Coronavirus: second wave threatens to overwhelm the capacity of Spanish hospitals | Society

“It looks more and more like the first phase of the pandemic. The situation is heterogeneous in Spain, but what is happening most is a rapid increase in ICU cases, with less slope than the first time, but with significant inertia. And this has brought many intensive care units beyond their capacities, ”summarizes Ricard Ferrer, president of the Spanish Society of Intensive, Critical and Coronary Care Units. According to the Ministry of Health, 14,539 people with covid-19 are admitted to Spain, 2,031 in intensive care. This means an overall occupancy of 12% of conventional beds and 22.5% of critical beds, although the Ministry’s calculation is measured on the sum of structural places and spaces equipped with beds (operating rooms, resuscitation rooms) to respond to the pandemic.

Going on the pitch, the situation is more worrying. In Castilla y León, there are five hospitals that have already exceeded their normal intensive care capacity and have had to resort to other additional places to accommodate all their critically ill patients. The Ávila hospital has nine patients and is already 113% of its conventional installed capacity. In Palencia they had 14 places in intensive care as a base, but they had to expand them because 22 patients are already hospitalized. This community, which has a cumulative incidence of 562 cases per 100,000 inhabitants and has four confined provincial capitals, adds 1,360 patients hospitalized with covid-19.

For efficiency reasons, ICUs already tend to work with relatively full ICUs, although they do have leeway to open and close beds depending on available staff and demand. “Now that margin is getting smaller and smaller,” says Ferrer. In Catalonia, intensive care units have been at 80% of their conventional capacity for a long time, but the Generalitat has issued a warning because there are more and more covid patients than other pathologies: previously they were 20% of the beds occupied and now they are around 40% (296 people), according to the government. “The proportion of covid patients increases and when that entry doesn’t stop, we have to stop the entry of non covids. With imprisonment we know we get it, but if we don’t want it, the only thing we can do is stop the surgical planning “, says Ferrer. Some hospitals in Spain, says the expert, have already had to postpone non-urgent interventions .

An example is Granada, where hospital pressure has overwhelmed the operating theaters and this week the first non-urgent operations have been suspended due to the danger of saturation, which is getting closer and closer. With a cumulative incidence of 976 cases per 100,000 inhabitants, Granada has reduced surgeries and visits to Virgen de las Nieves and Clínico San Cecilio hospitals by up to 50%. “The situation is becoming critical, albeit very irregular. The covid circuits are better defined and the capacity is better. Does this mean there will be no collapse? Not much less ”, warns Rafael Carrasco, president of the Andalusian medical union. Today, the 50 Andalusian hospitals support 1,794 patients, 513 more than a week ago. “The intensive care units work very hard, but Granada is in a hurry,” sums up Carmen de la Fuente, president of the Andalusian Society of Intensive Medicine and Coronary Units (Samiuc).

Catalonia did not have to suspend operations in a generalized way, but it is not far from having to do so. “It could happen soon. We would start with less serious and routine diseases ”, explains Julio Pascual, director of the health and medical area of ​​the Hospital del Mar in Barcelona, ​​which has seen income grow by 40% in just one month. “In Vall d’Hebron we have tripled the number of patients hospitalized in a conventional bed from the Pilar bridge [algo más de un centenar]. We are in a situation of growth, even if the difference compared to March is that it is not so abrupt ”, explains the deputy medical director of the center, María José Abadías. The doctor assures that they strive to “keep the balance” between ordinary activity and patients with covid-19.

Unlike the first wave, when the tsunami of contagions forced to reconvert almost exclusively the covid-19 care, the hospitals conspired to keep the ordinary activity as much as possible and prevent the waiting list from continuing to grow. “The first wave wiped out all the non-covid disease, which is now back. Now we see both and we are not neglecting any pathology due to saturation, ”says Pascual. Bellvitge hospital began operations on Saturday to reduce its waiting lists and both this center and Vall d’Hebron have restricted comrades’ visits to reduce the risk of transmission. In Catalonia, the accumulated incidence is about 430 cases per 100,000 inhabitants and the government has warned that the infections will increase in the coming days.

Given the increase in infected people, hospitals in some areas, such as Navarre, which has the highest incidence in Spain (1,062 cases per 100,000), have already relied on private health care to refer patients and peel their plants. A spokesperson points out that since the end of the summer, its hospitals have operated as an integrated network. “At the moment, ordinary business has not been deprogrammed, although the afternoon shifts have been bolstered with productivity, but we are seeing how long it can last based on the trend and type of infections,” he adds. According to the private association of employers, ASPE, 21% of those admitted to Murcia with covid-19 (386 people) are in private or subsidized centers.

Even in communities with better indicators – inside the bad ones – hospitals are “vigilant”, admits José Flores, director of the Galician health service (Sergas). In Galicia, which has 192 cases per 100,000 inhabitants, ICU admissions represent about 75% of the peak recorded by the pandemic and the influx to the emergency room has increased by an average of 10% in recent days. “We are concerned about the evolution,” says Pedro Rascado, coordinator of the national emergency plan for intensive care units and an intensive care specialist at Santiago hospital. In Coruña they also admit their “concern” about the increase in cases and a “significant pressure” in the emergency room. “Road diagnostics end up having an impact on the hospital and it needs to be prepared. And it is complicated because we have to respond to patients with covid-19 and take care of the needs of the rest “, admits Pedro Marcos Rodríguez, pulmonologist and deputy director of the hospital and emergencies in the health area of ​​A Coruña and Cee. Of the 5,580 active cases in In Galicia, 373 are hospitalized, 48 of them in intensive care, with almost a third of those admitted, the health zone with the greatest pressure is that of Ourense, precisely the oldest.

Even in the Valencian Community, admissions have increased in the last week between almost 40% in the ward and 46% in the intensive care units. This Tuesday there were 735 people on the plan with covid-19, which represents 7% of the total available beds (60.2% are patients with other diseases). In intensive care units, there are 115 patients with coronavirus, 20.3% of those employed in intensive care (40% suffer from other diseases). A week ago, this coronavirus critical record was 11.5%. Some ICUs need to start expanding spaces in the face of a future surge.

Madrid is still under stress

The community that is worse off is still Madrid, although after several weeks on the rise, it has stabilized. “We are on a plateau, which has allowed us to convert a covid plant into a surgical one. The activity of non-urgent specialties is recovering ”, explains a spokesman for Gregorio Marañón, who rescheduled the activity in September to cope with the increase in infections. Emergencies have decreased by 40%, but care pressure persists in smaller hospitals and intensive care units, whose occupancy is 109% of conventional medical ICU capacity, there were 484 patients yesterday.

The Basque Ministry of Health also admits that health pressure is increasing (339 inpatients and 69 in intensive care), although they ensure that Osakidetza has the capacity to set up 620 ICU beds. In Aragon, where the regional government has confined the provincial capitals, hospital pressure is growing: 628 hospitalized (80 in intensive care), 204 more than at the beginning of October. There are 51 free intensive care beds in the community.

However, one of the issues that most worries the hospital sector, experts agree, is the lack of staff to cope with the increase in demand. “I am concerned about the inertia of the curve and the impact of the bathroom quarantines. We can’t afford many quarantines and we are having them, ”admits Ferrer, who requires weekly CRP from the ICU to avoid contagion. María José García, from Satse, warns that there has been no adjustment of human resources: “The system is starting to strain and we have tired professionals, who have not been able to recover physically and psychologically. We must put an end to job insecurity ”.

With information from Sonia Vizoso, Isabel Valdés, Ferran Bono, Mikel Ormazábal Y Javier Martín-Arroyo.

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