"Incidental COVID" limits the return to normality of hospitals

7,200 people infected with SARS-CoV-2 are admitted to Spanish hospitals. The figure has grown 50% in the last month – on April 12 there were 4,779 hospitalized in COVID-19 plants – and the community of Castilla y León is at high risk with more than 10% of its beds occupied. However, not all hospitalized patients who enter the statistics have developed a serious illness from the virus, but are infected but their reason for admission is another. It's what doctors have dubbed "incidental COVID."

The phenomenon was already seen in the sixth wave, once the population was mostly vaccinated, but it is worsening in the seventh and complicates the return to normality for hospitals. In one part, because it forces patients to be isolated, to have a certain number of beds for the infected. In the other, because eventual infections are delaying scheduled operations.

"Before we had 70% hospitalized for COVID and 30% with COVID and now it's the other way around. I remember a man who collapsed in the street, broke his eyebrow and tested positive for coronavirus in the screenings that we continue to maintain. His The admission was due to the fall but it is counted as COVID," explains Pere Domingo, COVID coordinator at the Sant Pau hospital in Barcelona, ​​who admits that everyone who enters the center is tested for fear of outbreaks originating from the interior, although does not force the new strategy.

For Pedro Gullón, professor at the University of Alcalá de Henares, "it is a very difficult garden". "The incidents are important in the organization of care, with the flu they do not do an absolute screening of everyone and with COVID it continues to be done in many," says the epidemiologist.

Part of the "mess" that public health and hospital staff talk about has to do with where you frame the patient. "If a person has broken a leg and you admit him to the COVID plant, the traumatologists have to go see him somewhere else. It can be handled, but it is not comfortable, it alters the activity," says Salvador Peiró, an expert at the Foundation Biomedical Health Research of the Valencian Community (Fisabio).

Each hospital does it in the best way: in Sant Pau –Barcelona–, for example, they have several COVID-19 rooms distributed on different floors. The serious ones are in the respiratory or internal medicine unit; the indicentales stay in what they call "mixed room". "In the same way that COVID is going to stay, so will these beds, to a greater or lesser extent depending on where we are," predicts Domingo. "I would venture to say that in the coming years we are going to have to allocate resources to this. There are a good number of beds and we are not going to be able to leave that reality," says Yvelise Barrios, a member of the Spanish Society of Immunology, which develops his activity at the university hospital of the Canary Islands.

For Peiró, the data that Health offers twice a week "magnifies the seriousness of COVID-19 and this, with the increase in transmission, can lead to making decisions thinking that the situation is worse than it is." The epidemiologist warns that separating patients into two groups, in the face of statistics, has its difficulties. "Arriving at an operational definition is complicated. It can be done by clinical judgment, but sometimes you have cases that are not hospitalized for coronavirus but the infection complicates their picture," he develops.

Only the Community of Madrid breaks down this data in its weekly monitoring. 50.8% of those admitted to Madrid centers have developed a serious coronavirus; the other half has simply tested positive for the PCR that is usually done at the hospital entrance, according to the latest report from the Ministry of Health. The rest of the territories do not make this distinction, but the Ministry of Health is negotiating with the communities the breakdown of the figures to give a more reliable image of the situation, as confirmed by sources from the team led by Carolina Darias.

The other issue that disrupts this incidental COVID is surgical interventions. It is not minor collateral damage at a time of peak waiting lists. According to the latest data, December 2021, there are more patients than ever waiting.

The criteria vary depending on the community, the hospital and even the doctor himself. It is not written anywhere that a positive test now necessarily leads to the suspension of a scheduled surgery – in urgent ones it is not considered – but it is done in some cases. In Castilla y León, for example, interventions are automatically postponed in the event of a positive, reports Alba Camazón. Galician health also proceeds to delay operations in these cases, although the situation may vary depending on the patient, reports Beatriz Muñoz. While in the Community of Madrid the casuistry is broader. "The protocol contemplates an individualized assessment, there are surgeries that are a priority and it is the clinician who assesses the ideal moment," indicates a spokesman for the Ministry of Health.

"Suspending is a mess. If you do it with time, it gives you room to reschedule, but if the test is done the same day or a day before, you may not be able to relocate to use the operating room with another patient and you lose productivity," says Salvador Peiró, which ensures that more and more "operates with incidental COVID" for this reason. In emergencies, this dilemma does not occur: the operations that arrive through this route are all done.

The Federation of Spanish Medical Scientific Associations (FACME) considers that a positive test should not "necessarily be a reason for postponing surgery." Bet on an individualized assessment of each case, but warns that "surgical priority is the primary decision factor." The group of medical societies also considers that the time has come to end mass screening, something that they do not see clearly in many hospitals.

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