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2021: the year of vaccines, variants, pandemic fatigue and the regulation of euthanasia

2021, the second year of the COVID-19 pandemic, ends this Friday with practically 90 percent of the population vaccinated, but with the fear of a sixth wave that, although hospitals are not collapsing at the moment as in previous outbreaks, is overloading Primary Care, health professionals and is altering Christmas for many Spaniards.

The situation with respect to 2020 is much better, however. At the moment, the country is facing an explosion of infections even worse than that experienced at the end of last year, when up to more than 40,000 cases and 600 deaths were reported daily. Now, reporting up to more than 100,000 positives a day, Spain moves in figures around 50 deaths.

In terms of restrictions, Spain has also made progress. At Christmas 2020, many autonomous communities imposed the perimeter closure of their territory, with the sole exception of visits from relatives and friends. The opening and closing hours of hospitality and entertainment venues were much more limited and curfews were the norm.

In any case, pandemic fatigue is especially affecting citizens, generating serious mental health problems either due to fear of the virus or because of the exhaustion generated by this new normal, in which living with the virus has modified even the most basic routines .

In fact, 36 and 32 percent of Spanish citizens express high levels of fear and depression due to the pandemic, according to the results of the ninth round of results of the ‘COSMO-Spain’ study, carried out in December by the Health Institute Carlos III (ISCIII) and promoted by the World Health Organization (WHO).

According to this survey, the concerns of the population are increasing slightly, especially regarding the loss of a loved one, infecting the family and saturation of health services (with a mean greater than 4 on a scale of 1 to 5 ). Spaniards seem tired of COVID-19: respondents give a 3.4 out of 5 to the statement “I’m sick of hearing about COVID-19” and a 3.7 to “I’m tired of the debates about COVID- 19 “.

In spite of everything, if the situation is better than a year ago it is due to the vaccines. In just one year, since the first ‘puncture’ was given to 97-year-old Araceli Hidalgo in Guadalajara on December 27, 2020, Spain has administered almost 90 million doses, or what is the same, more than 90 percent of the population over 12 years of age is fully vaccinated.

Now, Spain is immersed in the administration of the third dose, which will foreseeably have to reach all adults due to the drop in antibodies against the virus, and in the vaccination of children under 12 years of age, the last group inoculated due to that the vaccine had to be adapted to this group. Only SARS-CoV-2 (and its variants) will tell if this vaccination continues over the years, in the form of one ‘pin’ or even two annually.

Meanwhile, the world is facing omicron, a more contagious variant than the previous one but which, according to recent scientific evidence, could produce less severity and, therefore, the number of hospitalizations. Will it be the variant that represents the end of the pandemic as we know it until now, with its large numbers of deaths and hospitalizations? In 2022 you will be able to answer this question.

Spain and most developed countries have practically the entire population vaccinated, but the situation is not homogeneous throughout the world. Many poor nations, especially in Africa, continue with very poor vaccination rates, and instruments such as COVAX, led by the WHO, have so far failed to alleviate this problem.

In addition to the repercussions it has in these countries, in terms of the number of deaths, this inequality in access to vaccines is also contributing to the appearance of new variants. Not surprisingly, two of the main variations of the virus, beta and omicron, were detected for the first time in South Africa.

Apart from COVID-19, the improvement of the pandemic has allowed other milestones in Spanish health to take place during 2021. Among all of them stands out, without a doubt, the regulation of euthanasia, which since last June 25 is legal in Spain.

The norm establishes that this practice may be carried out to patients who request it and who are in a context of “serious, chronic and incapacitating illness or serious and incurable disease, causing intolerable suffering.”

Euthanasia was one of the rights most claimed for years, mainly by the Right to Die with Dignity (DMD) association. Its acceptance among Spanish society skyrocketed after the case of Ángel Hernández, the man who helped his wife, María José Carrasco, die with multiple sclerosis, in April 2019. According to a Metroscopy survey, at that time 87 Percent of Spaniards believed that incurable patients had the right for doctors to provide them with some product to end their life without pain.

Likewise, in this year that ends today there has also been a certain advance, or at least visibility, of a problem that has been dragging on for a long time, mental health. These are the data: in 2020, the highest number of suicides was registered in Spain, 3,941 people.

In addition, suicide is the leading cause of death among young people between the ages of 15 and 29. And almost half confess to having had a mental health problem. There are more than seven million young people. 5.8 percent of the population confesses to anxiety. And almost the same percentage suffers from depression, doubling this number in the case of women. 13.2 percent of children between the ages of 4 and 14 are at risk of poor mental health.

The Ministry of Health, in collaboration with the Autonomous Communities, scientific societies and patient and family associations, is reinvigorating the Mental Health Strategy, which was updated for the last time in 2009. The Strategy includes a new suicide service telephone number (024 ) and the Mental Health and COVID-19 Action Plan, which will have an economic endowment of up to 100 million euros to help alleviate the problems of the Spanish due to the pandemic.

Another structural problem in Spanish health care is the deterioration of Primary Care, which was finally addressed by the Ministry and the Autonomous Communities through the ‘Primary and Community Care Action Plan 2022-2023’, approved a few weeks ago in the Interterritorial Council of the National Health System (CISNS).

Its main objective is to reduce the temporality of health professionals at this level of care to below 8 percent before 2024, as well as to set for the first time a “final, specific and sufficient” budget for Primary Care.

The impulse of this plan has coincided with a wave of protests by health workers, crystallized in a large demonstration in mid-December throughout Spain and convened by more than 100 professional, trade union and social organizations attached to the platform ‘Let’s save Primary Care’ , such as the Federation of Associations for the Defense of Public Health (FADSP), CCOO, UGT, the Spanish Society of Family and Community Medicine (semFYC) and Medicus Mundi, among others.

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