Misc 12/01/2021

Hospitals cancel part of routine activity due to Covid

Pressure grows on Barcelona's four major hospitals, which are starting to receive patients from all over the country

5 min
Hospital d'Igualada

BarcelonaCatalan hospitals have already begun to cancel and reschedule some non-urgent surgical procedures due to the high pressure of covid on the intensive care units (ICU). Eighty-three percent of the structural beds for critics -nearly a thousand of them- are already occupied, half of them by covid patients. The Catalan Minister of Health, Alba Vergés, has admitted that these percentages mean outpatient surgeries, such as cataract operations and placing prosthesis, will have to be postponed throughout the country.

Specifically, 470 people have been admitted for coronavirus surgery with a serious prognosis, 70% of whom have been intubated and connected to a ventilator, and in some hospitals bed occupation is already close to that achieved during the peak of the second wave of care, between October and November. "We have begun to deprogramme activity, always obeying clinical criteria, in order to have professionals available to attend to the most critical patients," Vergés said on Monday. With 400 to 500 ICU beds in use, hospitals cannot combine routine activity and coronavirus care, according to the government.

Despite the fact that the health system currently has 1,000 critical care beds and can increase capacity to 1,500 between the public and private hospital networks, the provision of space is not enough. Health centres are understaffed and cannot afford to allocate all their facilities to coronavirus care because urgent conditions such as heart attacks and strokes still exist. Moreover, 636 respirators are already in use among patients with covid and other diseases.

Thus, and given that the epidemic is in full growth and that there are predictions that the threshold of 600 occupied beds will be reached by the end of the month, hospitals have little room for manoeuvre and have already begun to cancel part of the non-essential activity in order to free up as much space as possible for the next few days. A sacrifice that, in general, had not been made since the first wave and that health professionals have been anticipating as an imminent possibility due to the continuous influx of patients over the past few days. "Critical days are coming," acknowledged the coordinator of the coronavirus monitoring unit, Jacobo Mendioroz.

Punctual" postponements in Barcelona

Vergés did not want to specify which hospitals have already had to activate contingency plans and reorganisation of services, nor which health regions are most affected right now. But she did point out that these plans are being taken up across the country and that the final word is in the hands of the centres themselves. For example, in three of the four large hospitals in Barcelona, all of which are major recipients of patients not only from their area of influence but also from all over Catalonia, some interventions have had to be postponed. This is the case of the Hospital del Mar, the Clínic and the Hospital de Sant Pau. The Vall d'Hebron, on the other hand, has not yet had to postpone any interventions.

"The number of patients with covid has doubled in about a fortnight and ICU has become more crowded than it should be while patients keep arriving at A&E," warns the head of the infectious disease service and coordinator of covid-19 at the Hospital del Mar in Barcelona, Juan Pablo Horcajada. Right now there are 85 patients admitted to the floor and 20 to the ICU, while a week ago there were 72 and 17, respectively. Although the rate of discharges is also high, this last weekend, says the doctor, have admitted 20 more people. "We are feeling the effect of December and part of Christmas, but we have not yet seen the New Year's Eve or the Epiphany.

At the Hospital de Sant Pau, 76 patients have been admitted to the general ward and 26 to ICU, which implies a very high occupation of the critical area. "During the Christmas holidays there has been less surgical activity and, in view of the increase in admissions last week, some non-urgent surgeries have been postponed", explains the coordinator of covid-19 at the centre, Pere Domingo, on the rescheduling of operations due to covid pressure: "The overall trend is upwards, although it is true that the increase has not yet been explosive and is variable: some days we have had 15 admissions per shift; others four". Even so, he predicts that the situation will get worse in the next few days.

Despite having to deprogramme some operations in a timely manner, the Hospital Clínic is currently maintaining almost all its ordinary activity. Right now, about 150 patients are hospitalised because of covid-19, a figure similar to that of mid-November, when the second wave peaked, according to sources at the centre.

Igualada is already referring patients

The large hospitals are beginning to receive more patients from all over the country, for example from the Anoia. Igualada Hospital has referred two covid patients to the Hospital de Sant Pau and the Hospital del Mar in Barcelona in the last few days. In addition, it has begun to restrict some of the non-covid surgical activities already scheduled - they will only perform urgent surgery or surgery that does not require hospital admission - and outpatient consultations.

In an interview with Ràdio Igualada, Jordi Monedero, Director of Healthcare at Igualada Hospital, has announced that the centre has moved to phase 4 because there are already 82 covid patients in hospital, nine of them in ICU and three in the semi-critical unit. This hospital in Central Catalonia was one of the most affected by the virus in the first wave, but Monedero has defended that there are "substantial differences" between the current situation and that of March of last year, like for example that at the moment they do not have so many sanitary professionals on leave because of infection.

Monedero, like many other healthcare managers in the country, hopes that the incidence of covid cases in primary care, which has already reached the emergency department, will result this week and next week in an increase in the number of patients hospitalised and in intensive care. Above all, he points out, because the effects of New Year's Eve are now beginning to be felt: "We estimate that by the end of the week we will have about ten or fifteen more".

Also the hospitals of the Consorci Sanitari de l'Alt Penedès i el Garraf already add this Monday one hundred patients admitted for covid-19, three times more than before the Christmas holidays: among the three centres, there were then only 30.

18.000 infections per week

Vergés warned: "We are starting from a very high hospital occupation, with 350 ICU beds full, and if cases rise as much [as during the second wave] we will have a very complicated situation." Coinciding with the return to school and work after Christmas, Vergés described the evolution of the covid curve as "complicated", with 18,000 cases detected each week, and called for teleworking "whenever possible" to reduce social interaction and mobility to the maximum "in those things that are not essential".

The curve of the current covid-19 wave is increasing more slowly than that of October, according to epidemiologist Jacobo Mendioroz. "Then on October 3 we detected that the number of cases was increasing and in just three weeks it rose to 6,000 cases. Now we have been growing for five weeks at around 4,000 cases; at the speed we were going in October, we would now have around 8,000," he explained. However, Mendioroz has warned that this does not mean that the epidemiological situation is evolving better: "We should not be too confident, because the new British variant can cause great growth, as we are seeing in some countries".