September 18, 2020

“If the second wave comes I don’t know how we will hold on”


The coronavirus epidemic continues its upward trend in Spain after the fall in cases recorded by the exceptional measures imposed in the state of alarm. August has started multiplying by ten contagions at the end of compulsory confinement, with Aragon, Catalonia and Madrid as the main focuses. The latest data indicates that hospital admissions are also rising. “In March a tsunami came, now we are watching the tide rise,” summarizes Dr. Belén Padilla, from the Gregorio Marañón Hospital in Madrid. As the first wave of the pandemic demonstrated, the peak of hospitalizations comes days after the maximum number of registered infections.

The increase in the transmission of the coronavirus appears in Spain to a second wave of the pandemic

The increase in the transmission of the coronavirus appears in Spain to a second wave of the pandemic

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Although the total figures of people hospitalized for COVID-19 in all of Spain are not offered (the Ministry of Health ensures that it collects this data, but “the total number of people contributes little to the monitoring of the epidemic since some have been admitted two months, “said Fernando Simón), the daily Health reports do report accumulated hospitalizations each day and in the last week, based on the data sent by the autonomous communities.

On August 6, 673 people had been hospitalized in the past seven days. On June 21, the day the state of alarm ended, this figure was 99 people, six times less. The latest Health report reported 41 new admissions to ICUs in the previous week, compared to 5 on June 21. The following graph shows the evolution of hospitalizations and admissions to intensive care weekly during the last two months.

This is how revenues have increased since June 21

Evolution of hospitalizations and those admitted to the ICU accumulated during the last week

Source: Ministry of Health

Although the upward trend is clear, the data should be taken with caution, as the numbers could be even worse. As published this week The confidential, the hospitalized data provided by the Ministry of Health does not coincide with those of the autonomous communities.

Catalonia is one of the territories where this gap is greatest. On August 3, the CCAES document reported that 45 cases had required hospitalization with a date of admission in the last 7 days in the region, and another 2 cases had been admitted to the ICU. However, the data published by the Generalitat that same day, the number of admissions in the last week was 414, and the number of admissions to the ICU was 84.


“We are tired and exhausted”

Healthcare workers and professional associations are concerned about the evolution of these data, among other reasons because they do not feel prepared to take on an onslaught of COVID-19 like the one they experienced from March. “We are very concerned, the situation that was experienced was very hard and from the personal point of view of the doctors as well. No matter how much medicine you have studied, seeing so many patients die like this leaves many sequels”, says the family doctor and secretary General of AMYTS Julián Ezquerra. In his opinion “a number of similar cases would be a real drama for health personnel, there would probably be many casualties due to depression and anxiety”.

Their criteria is very similar to that of the rest of the professionals consulted, and to which they express publicly in places like Twitter. Dr. Padilla, a microbiologist and infectologist at Gregorio Marañón, stated a few days ago her “anger and sadness” at the return from Madrid to the numbers of admitted in early March, and warned that the toilets are “very tired and exhausted” .

“Morally we are very agitated, in the hospital we commented that we could not bear what we have gone through again, because we have not recovered either mentally or medically,” the doctor, also vice president of the College of Physicians of Madrid, abounds in statements to this newspaper. She herself has been one of the more than 53,000 toilets infected by COVID-19 during these months. The last Council of Ministers approved the extension of the consideration as a professional contingency derived from an accident at work of the diseases suffered by health personnel as a result of the SARS-CoV2 virus. “As a health worker, it is also very hard to think that you can fall ill and infect your relatives. This is a very cruel disease, because it isolates patients,” says the infectologist.

Padilla affirms that the situation in the health centers has changed compared to the spring, but they are afraid of what they are seeing: “the patients are differentThey are now younger (the average age of those infected has fallen to 40 years in men and 43 in women). In March there was a stampede of very serious patients in a short time. We saw a tsunami and now we are watching the tide rise. It is a trickle that the last week has been increasing, “she describes.

For the moment, the Ministry of Health ensures that the epidemic is under control and affirms that although the global figures do not stop increasing, the context cannot be compared with that of March, among other things because right now the contacts of each positive case are tracked, and PCR tests are carried out (4.6 million have already been carried out since the start of the pandemic), while in the first months only the cases were analyzed more serious. In fact, more than 60% of the positives detected are asymptomatic, as the spokesperson for the Center for the Coordination of Health Alerts and Emergencies, Fernando Simón, usually emphasizes, although in the case of the Community of Madrid this percentage is only 15%, indicating poor tracking capabilities.

But despite the refusal of Health to recognize a second wave due to the absence of uncontrolled community expansion (if the Basque government considers it that way about the situation in that community), the evolution of events generates concern throughout the health sector, too among nurses. “She has not given time for physical or emotional recovery. Three months ago she caught us all by surprise and we put all the meat on the grill, but now we are observing irresponsible behavior, and we feel helpless: we leave our skin to move

Criticisms of health management

Apart from irresponsible social attitudes (family and friends gatherings are still the main reason for outbreaks, 35%, and nightlife is the one that causes more cases associated with each outbreak), the criticisms of these professionals have a lot to do with it. with health management. “It is not necessary psychological support, but to be able to rest from marathon days and without weekends,” explains Julián Ezquerra. The lack of personnel they denounce is further aggravated by the summer season. “In the Community of Madrid there are primary school doctors taking care of the consultations of up to five colleagues because there are no substitutes,” he says. A problem that is repeated in most communities (health in Spain is an autonomous competence).

“The feeling is one of continuous stress, exhaustion and the need for them to provide the necessary resources, many of them based on the hiring of personnel to reduce burdens and not double quotas for vacations, sick leave or other absences,” underlines a primary school doctor from Osakidetza (Basque public health). The SATSE union denounces that the epidemic has worsened job insecurity in the nursing and physiotherapy sector: “staff is not being replaced and physical fatigue is increasing. They offer three-day contracts in one hospital, four in another, or even within the same changing units. This is a Ferris wheel that does not stop at any time, “says its spokesman.

Beyond the need for personnel, who already know that it exists and will continue in September, Dr. Padilla, an infectologist in Marañón, denounces that professionals do not know if there are contingency plans or the necessary medical resources in the event of a second wave. Among the plans that in his opinion should be implemented urgently refers to reinforcing the work of the trackers (looking for possible positives among the contacts of those infected by COVID-19), work that in many cases Primary doctors are doing . “You need human resources, it is a job for which not just anyone is worth it, you need medical knowledge to interpret what they tell you, you cannot look for trackers at the University” (as the Community of Madrid is doing). It also talks about specific clinical protocols in all health centers and the establishment of specific circuits to which patients who arrive with symptoms such as cough or fever are sent, something that will be more and more frequent in the next season. “Now each one of us is getting organized,” he says.

“It gives us the feeling that we have learned almost nothing. As a society, when we see the irresponsibilities that are commented, our souls fall to our feet. And we do not see politicians doing their job to guarantee sufficient human and material resources. The phrase ‘you have to take care of who takes care of you’ does not mean that they applaud us, that they pat us or even that they will increase our salary, but concrete measures and changes so that what has happened these months is not repeated “, concludes the doctor .

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