What is it like to battle the coronavirus in Madrid, one of the hardest-hit European cities? How does coronavirus impact hospital infrastructure for the future? Find out from our health care expert

Our lives have changed with the coronavirus crisis. But have they changed forever? In Does This Change Everything? European Investment Bank experts examine the implications of the COVID-19 crisis for sectors from education and digitalisation to urban mobility and medicine—and for your everyday life.

To find out what coronavirus means for the public sector, we spoke to Tunde Szabo, a health care economist with the European Investment Bank’s life sciences division. Szabo, who is recovering from the coronavirus, talks about her own experience and the strain coronavirus has put on hospitals.

Read Does This Change Everything? from the European Investment Bank, the EU bank. Subscribe to the podcast on iTunesAcastPlayerFM and Spotify 

You’ve been battling the coronavirus for almost 18 days now. Can you tell us what it’s like and how you found out you had it?

Just to clarify, I am a health economist, I’m not a doctor. Physically right now I’m based in Madrid. Not in Luxembourg. My family lives in Madrid and I have been commuting for the last year. During this coronavirus crisis, I am right now based in and confined to our apartment in Madrid.

The emergency state was announced in Madrid on 13 March, and this was exactly the day when my 16-year-old daughter fell sick. She started complaining, “Oh mom, I feel very tired, I have headaches. I have very sensitive eyes. I need to sit down. I can’t go anywhere. I’m very, very tired.” Then we discovered that she had a fever. Then she got very frightened and she said, “Mom, I think I have the coronavirus. Could we call the coronavirus hotline? I would like to get tested.” So I told her, “Elena, don’t worry. Let’s wait a night, let’s see what will happen tomorrow. And then we’ll call the coronavirus hotline.”

And actually the day after, it was me who started feeling exactly the same symptoms. On the 14th, which was the second day for my daughter, we tried to call the coronavirus hotline, and nobody was answering.

After four hours of trying – my daughter was insisting, insisting, insisting – finally she managed to speak with the auxiliary nurse, who, based on the symptoms described by my daughter confirmed, that yes, “Elena you have the coronavirus, don’t worry, a doctor will call you back later.”  But this never happened, nobody ever called us back.

The same situation was repeated a day after, when I felt sick. We called the coronavirus hotline, and I spoke with someone who was just recently hired, not even an auxiliary nurse.

The person just asked the symptoms. I mentioned all my symptoms and he asked if I had a fever. I said I didn’t, so he basically assumed that I didn’t have the coronavirus. He nearly hung up the receiver. But I said, yes, yes, we have one case in the family, and I’m pretty sure I have it, too. He took my data and he said, “Ok, someone will call you back.” And again, this never happened. Then we called a third time, because my husband also started feeling the symptoms, like five or six days later. Again, we asked for help. We asked for a test. We were promised something for the second or third time, and this just never happened.

Nobody has called us, nobody has tested us. It’s us who have set our own diagnosis, and we speak with many people who are in a similar situation—who most likely have the virus, have the symptoms, but who cannot get tested, because they are only a mild case and not a complicated case. Basically, if you are a mild case, there is no way to get tested or to get professional help in Madrid.

So what has the virus been like? How has it affected different members of your family?

We have spoken with physicians who live nearby, our neighbours. They are a couple who every day are working on the coronavirus frontlines – really, my heart goes out to all the people who work on a daily basis on the coronavirus frontline. This couple comes from time to time to see us and to check how we progress. From speaking with them, we know that our case is still ridiculously mild.

Basically, the big difference between the mild case and complicated case or a bit more complicated case is this gasping. Fighting for breath. You cannot fill your lungs enough, you never have enough oxygen. You gasp. This we never had. But still, if we call our case a mild case, with mild symptoms, similar to a normal flu, we still are having such a [bad] flu episode that I wouldn’t wish it on my worst enemy.

My heart goes out to all the people who right now are suffering from the coronavirus. My heart goes out to people who sacrifice themselves – the heath workers attending them – because this is a really, really difficult and desperate fight.

How do you think this will change life for citizens in Spain over the next year, and citizens in general? Obviously, once Spain hits the peak, there is still a lot of work to do to combat and stamp out the virus.

I think this will change people’s lives in many aspects. I think we have a very, very difficult year ahead. Once we overcome this coronavirus crisis, I think this global pandemic will affect two major aspects of life. It will have both an economic aspect and a lifestyle aspect. In regards to the economic aspect, I fear that many small and medium-sized businesses will unfortunately not survive this global crisis.  

We all know already friends, family members, who work in enterprises, in business that will be heavily impacted. I’m thinking of my brother, my sister-in-law, who are working in the aviation industry. They are worried. They don’t know what the future will bring. Tourism will be affected so much. Meanwhile, stimulus such as the European Investment Bank is providing, bridge loans, etc., can help. But I do not really believe that there is any stimulus that will, in the short run, pull frightened consumers back into the restaurants, or to the shops to browse again, let alone boarding a cruise ship. I think that these activities, and the associated spending, will have to wait until the whole episode is past.

We will also see a lot more changes to our style of work. We will see more teleworking, videoconferencing. This is just one example. As you are interviewing me, I am sitting in my home in Madrid and you are in France.

Regarding the lifestyle aspect, I think we will change many habits. Like personal hygiene. I think we’ll wash our hands more frequently and more carefully. We will sanitize our smartphones, keyboards. I recognize myself that I never sanitized my smartphone before, but I now I will be doing it regularly. These new habits will be beneficial for keeping normal flu outbreaks under better control.

I also hope that attitudes will improve towards prevention. I hope that vaccination will be taken more seriously. We have seen these anti-vaccine movements in the past. I just hope that those will be played down, and that they will be overshadowed somehow, and those movements will be seen as being harmful for society. This is what I really hope.

The outbreak has put enormous pressure on European health systems, particularly in Northern Italy and Spain. These places have some of the best health care systems in the world. Why do you think the outbreak has been so overwhelming? Is it just the sheer volume of patients? Or are there things that could have been done differently before? 

You are right that both Italy and Spain have some of the best health care systems, both in the European Union and in the world. Both countries have just the right-sized hospital capacity. Both countries have well-trained healthcare personnel. And they create very high value for money. What does this mean? This means that both Italy and Spain are achieving the longest average life expectancy and the lowest avoidable mortality rate at the lowest possible cost. There are other countries with very good outcomes like the Netherlands, Germany, Belgium, etc., but also at high costs. But Spain and  Italy are countries that create the highest value for money. How is this achieved? This is achieved partially by keeping the minimum necessary quantity of acute care hospital beds, including intensive care beds.

We are speaking about bed occupancy rates of about 80%, which is not achieved by long hospitalization times. It’s not that patients are kept a long time—there is a high turnover, a high throughput of patients so that hospital beds are always kept busy. This efficiency of health care systems is very much needed, especially now in an aging Europe where social security costs will be more and more strained in the future. But during this crisis, this has been counterproductive. Countries like Germany, which has the highest number of hospital beds relative to population size, are the ones who could better cope with the coronavirus pandemic.

We cannot predict the healthcare infrastructure that is needed for the next outbreak. Having unoccupied intensive care beds does mean [that a system] is better prepared for outbreaks in the future. It was a coincidence that the coronavirus outbreak needed intensive care beds and respiratory equipment. Those countries that already had it are the lucky ones because they can better cope with this pandemic.

But we cannot know what the next pandemic will be. Pandemic preparedness isn’t about having more intensive care beds, or even hospital beds unoccupied. Pandemic preparedness is something else. It is an international effort – it has to be an international effort – where a flexible team of health care professionals and equipment must be able to very swiftly go to the place where the outbreak happens. Once there, the healthcare personnel needs to have the proper personal protective equipment in place, so there needs to be some minimum preparedness. And this was what was lacking completely in most European countries, including Spain and Italy.

What can the European Investment Bank do to help? What is our role in helping hospitals get through this crisis and making sure that Europe is better prepared in the future?

The EIB is not a policy-setting organization. The EIB is helping existing initiatives. The EIB is designing new financing products. The EIB is setting priorities. And the EIB is always there, now more than ever, to help the world prepare for future pandemics. One thing is epidemic or pandemic response, and the other thing is epidemic preparedness. What we are now doing with the coronavirus is response. We were not prepared, so we are reacting to a new condition. The bank has announced that it plans to mobilise financing for bridge loans and other measures to alleviate constraints in liquidity and working capital for SMEs and mid-caps. In addition, the EIB is using financial instruments, some shared with the European Commission, such as the InnovFin infectious disease facility, to finance projects that work toward halting the spread, finding a cure and developing a vaccine against coronavirus. But again, this is an ex-post reaction to a new situation.

But the EIB has also always been there to finance preparedness. EIB services have been actively cooperating with a number of important actors in health -- the World Health Organization, the European Commission’s DG Santé, the Bill and Melinda Gates foundation, the World Bank, the Wellcome Trust, etc – on areas of high priority for public health. The EIB has been designing innovative financial instruments to effectively address underinvestment and to seek additional sources that can be mobilized by third parties and donors.

These days, while I was unable to work, while I was fighting my own coronavirus infection, I was listening to a number of world leading epidemiologists. They coincided in one thing. They described emergency preparedness as an international effort – we could call it a chain – where every country is a link.

The chain is only as strong as every individual link. It means that every single country in the world, regardless of its wealth, should have the health care infrastructure and qualified health care personnel who are able to identify a new epidemic—who are able to diagnose people who have been affected by that epidemic, to attend to the first cases, and to communicate with other countries for help and mobilise a joint international effort to combat the outbreak.

This is the only way the world can be prepared for the next pandemic.

Read Does This Change Everything? from the European Investment Bank, the EU bank. Subscribe to the podcast on iTunesAcast and Spotify.