The intensivists, concerned: "In three weeks we have almost tripled the number of admissions to the ICU"

Concern in the ICU Spanish companies in the face of the sustained but constant rise of coronavirus patients who are admitted to the units. Nothing to do with previous waves, they need, but the data of the sixth wave worry them. The intensivists consulted by THE PERIODIC OF SPAIN, a newspaper belonging to the same publishing group as this medium, show his uneasiness and tiredness. "In three weeks we have almost tripled the number of admissions to the ICU," explains the doctor. Alvaro Castellanos, President of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC). The number of positives admitted to ICUs in Spain already exceeds a thousand, with Catalonia (with 261) and Madrid (139), to the head.

From this region, Alfonso Canabal, President of the Madrid Society of Intensive Medicine (SOMIAMA), warns: "Every day we are admitting more patients than we are discharged." More than half are not immunized but doctors prevent: the circulation of the virus is "wide" and it is already beginning to affect the patients who have been immunized because the effect of vaccines, over time, it decreases. They suggest: if the contagions continue to rise, we will have to take "more restrictive measures"Something that, for now, the Government and communities discard.

"We are in a scenario in which all indicators are on the rise: cumulative incidence, hospitalizations, ICU admissions ... In three weeks, we have almost tripled the number of admissions. It is true that we are not under the same pressure as a year ago around this time. So we had incidents a little below 300 and yet the number of patients admitted (in critical units) was three times more. That is, the pressure is not as important as at that time, "says the doctor Castellanos when asked how the latest data provided by the Ministry of Health speaking -this Friday- of 5,569 patients admitted for covid-19 throughout Spain and 1,056 in ICUs with a 14-day cumulative incidence of 323 cases per 100,000 inhabitants. Undoubtedly, the differences between those Christmas of 2020 and those that now begin, in 2021, are due to the vaccination of "a high percentage of the population," says the doctor.

"In some communities we are already at an occupancy rate of 15%. A not inconsiderable increase", emphasizes Dr. Álvaro Castellanos

But, immediately afterwards, the president of the Spanish intensivists clarifies that, in recent weeks they are observing "an increase in the number of admissions slow but steady. Well, slow ?, moderately slow. In some communities we are already at an occupancy rate of 15%. So maybe he wouldn't say the word slow. Sure, it is not the same as January of this year but it is a significant increase, Nothing despicable. Worrying. That is the word that best defines the situation. Not alarming, but worrying. "

In the same line the doctor pronounces Alfonso Canabal Berlanga, head of the ICU of the University Hospital of La Princesa. In the ICUs of the region, he details, there are approximately about 140 sick. "Three or four weeks ago we were at the minimum of about 75 sick. In the last four weeks We have practically doubled the number of patients we had. It is a slow ascent, not exponential, but constant. Every day we are admitting more patients than we are discharged. This is so roughly from November 20", indicates the intensivist.

Infections among vaccinated

The profile of the patient who is entering the sixth wave, according to Dr. Castellanos, is of middle age between 60 and 63 years, more than half not vaccinated and, the rest, people who have been immunized but who are "fragile, vulnerable patients, because they have diseases chronic, transplantedwith immunosuppressive treatment) and older patients who received the last dose of the covid vaccine about five months ago. "

Right now, it depends on the community, he adds, there are those that, with older populations, as in the case of Castilla y León, doctors are seeing that, among those admitted to ICUs, those vaccinated are two out of three. "In all of Spain, we could say that right now that those vaccinated account for between 40 and 50% of those admitted", specifies the president of the SEMICYUC. The other half, he details, are patients who have refused to receive their doses.

A percentage that rises in the case of the Madrid's communityHis colleague Dr. Canabal points out: "Of the patients that we are entering now, in which we can already recognize as the sixth wave, we have 68% of those not vaccinated and 32% of those vaccinated." In this last percentage, he continues, there is a large proportion of patients with immunosuppression, with altered defenses due to different ailments or immunosuppressive treatments. Also, around 15%, people who have received the second dose of the vaccine more than five or six months ago.

The effect of vaccines

"We have a false security. We have again mismeasured the impact of the pandemic and we have not taken into account that vaccines do not protect one hundred percent. Depending on the type of vaccine that we have received, the protection is between 80 and 90%. Second, it does not eliminate the risk of infection and transmission (it does so by 60% in this section, he says) and what it does prevent is serious disease, "warns Dr. Castellanos.

Thanks to that vaccination, insists the doctor, the pressure in beds of hospitals and UCI, with similar accumulated incidents, or even higher, than last year, is lower. Also, he repeats, it must be taken into account that the effect of vaccines over time decreases and there is a percentage of the population (around 20% if children are counted) not immunized "and that also makes the virus circulate freely and increasingly affects people already vaccinated."

"Probably the peak of the sixth wave will be reached in a maximum of two weeks", predicts doctor Castellanos

"Therefore, more restrictive measures will have to be taken, in terms of mobility or meetings," suggests the president of the intensivists. An opinion that, for now, does not seem to be shared by the Government and communities that - beyond those regions that have decided to implement the use of the covid passport - do not contemplate new measures for Christmas. When Dr. Castellanos is told, he responds: "I imagine they will have your information. What is clear is that the peak of this sixth wave has not yet been reached. It will probably be reached in a maximum of two weeks. It has been bet because there is a very high percentage of population vaccinated to avoid serious illness. They may be thinking that it will be achieved soon the peak of this wave; that the hospital pressure will be much lower than other waves and the impact may be much lower both in Health like in economy. I think they are thinking a bit in those terms, "he says.

If the incidence of cases continues to increase, he warns, as is being seen now, in the end it will have an impact on hospital admissions and ICU admissions and, finally, it will be necessary take more restrictive measures. Did the doctor expect to see himself in the same position again? "No," he replies. "Having a very high percentage of the population vaccinated has made us feel confident and think that we would not see a new wave like the one we are seeing with more than a thousand patients admitted today to intensive care units in the country."

For this reason, indicates the president of the SEMICYUC, it is necessary to re-educate the population that "the vaccine is essential, that the third dose is essential to maintain its effectiveness and that you must continue to use the mask indoors and avoid numerous gatherings in closed and poorly ventilated spaces ".

Getting used to Covid

In the same vein, head of the UCI of the Hospital de La Princesa: "There is a population transmission that is increasing and will continue to increase in the coming weeks with Christmas. The increase will not be proportional, but lower. Because the impact of the disease in the most serious forms is less. "We have to change a little the criteria that have been used so far. Perhaps population transmission will not be so important and hospital admission will be. This is where we must be more vigilant," he says.

"This wave is more manageable, but what it does cause us is saturation: fighting for a disease that has not just happened," says Dr. Canabal

The truth is that the president of the Madrid Society of Intensive Medicine admits that they are prepared: "We expect prolonged waves and stays of patients with covid for months. For now, what should worry us more is that there are no strong waves like the first or third That was a very strong pressure. But that the presence of the sick covid will continue, well yes. For an indeterminate time. Any forecast, there is a risk that it will not be fulfilled, in fact the coronavirus It was a humbling cure for all of us ", Alfonso acknowledges. Canabal.

"Now, the number of beds prepared for covid was reduced and we are going to have to start increasing them," warns the president of the Madrid intensivists

Is there tension in the Madrid units these days? "Tension maybe not. Yes maximum concern. This wave is more manageable, but what it does cause us is saturation and fatigue. It is fighting for a disease that has not just passed, that the end is not seen. Our devices have been adapting, already after five waves suffered. In the worst moments, the units rose and fell like an accordion. Right now, the number of beds prepared for covid was already reduced and we are going to have to start increasing it. About, 20% of medical ICU beds (which include other units) are already occupied and, if we consider the globality of all critical beds, we will be between 12 and 15% ", concludes the intensivist when referring to the situation of the patients. Madrid hospitals.


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