Dr. Isabel Muñoz was a family physician in the small town of La Fuente de San Esteban, in the heart of the Salamanca province. She is the first Spanish physician to die of COVID-19. Her passing at 59 years old, brings into question the protection of health professionals and the protocols for the care and monitoring of people in quarantine.
Her patients described Dr. Muñoz to the local media as a physician who was "devoted and of impeccable conduct, as much for her skills as for her humanity". Isabel Muñoz, who had been showing COVID-19 symptoms for a few days, had asked to be tested and had placed herself in isolation waiting for the results.
Her condition deteriorated last weekend (March 20th-22nd, 2020) and she was eventually found dead at her home. The circumstances of her death raise two key issues: the protection of front-line health professionals and the methods to follow-up on those placed in isolation.
Laura, a substitute family physician, had been in contact with Dr. Muñoz on several occasions. For her, her colleague’s contagion must have occurred during the first days of the crisis "when we were still doing ENT exams on everyone, as if nothing was wrong", explained Laura.
Now, on the other hand, she feels that the protection conditions have improved: "We have gowns, masks, glasses. We have to bleach the equipment after each visit, but we don't have so many outings, no more than one or two a day. If we protect ourselves well, with the measures we have now, we shouldn't get contaminated."
The La Alamedilla Health Center is located in Salamanca, the main city of the province to which La Fuente de San Esteban belongs. It is a reference in the field of family medicine, and Dr. Pilar Moreno is one of its most experienced physicians. She confirms Laura's impressions: "I think the reason we've had so many infected health professionals is that for more than a month we've been witnessing an increase in the number of respiratory charts without suspecting it was the coronavirus. No safety measures were taken. Now that we are aware of the danger, and even if we don't have everything we would like, at least we have enough PPE (personal protective equipment), like gowns, gloves, masks, and goggles, to protect us."
Dr. Moreno also mentions the follow-up of isolated patients: "Despite a telephone follow-up which, in our protocols, is scheduled every 24 hours for certain cases, we have this problem of people who live alone. Extreme isolation means that even the closest neighbors don't know what's going on on the other side of the door."
For Laura, it's the speed at which COVID-19 patients can decompensate which makes the protocols difficult to adjust. "We do everything we can to keep people out of the centers, we call them up to twice a day, and I even call them once more when I get home," she explains. But this follow-up has its limits. It can happen that a patient talks to his family on the phone at noon, to tell them that everything is fine and that he has sudden bronchospasm during the night and dies alone, at home".
Laura wonders how much reliance can be placed on the clinical data collected during a telephone assessment or a face-to-face visit with a clinical examination that has become extremely simplified. "We would tend to put in place treatments to avoid being caught off guard, with antibiotics, acetylcysteine, chloroquine, etc, and then we'd be able to see the results. But we want to avoid drug intoxication."
The substitute physician knows that if her colleague had been in the hospital when her condition deteriorated, she might be alive. But Laura remains lucid: "We can't send everyone to the university hospital if there's even the slightest doubt."
(Text by Dr. Juan Manuel Calvo Mangas)
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