the reader that any questions related to health be consulted with a health professional.

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