Second Wave Threatens To Overwhelm Capacity Of Spanish Hospitals

The increase in admissions and admissions to the ICU forces to postpone interventions, deploy contingency plans and restrict visits.

The tension returns to the hospitals After a spring in the front line of combat against covid19 hospitals had moved to the rear to recover care for patients with other pathologies and reschedule the activity that was delayed.

However the boom in cases that this second wave dragged in Spain has once again put hospital capacity on the ropes Saturation is uneven in the country but there are already intensive care units ICUs that reach or exceed 100 of their installed capacity and visits to the emergency room that grow 40 in a few days

In communities such as Catalonia Andalusia or Castilla y León among others they begin to show the increase in patients with covid19in their hospitals and rush contingency measures from restricting visits to opening more plants or postponing nonurgent interventions.

Unlike the first wave however the maxim is to maintain as far as possible care for covid and noncovid patients

The Government warns that the healthcare pressure is growing due to the rise of infections in Catalonia
Spain exceeds one million cases

It looks more and more like the first stage of the pandemic The situation is heterogeneous in Spain but what is happening the most is a rapid rise in cases in the ICU with less slope than the first time but with significant inertia

And this has led to many ICUs being over their capacity sums up Ricard Ferrer president of the Spanish Society of Intensive Critical Medicine and Coronary Units According to the Ministry of Health there are 14539 people with covid19 admitted to Spain 2031 in the ICU

This means a global occupancy of 12 of conventional beds and 225 of critical beds although the Ministrys calculation is measured on the sum of the structural places and the spaces equipped with beds operating rooms resuscitation rooms to respond to the pandemic

Going to the field the situation is more worrying In Castilla y León there are five hospitals that have already exceeded their usual ICU capacity and have had to resort to other additional places to accommodate all their critical patients

The Ávila hospital has nine patients and is already at 113 of its conventional installed capacity In Palencia they had as a base 14 ICU places but they have had to expand them because there are already 22 patients admitted

This community which has a cumulative incidence of 562 cases per 100000 inhabitants and has four confined provincial capitals adds 1360 admitted patients with covid19

As a matter of efficiency intensive care units already tend to work with relatively full ICUs although they have room for maneuver to open and close beds depending on the available staff and demand

Now that margin is getting smaller and smaller says Ferrer In Catalonia ICUs have been at 80 of their conventional capacity for some time but the Generalitat has launched an alert call because there are more and more covid patients than other pathologies before they were 20 of the beds occupied and now they are around 40 296 people according to the Government

The proportion of covid patients rises and when that entry does not stop we must stop the entry of noncovid With confinement we know that it is achieved but if we do not want that the only thing that can be done is to stop the surgical programming says Ferrer

An example of this is Granada where hospital pressure has overwhelmed the operating rooms and this week the first nonurgent operations have been suspended due to the danger of saturation which is getting closer and closer

With a cumulative incidence of 976 cases per 100000 inhabitants Granada has reduced surgical interventions and consultations at the Virgen de las Nieves and Clínico San Cecilio hospitals by up to 50 The situation is becoming critical although it is very uneven

The covid circuits are better defined and the capacity is better Does this mean that there will be no collapse Not much less warns Rafael Carrasco president of the Andalusian Medical Union The 50 Andalusian hospitals support 1794 patients today 513 more than a week ago The UCIs work quite hard but Granada is in a hurry

Catalonia has not had to suspend activity in a generalized way but it is not far from having to do so either

It could happen shortly We would start with less relevant and routine pathologies explains Julio Pascual director of the healthcare and medical area at Hospital del Mar in Barcelona who has seen income grow by 40 in just one month

In Vall dHebron we have tripled the number of hospitalized in conventional beds from the Pilar bridge just over a hundred We are in a situation of increase although the difference with respect to March is that it is not so abrupt explains the medical deputy director of the center María José Abadías

The doctor assures that they strive to maintain the balance between ordinary activity and patients with covid19

Unlike the first wave when the tsunami of contagions forced to reconvert almost exclusively assistance to covid19 hospitals have conspired to maintain ordinary activity as much as possible and prevent the waiting list from continuing to swell

The first wave swept away all noncovid pathology which has now come back Now we see both and we are not neglecting any pathology due to saturation says Pascual

The Bellvitge hospital has started operating on Saturdays to reduce its waiting lists and both this center and Vall dHebron have restricted visits by companions to reduce the risk of transmission

In Catalonia the accumulated incidence is around 430 cases per 100000 inhabitants and the Government has warned that infections will increase in the coming days

Faced with the increase in infected hospitals in some areas such as Navarra which has the highest incidence in Spain 1062 cases per 100000 have already relied on private healthcare to refer patients and fluff their plants

A spokesperson points out that since the end of the summer its hospitals function as an integrated network At the moment ordinary activity has not been deprogrammed although afternoon shifts have been reinforced with productivity but we are seeing how long this can be according to the trend and the type of infections he adds

According to the private employers association ASPE 21 of those admitted to Murcia with covid19 386 people are in private or subsidized centers

Even in the communities with better indicators within the bad hospitals are vigilant admits José Flores manager of the Galician Health Service Sergas

In Galicia which has 192 cases per 100000 inhabitants ICU admissions are around 75 of the maximum peak that has been experienced in the pandemic and the influx to the Emergency Department has risen by 10 on average in recent days

We are concerned about the evolution says Pedro Rascado coordinator of the national contingency plan for ICUs and specialist in Intensive Medicine at the Santiago hospital

In Coruña they also admit their concern about the increase in cases and a significant pressure in the emergency room

Street diagnoses end up having an impact on the hospital and it has to be prepared And it is complicated because we must respond to patients with covid19 and attend to the needs of the rest admits Pedro Marcos Rodríguez pulmonologist and deputy director of Hospitalization and Emergencies of the Sanitary Area of A Coruña and Cee Of the 5580 active cases in Galicia 373 are hospitalized 48 of them in the ICU

With almost a third of those admitted the health area with the most pressure is that of Ourense precisely the oldest

Also in the Valencian Community the admissions have increased in the last week between almost 40 in the plant and 46 in the ICUs This Tuesday there were 735 people on the floor with covid19 which represents 7 of the total available beds 602 are patients with other pathologies

In ICUs there are 115 coronavirus patients 203 of the occupation in critical care 40 suffer from other diseases A week ago this record of critics with coronavirus was 115 Some ICUs have to start expanding spaces in the face of a future upsurge

Madrid is still stressed
The worstoff community 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 again Nonurgent specialties activity is recovering explains a Gregorio Marañón spokesman who rescheduled activity in September to face the rise in infections

The emergencies have dropped by 40 but the care pressure persists in the smallest hospitals and in the ICUs whose occupation is 109 of the conventional capacity in medical ICU yesterday there were 484 patients

The Basque Department of Health also admits that healthcare pressure is increasing 339 admitted to the ward and 69 to the ICU although they assure that Osakidetza has the capacity to enable 620 beds in intensive care

In Aragon where the regional government has confined the provincial capitals hospital pressure grows 628 admitted patients 80 in the ICU 204 more than at the beginning of October There are 51 free ICU beds in the community

However one of the issues that most worries the hospital sector experts agree is the lack of personnel to deal with an increase in demand I am concerned about the inertia of the curve and the impact of the quarantines of the toilets

We cannot afford many quarantines and we are having them admits Ferrer who demands weekly PCR from ICU staff to avoid contagion María José García from Satse warns that there has been no adjustment of human resources

The system is beginning to strain and we have tired professionals who have not been able to recover physically and psychologically We have to end job insecurity.


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