EUROPEAN JOURNAL OF GENERAL PRACTICE 2020, VOL. 26, NO. 1, 106–107 https://doi.org/10.1080/13814788.2020.1796962 LETTER TO THE EDITOR Lessons learned from the approach to the COVID-19 pandemic in urban primary health care centres in Barcelona, Spain The recently published article by de Sutter et al. [1] quick in emerging, and the changing rules and recom- reflects the transformation that the coronavirus epidemic mendations confused professionals about the best way has caused in our world. With the need to adapt to the to approach the disease. novel reality, new challenges and tasks for primary However, the challenge was faced and patients healthcare (PC) professionals have arisen. We will present were attended. here how PC has dealt with the issues emerging as the aftermath of the disease in Barcelona, Spain. Why was primary care crucial during the worst period of the outbreak? How the pandemic affected primary care and The organisation of the PHC needed to adapt to the new its response scenario. The number of patients attending the centres The organisation of PC varies across Europe. In the decreased dramatically whilst the number of virtual con- Spanish urban setting, it is managed in large primary sultations via email and telephone increased. Among the healthcare centres (PHC), which act as gatekeepers pro- 2,127,610 consultations attended in the PHC between 1st viding services to an average of 25,000 inhabitants. March and 7th June in Barcelona, 1,453,666 (68.3%) were Citizens are assigned to a team consisting of a General solved in this way. Also, healthcare professionals visited Practitioner (GP) and PC nurse who manages a list of their patients at home 72,825 times. The PHC also around 1,300 patients. opened at weekends to improve accessibility. The coronavirus initially appeared in Barcelona on PC has been shown to be essential in early diagnosis. 25th February 2020. During the first weeks of the pan- Patients who consulted the healthcare professionals due demic, several patients visited the PHC with symptoms to fever, coughing or breathlessness were assessed by compatible with COVID-19; nevertheless, they did not fit clinical exploration and oxygen saturation. GPs advised the epidemiologic criteria used at that moment to be patients to either return home (with or without COVID-19 considered as possible cases. As a consequence, health- diagnosis) or referred them to the hospital if they pre- care professionals did not protect themselves appropri- sented severe symptoms and signs. ately. This might be one of the reasons that by 21st May In the case that symptoms persisted or worsened, 2020, a total of 40,921 healthcare professionals had been patients were instructed to consult their GPs and then infected and 53 had died in Spain [2]. directly referred to the radiology service for a chest X-ray. With the arrival of COVID-19, everything in PC organ- Patients identified as COVID-19 had a telephone fol- isation changed. Patients were afraid to attend the PHC, low-up with PC professionals every 24, 48 or 72 h, and GPs and nurses were instructed to avoid as much depending on their clinical status. Patients and families physical contact as possible with them. Triage by tele- were taught to manage symptoms, implement isolation phone or telemedicine/online was provided to reduce and hygienic measures, and encouraged to call the PHC the number of contacts of the symptomatic population in the case of worsening. A total of 12,497 and 28,799 following the recommendations of the European Centre patients were registered in PC records as a confirmed or for Disease Prevention and Control [3]. possible coronavirus infection, respectively, and 122,479 Clinical examinations were restricted to those cases follow-up consultations were made with these patients considered unavoidable, and invisible and visible barriers between 1st March and 7th June. were constructed between the population and healthcare Elderly residents in 200 nursing homes located in professionals. Separated areas were created to attend Barcelona were most affected by COVID-19, leading to patients with respiratory symptoms and healthcare pro- high morbidity and mortality. PHC professionals took fessionals were instructed to adopt the highest measures care of this population by detecting infections, recom- of safety and protection. mending isolation, or referring patients to hospital if Nevertheless, masks and adequate personal protective necessary. In addition, they assisted those experiencing equipment were not always available. Subsequently, in the final stages of the disease by providing end of life many cases, GPs and nurses had to wear improvised face care. One in three older adults living in these facilities shields made by themselves. Scientific evidence was was affected by the disease, and 31,877 consultations EUROPEAN JOURNAL OF GENERAL PRACTICE 107 were attended by GPs, primary care nurses, and [3] European Centre for Disease Prevention and Control. Infection social workers. prevention and control for COVID-19 in healthcare settings – Patients with social problems regarding proper home Second update. 31 March 2020 [Internet]. Stockholm: ECDC; 2020 [cited 2020 Jul 7]. Available from: https://www.ecdc.europa. isolation, and those cohabiting with vulnerable individu- eu/sites/default/files/documents/Infection-prevention-con- als (the immunosuppressed, individuals with multimor- trol-for-the-care-of-patients-with-2019-nCoV-healthcare-settings_ bidity or other risk factors), were accommodated in six update-31-March-2020.pdf hotels adapted by the Department of Health in Barcelona. Miguel-Angel Mun ~ oz One of the most important tasks of the PC professio- Gerencia Territorial de Barcelona, Institut Catala de la nals was the emotional support they offered to the fami- Salut, Barcelona, Spain lies and patients. COVID-19 originated an unprecedented Fundacio Institut Universitari per a la recerca a l’Atencio situation, which resulted in patients’ isolation at home or Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, hospital and exacerbated feelings of loneliness and men- Spain tal distress. Departament de Pediatria, Obstetricia i Ginecologia, i Medicina Preventiva, Universitat Auto noma de Barcelona, Disclosure statement Bellaterra (Cerdanyola del Valles), Spain mamunoz.bcn.ics@gencat.cat The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Merce Lopez-Grau  de la Gerencia Territorial de Barcelona, Institut Catala References Salut, Barcelona, Spain Primary Healthcare Centre Passeig de Sant Joan, Institut [1] De Sutter A, Llor C, Maier M, et al. Family medicine in times  de la Salut, Barcelona, Spain Catala of ‘COVID-19’: A generalists’ voice. Eur J Gen Pract. 2020; 26(1):58–60. [2] n de COVID-19 en personal sanitario Informe sobre la situacio Received 23 June 2020; revised 7 July 2020; accepted 9 July 2020 en Espan ~a a 21 de mayo de 2020. Equipo COVID-19 [Internet]. Madrid: RENAVE. CNE.CNM (ISCIII); 2020 [cited ß 2020 Institut Catala de la Salut. Published by Informa UK Limited, 2020 Jun 7]. Available from: https://www.isciii.es/ trading as Taylor & Francis Group. QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/Enfermeda This is an Open Access article distributed under the terms of the desTransmisibles/Documents/INFORMES/Informes%20COVID-19/ Creative Commons Attribution License (http://creativecommons.org/ COVID-19%20en%20Espa%C3%B1a.%20Situaci%C3%B3n%20 licenses/by/4.0/), which permits unrestricted use, distribution, and en%20Sanitarios%20a%2021%20de%20mayo%20de%202020. reproduction in any medium, provided the original work is pdf properly cited.