It’s a complex issue. We have initially classified it as an infection that mainly affects the lungs. We say patients have “pneumonia” when there is a fever and at the same time we have pathological imaging (plain x-ray, computed tomography) of the lung. The fact that the earliest and most serious damage can be seen in the lungs, may be because there are special cells which have something called an angiotensin receptor, and the virus is especially attracted to this receptor.

But we are also seeing that the cardiovascular system (blood vessels and heart) is particularly sensitive to this virus. It could be that part of how the lung is affected does not only have a contagious-inflammatory origin, which it clearly does have as well, but that there is also a part caused by the malfunctioning of the pulmonary circulatory system, which causes ‘water’ (serum) to come out of the vessels and enter the alveoli, hindering the oxygenation of the blood; and at the same time thrombosis occurs in small pulmonary vessels and there are infarctions (necrosed areas) in this organ.

This is an extremely sophisticated virus which also attacks many different parts of the body

Now, this is an extremely sophisticated virus which also attacks many different parts of the body. For example, scientific papers are beginning to appear that indicate that the virus can affect the haemoglobin. Our blood carries oxygen to body tissue using this molecule and the virus seems to be able to block this function. It also affects the kidneys, liver, heart, muscles and vessels all around the body. Recently, it has been seen to cause inflammation of the blood vessels (vasculitis) in the skin and other tissues, especially in children. Unfortunately, it is an incredibly sophisticated virus.

I think that we’ve been innovative in this hospital and have done things a little differently to other health centres. We’ve overlooked, to some extent, the different specialities, which usually work a little separately from one another, and we have organised ourselves together, based on the severity of the patient’s condition. I think this has been a very interesting approach because, in fact, often where the best work is done and real progress is made is at the points of intersection between the different disciplines. Interacting with colleagues from different specialisations is a very positive practice.

We’ve overlooked, to some extent, the different specialities, which usually work a little separately from one another, and we have organised ourselves together, based on the severity of the patient’s condition

On the one hand, patients with moderate COVID-19 have been treated by a group of doctors with different specialities who complement one another. But then, for those patients whose condition worsens, but who are still not critical, it is, specifically, the pneumologists who have provided support through non-invasive ventilation, in other words , with face masks, to try to avoid these cases requiring tracheal intubation, conventional ventilation or being referred to the ICU. We have had spectacular results, with a very substantial reduction in intubations and deaths among seriously-affected patients (just 2%!). An article describing this, and which changes the current management paradigms, is under review at a high-impact biomedical journal.

We’ve merged the other part of the Department of Pneumology with the ICU team to deal with the most serious cases. These colleagues have been using more sophisticated ventilatory support machines. Our speciality is somewhere between the moderate-severe respiratory patients and intensive care patients. Like in the United States, where intensive care and pneumology are, as a rule, the same speciality (Respiratory and Critical Care Medicine).

With the exception of certain patients, whose heart and kidneys have been affected, the key has been to ensure survival through the acute phase of the illness during which the lungs are unable to properly exchange oxygen. If this exchange is enabled, using machines that help the patient to breathe, their chances of recovering from the disease are very good.

I’ve spoken with colleagues in Madrid and it was more chaotic there because it was all much more sudden; they weren’t expecting it and neither did the political authorities really anticipate the situation. It came to us around seven or eight days later, which gave us a little more time to prepare. Measures like kitting a gym out with beds and other necessary elements near the hospital is an example of this; the preparation of units exclusively dedicated to these patients or the fast acquisition of ventilation systems through all possible channels, or even designing our own, are also good examples. The situation overwhelmed us a little to start with, because we weren’t used to dealing with something like this; but it didn’t get completely out of hand and I would say that in the last week, it has calmed down a little.

But there could be a (minor or major) resurgence with the partial and gradual deconfinement being implemented, and that really worries us

Now we are very concerned, even though we know that political decision-making has to take into account other factors like the economy, as it seems there’s going to be a major financial disaster. But there could be a (minor or major) resurgence with the partial and gradual deconfinement being implemented, and that really worries us. To start with, like always, there’ll be patients showing mild symptoms until the seventh or tenth day when some will deteriorate, and we have to be ready for them. At the moment, there are beds free in the intensive, semi-intensive and post-intensive care units, and fortunately, the situation seems to be similar in Catalonia’s different tertiary hospitals.

I think the teaching staff realised that this would radically change how teaching and learning is done. Sometimes, critical situations like this force you to push ahead as best you can, and our adaptation to new technologies and ways of working would have been much slower under normal circumstances. We are seeing how we can change the way we do things, we’ve seen how the results of the online exams have, in general, been good, and we can make other changes regarding areas we’ve always done in the same way, partly out of inertia. In fact, it could be that with fewer lectures the students’ learning could be just as effective. That said, I believe the face-to-face part is of great importance; for example to convey an attitude, values, additional skills and resolve doubts. It is possible that many of us teachers have seen how quickly we can change the learning system.

I think the teaching staff realised that this would radically change how teaching and learning is done

For the students, I understand that it is the uncertainty they find most disconcerting, which is understandable. We live in a world in which, fortunately, we can predict most things. Now, however, when it comes to questions like: how will the end of year exams be done in the third term, or the resits? I can offer the different possibilities and what I think may happen; but there is a great deal of uncertainty, and circumstances that change on a day-to-day basis. So it is hard to define a clear medium-to-long-term time frame. We always try to ensure the messages are as clear as possible, but it’s not easy under these circumstances.

I’d like to underscore that there has been a subgroup of students, mainly from Medicine, but also Human Biology, who have been intensely involved in giving support. They’ve been on 061, helping the elderly in nursing homes, working here in Hospital del Mar, in research projects on COVID-19, etc. I take my hat off to them. They have really surprised and moved me, and these people are really committed and want to help their fellow citizens; I think they’ve been fantastic.

There has been a subgroup of students who have been intensely involved in giving support

There has been a proposal that a committee of teachers assess these activities and they will likely count for 20% of the mark for clinical subjects, because, at the end of the day, these are clinical internships. I really believe that from all points of view, in terms of their maturity, knowledge, skills, understanding of the health and social system, that this will mark a before and after in their learning.

The degree final projects (TFG) on the Medical degree are working well. As the degree is six years, the projects begin in the third or fourth year, and the assessment boards have already been set up. They can present their TFG online, and I don’t think the crisis will affect them very much. In Human Biology, which is a four-year degree, the experimental part is difficult, because most of the laboratories are closed. We’ll have to adapt; in all likelihood the TFGs will be a little less experiment-based this time, and the initial design for this part of the degree will have to be adjusted.

In addition, many students have shown an interest in changing the topic they had originally planned for their TFG and are instead doing something related to COVID-19. There are so many research projects emerging on this subject, that this will likely be possible. In general, the TFGs aren’t too much of a concern for me. In fact, in our case, with subjects like medicine and human biology, crises can sometimes throw up opportunities.

As is always the case, in the short term, the clinical projects have a more immediate application; but perhaps with less relevant results. Different drugs are being tested that are already used for other situations (anti-inflammatories, antivirals, antibiotics, antimalarials); there is a vaccine under fast development. For more basic research projects, more steps have to be taken, and, therefore, more time is needed before they can be applied; although, they lead us down new paths. In this sense, I think the combination of clinical and basic researchers is very positive and can speed up a little the transfer of progress made in knowledge and clinical practice. Furthermore, the engineering projects are also very interesting; there are engineers from fields that are not always healthcare that are doing very promising research into COVID-19. This pandemic has a lot of negative aspects, but one of the collateral effects is the collaboration between researchers of very different fields, and that can really help us to make great and faster progress.

The collaboration between researchers of very different fields, and that can really help us to make great and faster progress

In our team, we have around ten or eleven projects underway on the COVID disease or the virus itself. Many of them are multicentre, as they involve the collaboration of other Catalan, Spanish and international hospitals. Some combine basic and clinical research. As I said before, it’s very interesting to bring these two worlds together. In some of these projects we are looking for clinical or biological risk factors that can help us to predict how patients with the disease will develop. We know some of these, like for example, smokers, the elderly, people with a high number of comorbidities...

In some of these projects we are looking for clinical or biological risk factors that can help us to predict how patients with the disease will develop. We know some of these, like for example, smokers, the elderly, people with a high number of comorbidities...

Strangely, it has been seen that having a respiratory illness can even be a protective factor. There are diverse theories here, and one of the clinical trials we’re doing is related to this topic. There are patients who regularly take a strong anti-inflammatory drug: inhaled corticosteroids. This could explain why people with chronic respiratory illnesses are not the ones most affected by this disease, and we want to use the trial to find out if these patients are better protected. It could also be because of the antibiotics they take regularly or their specific immune response.

Another clinical trial is to find out if low doses of radiotherapy, which can help with other lung diseases involving acute inflammation, can also lower the inflammation for COVID-19 patients. And then we have a project on ventilatory support modes, with devices that are more simple and cheaper than their commercial counterparts, designed by people from our group together with different companies from the IT world.

Also, with sound engineers from UPC, we are analysing COVID patients’ coughs to try to ascertain if they have a different profile to the coughs of other illnesses. It might be similar to the flu cough –we don’t know this yet–; but it is clearly different to the coughs produced by people with asthma, colds or COPD. We want to find out if a type of cough can suggest that a patient is positive for the virus or even provide us with information on how their lungs have been affected and their prognosis.

In one of the most basic projects with researchers from the DCEXS and the Institute of Evolutionary Biology (IBE-CSIC-UPF) we are looking for the genetic base that might make a poor prognosis likely, and in another one we are implementing different types of analysis with the so-called omics sciences: specifically with transcriptomics and proteomics. In addition, due to the involvement of the cardiovascular system in the COVID disease, and in collaboration with researchers from the Barcelona European Molecular Biology Laboratory (EMBL), simulations of blood vessels will be done on a chip, subjected to serum from patients with the virus, to see how it affects the vascular system and even to try out different drugs.

I think that as a mechanism to stop transmission, confinement has been very useful. The other instrument is herd immunity (how many people have already had it, thereby hindering transmission because of their new defences). Personally, I think a lot of us have had it. Among healthcare staff I would hazard a guess at perhaps even 30-40%, and for the rest of the population of Barcelona, maybe 20%. Because there are a lot of people who describe symptoms of high fevers, discomfort that has lasted 24 hours, or just a night, and in this context there must have been a lot of people who have had it, which will greatly help to keep transmission down and prevent a major resurgence. As long as they have antibodies, of course; as we don’t know how long they last. It will act as a very significant barrier against the disease.

As regards the tests, it is clear that they should have been done in the country right from the beginning of the pandemic in order to isolate the positive cases. Because the diagnostic techniques are not complicated, they are PCR or ELISA, which we regularly do in the laboratory. I can’t understand why we had to wait so long. Chinese scientists published the sequence of the virus to be able to do PCR a week after announcing that they had the epidemic. It made sense to carry out tests on suspected cases right from the beginning and isolate them, as was done in some other countries, with good results. None of the epidemiological data we have is very accurate; the increase in the number of infections has come about because we are doing more tests. Something is going wrong with the figures here, because it makes little sense that in a system that is not overwhelmed and which, in terms of healthcare, works very well, there is such a high mortality rate. Perhaps it is mainly because of the issue of the nursing homes, in many of which elderly people live in cramped conditions and the care they are given is not always optimum. In addition, the percentage of deaths out of the total number of infections that is published cannot be accurate if we don’t know the real number of the latter. We are just starting now (!) to explore this officially.

We need much more local figures because, across the territory, the impact has been very heterogeneous

Another issue is that conducting countrywide studies makes little sense; talking with colleagues from hospitals in other areas makes this clear. You cannot compare, for example, the situation in certain areas of Galicia, where the problem has never been particularly serious because there is a large rural population which is more isolated, with what we have experienced in Madrid or Barcelona, where it is totally different. That is to say, when they do an average prevalence on a national or state scale, it will be a number that is not much use to us.  We need much more local figures because, across the territory, the impact has been very heterogeneous.

Yes, the Barcelona Respiratory Network has set in motion different research initiatives. One thing we are doing is looking at risk factors with artificial intelligence techniques, as well as if the pulmonary and vascular effects leave recovered patients with serious pulmonary sequelae; because clearly, what in some cases is such a serious disease, will leave its scars. Through the association, the major hospitals in Catalonia and some in Madrid are collaborating with the Barcelona Institute for Global Health (ISGlobal), where there are epidemiologists and statisticians who are experts in the analysis of large databases. The teaching staff at UPF are heavily involved In this network.

The Barcelona Respiratory Network has set in motion different research initiatives

Then, through the association we have obtained donations of material both for protective and diagnostic purposes. Pharmaceutical laboratories have given material we needed like stethoscopes, face masks and oximeters, which has been a great help. As they are multinational companies, they sometimes have their own channels for obtaining and distributing material, and that has been much faster than the institutional purchases and distributions at state level; in fact, we have seen that the centralised supply system has not worked very well. These donations have been directly managed by the Barcelona Respiratory Network; but they have been distributed across all connected hospitals.

That is complicated. I understand that politicians have to consider the impending economic disaster, and that it’s going to be hard on a lot of us; people are even saying it might be similar to the post-Civil War period. I think that it will have to be done on a strongly sequential basis, firstly, appraising at all times the response to each measure…, and that means fifteen days after. And even if the response is low, making decisions will be very difficult, as any mistakes will mean more deaths. Clearly, it is very hard to decide what is an acceptable threshold to start ‘opening up’ activities again, where the weight of the other side of the equation (the number of seriously affected and deaths) is acceptably modest. In activities like education, and specifically universities, I’m convinced that this year will be entirely done online, and that we’ll see in September.

I’m very fearful about the holidays; we’ve all been shut away in one way of the other, and people are getting very restless. Stopping this from a sociological and emotional point of view will be very difficult, as will remaining prudent. Just look at what happened the first weekend that children were allowed to go out. The holidays may mean that the virus reaches areas where the population still doesn’t have antibodies. I don’t want to imagine the effect of crowds of people from highly affected areas, mainly Madrid and Barcelona, arriving in Asturias, Galicia, rural parts of Andalusia or La Cerdanya.

There are people who have already made these kinds of journeys, and I think that it is highly irresponsible. Some have gone, for example, to Alp to spend confinement, which is very pretty; but they don’t seem to realise that some of them will have taken the virus there. What’s worse is that in many of these areas the healthcare infrastructure cannot properly handle the consequences of a major local epidemic outbreak.

I think that one of the few positive things that this crisis might leave in its wake are improved hygiene habits, which could, collaterally, even prevent other diseases

I think that one of the few positive things that this crisis might leave in its wake are improved hygiene habits, which could, collaterally, even prevent other diseases. I think things could change: for example, people are now washing their hands in a different way. Maybe customs we have like kissing on both cheeks when greeting colleagues or people we are introduced to will be less common; although I don’t know if this will be to the extent seen in English-speaking or Nordic countries. These changes could certainly have an impact on our behaviour.