The collapse of primary care due to COVID leads to hospital emergencies

The emergency room door, open 24 hours a day, is absorbing the cases that the health center cannot respond to. The service has become a one-stop shop for everything: for people (infections or not) who do require preferential attention, but also for mild cases, suspects or those who request a PCR. Doctors warn that patients even arrive asking for reports to justify a positive home test at work. In the Community of Madrid, the regional government has had to open a separate circuit in hospitals just to test for antigens before the avalanche of demand.

The toilets are exhausted. "This seems like groundhog day, again thinking about where we are going to expand. We have had to reopen 10 extra beds in the emergency that we had already managed to close," laments Pascual Piñera, head of the Reina Sofía Hospital in Murcia. The service cares for 340 patients per day compared to the usual 275. A few weeks ago, 8% came with suspicions of Covid but that percentage already reaches 30%.

In the La Fe hospital (Valencia), one in four patients has symptoms of coronavirus although only 5% end up in admission. It is an abysmal difference with the previous waves, but the load does not stop. Many come "either because they have not been able to be treated in Primary Care or because the appointment that is provided does not fall within the response they expect," explains the head of the Service, Javier Millán.

Madrid emergency rooms have a queue. Literally. People who are ill and who unsuccessfully request an appointment for their family doctor have formed a line for days outside the service of the 12 de Octubre hospital, says Luis López, the prevention delegate of the MATS union at the hospital. The Community of Madrid has set up exclusive points in this and other hospitals for taking antigens without appointment to patients with symptoms to contain the overflow, visible from the street. The Primary Care emergencies have been closed since March 2020 without reopening visas.

Healthcare infections are also skyrocketing

Patients who request a report to prove at work that they are positive after having done a home antigen test reach the emergency services of Madrid hospitals. "They do not pick up the phone and end up here. And in addition to these come those who are really sick," says a doctor from the Getafe hospital with a temporary contract linked to the pandemic.

His center receives an average of 150 respiratory-only patients a day. "We are nine doctors with a COVID contract in the emergency room and they have renewed eight of us, they have made a fix for the other so that he can stay until January 31," he says. Added to the shortage of hands are the casualties of infected toilets, which are not replaced, according to this professional. The positives among reported health workers to the Ministry of Health in the last 14 days have gone from 3,871 a week ago to 5,211, according to the latest data update, as of December 23.

High pressure and few personnel, insists the MATS union, which ensures that despite the extension of the COVID contracts for a few more months, professionals are signing reductions in working hours and doubling shifts. "They are the same, but with less work time. There have been contracts of up to an hour and a half," laments López. In his hospital, patients with suspected coronavirus accumulate in barracks that serve to decongest the main emergency.

The situation is more complicated than in previous waves because the coronavirus cases are joined by the rest of the emergencies of a country already without activity restrictions - traffic accidents, alcohol poisoning, multiple injuries that plummeted with confinement - viruses winter respiratory symptoms that have reappeared and chronic patients "decompensated" due to the overload of the system throughout the pandemic. "We have many mild cases of suspected coronavirus but that condition the organization and resources," summarizes Millán.

Almost no territory is spared. In the Insular Hospital of Gran Canaria they are also receiving in recent weeks a barrage of mild patients "who are not released at previous levels", who increase the pressure in a "party period in which people drink, intoxicates, has accidents, fights ... ", says the doctor Manuel Fuentes, assistant in the emergency service. "It is a difficult breeding ground to handle and it rains in the wet: it is not only the COVID patient, but the non-COVID patients who have not been treated in a timely manner and have worsened considerably. I would say that we have been bad since June, working in the corridor and outside the emergency department itself, "he adds. This hospital has also put into operation a second unit for patients with suspected coronavirus with 20 extra beds.

The sixth wave, they think, has not peaked and they anticipate the highest hospital peak in the second week of January. The head of the Emergency Department at La Fe works with that forecast. Not only because of the expected pressure for the emergencies, but because of the replication of infections today in the ICUs of tomorrow, the last step in the system and the one that receives the wave later. "The demand will continue to increase. Although it seems that the variant is not so harmful, the contagion power is much higher," adds Fuentes. The "system safety net" assumes that it will continue to suffer as long as the circulation of the virus is not reduced with more severe measures that few communities are willing to take at the moment.