I'm a specialist in family medicine, and have ER experience and primary health care experience from various regions in Spain, and specialized experience (I did heart surgery in Milan, BTW).
I'm also in the front line right now in the primary health care sector (health centers), but we receive updates from our local hospital. I can see how this mess is/was created and you can read my posts by going to my username and checking what I posted in this thread in the past.
One problem that has brought up multiple times in this thread already, is that they're not testing people because they consider the entire population suspect. Those tested are hospitalized patients. The international codes for this COVID-19 are as follows:
B34.2 for both COVID-19 confirmed cases and PROBABLE cases, and Z20.828 for possible cases and contacts of those who were confirmed and/or are probable cases.
We just finally received detailed instructions TODAY as to how to use these codes in our primary health care patients. Before that, a bunch of people got labelled B34.2 when they should have received the second code. It will be taken into account for statistical purposes even though the data is not reliable. And notice how those whose tests were inconclusive (probable cases), still get piled up with the confirmed cases.
I highlighted in your post the problem that seems to be compounding this madness. A lot of people that could be at home with primary health care follow ups are staying in the hospital when they have no criteria of hospitalization. That is a luxury that you can't take in countries like Italy or Spain which has a very elderly population that could go into respiratory failure even with a banal bug. There are a lot of comorbidities in our populations as well.
It's true that the COVID factor is playing a role in atypical pneumonias in younger people that can go into respiratory distress. But I don't see much difference from previous flu seasons where I had to sell an elderly patient to the ICU doctor and the later would say no, so he can keep the beds for the younger population. It is often the case that an elderly patient with multiple diseases just wants to pass away and not be reanimated. The mortality right now still doesn't seem to match the mortality from previous seasons.
Right now, the problem is the hysteria and the directives which are fuelling ALL patients to the hospital (see below). The fact remains, MOST people in the general population will not go into respiratory distress. Perspective should be kept as to not break the hospital system - they're the only ones with ICU beds!
In my regional hospital, there are now 6 COVID confirmed cases. Most of them could be at home, but one woman specifically, demanded to be in the hospital. Her husband died last night and he had COVID. However, he also had a pneumonectomy AND lung cancer. I'm pretty sure he will be labelled COVID death, but he was already dying before COVID. The specialist decided to keep other COVID cases, even though we could have followed them from their homes.
I worked today in the COVID circuit and didn't saw a SINGLE patient. Yesterday I worked in the non respiratory circuit at the health center, and saw only 2 patients. I phoned half a dozen people with the common cold, and none have breathing problems, they're all doing better by the day. Nevertheless, as per protocol and because COVID patients are recovering and then after one week, it hits them again, we're doing follow ups after one week.
Now, before all of this began, I was seeing up to 60 patients with either the flu or the common cold in just ONE morning. It was one patient after the other with respiratory symptoms as you just described. But due to the directives of this emergency, these patients are all going to the ER and/or hospital (instead to primary health care centers) or essentially, staying at home instead. Now I'm seeing none or 2 patients at the most per the entire day. Again, primary health care has been effectively shut down. And we do a very important job in avoiding decompensations that otherwise ends up in the hospital. My patients have stuff like heart failure, cancer, COPD, diabetes, high blood pressure, etc, and they need constant check-ups and follow ups. None of this is being done during the "national emergency". They're waiting at home. If something happens to them that can't be managed by phone, they have to go to the hospital. A good number of my patients have 6 diseases or more in one single body.
If the regional hospital doesn't let go of the MILD cases, they will soon be in very big trouble. I can think easily of 100-300 people in my post which covers 1500 patients (1900 if you count the ones in the elderly residency hospital) that will easily go into respiratory failure or get into trouble if their check-ups are withheld for longer and/or if they catch a cold. And yes, this COVID is highly contagious and has its peculiarities. Fact remains, people have multiple comorbidities and MOST people, specially those without comorbidities, will only have a mild form.
Now, anything that happens to anybody, has to be dealt by the emergency services in the hospital because they can't come to me, nor I can derive them to specialists the usual way. And never mind the people that I was following up every week because they had either anxiety or depression, and I was leaving them homework and listening to their problems as to prevent suicide attempts.
It's like cooking up a storm. They emphasize so much the work of primary health care, but you don't see that in the news these days. They need hospital heroes and stories of how ER staff doesn't have time to eat and how a ICU nurse committed suicide after testing positive for COVID. I have received phone calls from people that I haven't heard of in decades because they are concerned about my welfare, now that I have only seen like 2 patients per day. Whereas before, when I didn't have time to eat nor go to the toilet, or was spending up to 4 consecutive days working non stop (sleeping like 2 hours per night) and even dealing with 4 significant emergencies at the same time, they didn't care for me. Such is life.
