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Infectious diseases: how to deal with them?

Aware of the dark picture drawn by Covid-19 and now the war in Ukraine and the resulting economic and energy crises the planet is going through, The Network against Tuberculosis and for Solidarity (TBS Stop Epidemics Network) performed the 1st Joint Conference of Prisons, Social Health Centers and Humanitarian Organizationstargeting the various professionals involved in the management of 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 working together enrich us, but learning about different experiences is undoubtedly an opportunity for everyone.” And this is how it materialized after more than two and a half hours of an online day that revealed the devastation of a situation, as defined by the moderator of the meeting, in which the conflict was placed as something of every day . A daily life in which Solidarity, with capital letters, is increasingly necessary for the members of this entity to deal with diseases whose common denominator makes a bigger dent in the most disadvantaged populations: Covid-19 and Tuberculosis They only share the image of the lung that destroys them, but also the fact that they are both examples of what is an epidemic of injustice. And in the different areas it was lived in a similar way, in some with more fortune than in others:


Good job of control in penitentiary centers

Enrique Acín, Head of the Public Health Area of ​​the General Subdirectorate Prison Health of the Ministry of the Interiortalked about the situation of the most common 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 directly observed is treatment. The incidence 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. Regarding SARS-CoV-2 infection, the death rate in prisons was much lower than that of the general population, and a striking fact: 0 deaths due to Omicron.

On his 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 prisoners 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 should be insisted upon: screening, clinical history, chest x – ray , serial smear microscopy, Mantoux … The importance of doing things right.

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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 made it known all reportable diseases were affected by the pandemicwhich leaves a serious setback in the whole population, “we can no longer talk about immigrants or natives”, argued this expert, although he remembers that traditionally the approach to tuberculosis through migration was characterized as one of the problems (like 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 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 happens in large cities, where the disease is concentrated in certain areas.

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


The detection of tuberculosis is decreasing, also in Spain

Specifically, the “covidcentrism”, as this speaker defined it, meant that the notification of tuberculosis cases fell by 23% in Spain since 2019, from 4,400 cases in 2019 to around 3,400 in 2021. Javier García Pérez, president of NeumoMadrid and general secretary of the Red TBS – Stop Epidemics has not tired of showing how striking the impact of COVID-19 has been on tuberculosis control, forcing professionals to change approaches and goals. “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 million 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 recalls the disastrous association “low detection, less treatment, higher mortality.” But it seems that the course is changing, and to illustrate this, 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 appears that in 2022 He begins to diagnose more, and in these nine months is they already 11. For Dr. García Pérez, uncertainty is what will mark the immediate future.

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The importance of directly observed treatment

Especially in vulnerable population, as validated Xavier Casas, medical director of Clinical Services, who explained the experience in health and social care in a referral center for tuberculosis, where hospitalization is combined with outpatient treatment. Dr. Casas laid great emphasis on the multidisciplinarity and comprehensive care, which emphasizes the important role of Social Work and highlights the great work done in prisons. He also spoke of the progressive increase in the immigrant population.


The core? 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 to improve access to medicine, a major challenge in the not-so-distant future and an aspect in which, for Julio Ancochea, “all of us together must go further”.


Coordination, coordination and more coordination

And if it is always extremely important, 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 taking care of risk groups and those situations of social vulnerability and again emphasized the bureaucratic problems and problems 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, except for musical references, this 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, and emphasized the great importance of these social determinants. for the director the great current pandemic is lonelinessof the elderly and also of carers.

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This is proven by the vulnerability reports that the Red Cross carries out among its users. Some reports that Cabello says have shown that the profile of the population they serve has become younger: almost 65% are women, on average, around 55 years old.

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 admit pandemic fatigue, 25% if it is limited to the group of people over 65 years old.

Along with the loneliness of the elderly, Fátima Cabello highlighted the possible fragility in the young population, especially in terms of mental health, as 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 emphasize the verification of the intergenerational transmission of poverty and reiterated the emphasis on the importance of the work situation, housing, energy poverty, the underground economy… and even the digital divide that affects a large number school children.

A poverty which 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. This is why it continues to work hard to defeat infectious diseases by spreading commitment and solidarity with actions like 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, 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 in an increasingly real dream for more than a decade.

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 advise the reader to consult a health professional with any questions about health.

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