LAUSR

Following the first outbreak of COVID-19 in Wuhan in December 2019, where Chinese authorities confirmed 41 cases detected between December 8 and January 2, 2020, the city stopped reporting cases until January 19, when 17 more cases were confirmed. By then, the first cases of COVID-19 had been reported outside China: two in Thailand and one in Japan. The rapid spread of the disease led the World Health Organization to declare it an international health emergency on Jan. 30, 2020. By that date, COVID-19 had been detected in all provinces of mainland China and cases were reported in 15 other countries. On March 11, the disease was present in more than 100 territories worldwide and was recognized as a pandemic by WHO. The number of confirmed cases continued to grow and on April 12, the number of confirmed cases worldwide stands at 1,524,161, in Europe at 830,260 and in Spain at 161,852. Globally, the United States, Spain, and Italy thus far, have the highest number of diagnosed cases and the highest number of deaths. The first patient in Spain diagnosed with the coronavirus was known January 31. He was a German patient admitted to the island of La Gomera (Canary Islands). Nine days later another case was detected on La Palma. But it was not until February 24 that the virus jumped to the peninsula, with the first cases being detected in the Communities of Madrid, Catalonia and Valencia. Although the progression and rate of infection that this disease has shown is remarkable, the good news is that so far in Spain, 59,109 people have recovered and the increase in diagnoses has stabilized, with a decrease in the growth of infections from 38 to 3%. The bad news is, of course, that already 16,353 people have died from COVID-19 in Spain [1]. According to the Competitiveness Index prepared by the 2019 World Economic Forum, Spain is the country with the best health system in the world, a privilege it shares with Singapore, Hong Kong and Japan, all of which have the highest score obtainable [2]. After Singapore and Japan, Spain has the longest healthy life expectancy on the planet. However, in spite of having a highly accessible public and universal health system, the COVID-19 epidemic has managed to collapse its services. Intensive Care Units have been overwhelmed by COVID-19 cases. Long working days without rest and with insufficient individual protection equipment have left a picture of thousands of health professionals infected and physically and mentally exhausted. With an excellent Spanish health system, what explains the explosion of COVID-19 cases and its large spread in such a short time? Surely we must appeal to the central role played by the mildest and most asymptomatic cases in Spain. The first cases were not identified early, and individuals continued to unknowingly infect other people. As in other countries such as Italy and the United States, diagnostic tests began to be carried out in the population, although too late and only in cases where the symptoms were already severe. This made the coronavirus capable of infecting so many people without setting off alarms of the health authorities at the beginning of the epidemic. Surely the Latin and Mediterranean character of the Spanish people, a population that likes social closeness, parties, street life and physical contact through kisses and hugs, could also contribute to the rapid spread. But in addition to these reasons, there were two other factors that had a negative impact, and which have to do with some features of this coronavirus. The first is its long incubation period: 2 to 14 days until symptoms are shown if they appear at all, and 5 to 7 days from the appearance of the first symptoms until patients develop more severe symptoms. And the second factor is that the clinical manifestations in mild cases (80% of cases) are similar to those of colds and flu. Unfortunately, the beginning of the COVID-19 epidemic in Spain coincided with the height of diseases typical of winter, that is people with COVID-19 but did not suspect * Rafael Ballester-Arnal [email protected]