Juan Pablo Horcajada


“Too little has been spent on preventing epidemics”

Dr Horcajada argues that the speciality of infectious diseases has not received the attention it deserves and that a change of mindset is needed to help prevent the threats from epidemics and even bioterrorism

Dr Horcajada runs the infectious diseases service at the Hospital del Mar and is a leading infectologist. He claims that his speciality has been unfairly neglected.

What went wrong to put us in the current situation?
It’s the million-dollar question. I think the WHO initially downplayed the threat and that has had an influence on how things have unfolded. Different motives and people have come into play, regardless of whether or not the epidemiological work has been done well. It’s also true that epidemiology is not an exact science. It’s based on a number of indicators, and there are also those who doubt the veracity of the data provided by China. For now, there are only hypotheses.
Infectious diseases were being neglected in the health system. Maybe now they will get more attention?
Yes, infectious diseases have been left out for some time, to the point that Spain is one of the few countries in Europe that does not recognise this speciality. We are doctors in other specialties, especially internal medicine, who have worked in infectious diseases, but without official recognition. For decades, medicine has focused on other areas, such as cancer and cardiovascular disease, which have very high mortality rates and can be partially prevented. I’m not saying it shouldn’t be done, but infectious diseases come at a very high cost. There is a lot of research to be done and we have the big problem of antibiotic resistance, which we feed every day, and it won’t be easy to control that without investment. Now coronavirus has arrived and there seems to be nothing else in the world, but if a vaccine arrives and we get back to normal we’ll go back to how it was.
At least we will have had a warning.
In a 2003 article about SARS, experts said that these coronaviruses are here to stay and that, although SARS was controlled, knowing the nature, social factors and the behaviour of viruses, it is a ticking bomb. But no notice was taken. There has been a political lack of attention in the media, in research and in training, because there are no tangible results in the short term. We need to change our mindset and invest in preventing threats, even if they may never materialise.
And now we are scrambling.
Of course, because few non-infectious diseases are able to cause the economic crisis that we’re facing now. We must learn from history. Everyone knows that these epidemic cycles are periodic. And that’s without even talking about bioterrorism, which could make things very bad. Very little is invested in preventing bioterrorism and epidemics.
We are now entering the de-escalation phase and it seems we have gone from strict confinement to overconfidence.
There have been a number of measures that, together, have conveyed the feeling that we have gone from night to day in no time. People felt like they had been locked up at home for a long time and everyone came rushing outside in the same place and at the same time. The distribution of hours for leaving home could have been done differently. The most important thing is that people are informed and do things right. It’s safer to have 40 people running on their own than two talking close together without protection.
How do you assess the decision to lift the restrictions by stages and provinces?
Easing restrictions must be based on a series of indicators, which I don’t have, but which are related to the availability of ICU and hospital beds, the ability to perform diagnostic tests, the famous PPE, curves, and so on. The most logical thing is to base the easing of restrictions on data and not on dates. And to do it by areas according to the state of the epidemic.
Early studies indicate that the percentage of the population that has been through Covid-19 is very low.
This is a very important factor in making decisions. A study carried out in a primary care centre in Barcelona indicates a 5.4% prevalence, which is very low. The bulk of the population is still susceptible to the virus. We have to be careful with lifting restrictions, because we thought that more people would be immunised. Herd immunity would slow the epidemic once 60% of the population has had the disease, but we are still a long way off. This tells us that it will be an even slower process than previously thought and that we must be very vigilant to prevent another tsunami like the one we’ve already experienced.
Apart from respiratory problems, Covid-19 has also shown many other manifestations. Could it hold more surprises?
It’s a new disease. Every day we learn new things about it and we’re not done yet. Along with the loss of smell and taste, we’ve seen that a minority of patients have mild memory disorders. There are also effects on the digestive system, the central nervous system, the heart, and so on. It is a disease that can even affect the skin, which normally doesn’t occur in a respiratory virus. Trying to learn everything about a disease in just a few months is impossible, because it usually takes years to define it well. The advantage we have in this case is that Covid-19 is a digital disease, information travels very fast.


Leading the fight against Covid-19

In addition to leading the team of infectologists at the Hospital del Mar, Juan Pablo Horcajada (Valladolid, 1966) coordinates the research group on infectious pathology and antimicrobials (IPAR) at the Hospital del Mar Institute for Medical Research (IMIM). Some of the areas in which he has worked most are the prevention, monitoring, and control of nosocomial infections (those that are contracted in clinical centres) and the resistance of bacteria to various drugs. In this health crisis, he has also been the general coordinator of the Covid-19 unit at the Parc de Salut Mar.

Looking to the future, Horcajada says it is too early to say whether the virus will disappear with the approach of the warm weather. “It doesn’t seem that simple,” he says, adding that “the fact is that the spread also depends on social factors that change the equation. We can’t relax now or when summer comes.”

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