Fourth wave arrives with ICUs already full

BarcelonaFor over a year hospitals have been living a constant déjà-vu: wards are never completely emptied and each new wave of patients challenges intensive care services. It is only a few days since the fourth wave of the coronavirus broke out - or a rebound in the third wave, depending on who you ask - and intensive care units (ICUs) are already suffering. Occupancy in critical areas has soared 19% in the last ten days and has gone from 406 covid patients on March 31 to 495 that this Friday. The centres had already compromised much of their activity through covid, as since the summer Catalonia has failed to bring occupation below 300 patients, and the desire to continue to ensure care for other diseases is subjecting professionals to great stress.

In fact, the current rate had not been observed since the first wave, admitted Catalan Health Minister Alba Vergés. Experts consulted by ARA attribute this sudden increase in serious cases to the influence of the British variant. Despite being predominant since the beginning of the year - it already accounts for 90% of the infections - it had managed to modulate its impact by means of restrictions. "But with the lifting of regional travel restrictions in mid-March we have been seeing the true face of the British variant, which is more transmissible and more virulent," explains the president of the Catalan Society of Intensive and Critical Care Medicine (SOCMIC) and head of intensive care medicine at the Hospital Arnau de Vilanova in Lleida, Jesés Caballero.

For weeks the critical beds have remained busy despite the high and have failed to empty enough. Now, the high occupancy to the ICU threatens to return to bring the health system to the limit and reawakens the specter of health collapse. "The problem is that we start from over 400 patients admitted toin intensive care [from the third wave] and the rise already starts from here. This is unsustainable," warns the head of the emergency department of the Hospital de Sant Pau, Mireia Puig, who says it is "hitting the ceiling earlier than in previous waves". Catalonia reached the peak of the third wave of care on January 31, with 728 patients admitted to ICU only for covid, and since then, for three months, the curve has been declining very gradually.

The growth is occurring from very high baseline occupancy figures (392 beds) and hospitals, which have not managed to free up enough beds, had not yet finished the third wave. For this reason, the epidemiologist of the Hospital Clínic Antoni Trilla prefers to speak of an upturn "in the third wave" rather than a fourth wave.

Trilla recalls that the British variant is clearly more contagious and this is seen in areas where infection is easier, such as inside homes or indoors. "Before you had a positive case and 20% of their contacts were symptomatic cases, but now 80% or 90% of the contacts of patients will end up being positive. We are seeing entire families infected," confirms Puig

Some family members even end up in hospital at the same time. "In recent weeks we have seen several members of the same family in ICU and this can only be the effect of the British variant. In the United Kingdom this behaviour was observed," says the medical director of the Germans Trias i Pujol Hospital in Badalona, Josep Maria Mòdol, one of the centers that receives more critical patients from densely populated areas such as North Barcelonès and Maresme.

In the Consorci Hospitalari de Vic, one of the areas most affected by hard to control outbreaks since September, described the situation in the intensive care unit as "catastrophic". The head of the ICU of this regional hospital, José Luis Lopera, says that the staff lost track of the waves in November: "Now we have 80 hospitalised covid patients, 12 of them intubated. But they are not the only serious patients we serve: we have about 12 more in the semi-critical area receiving treatment that is usually given in ICU because we have no space," admits the doctor, who summarises the activity in the critical area as "desperate". "One intubated patient goes out and another comes in, and we don't even cure them: we can only offer them treatments that act as extinguishers to deflate their lungs," he stresses.

60, average patient age

At this point, Catalonia allocates 52% of critical care beds to covid patients, who represent 16% of the patients being treated in a hospital, both in ICU and on the ward. The epidemiologist of the Hospital de la Vall d'Hebron Magda Campins is concerned about this: "What worries me most is that the increase in admissions to the ICU is much faster and disproportionate to the number of admissions to the plant and the number of diagnoses. If patients used to be admitted to the critical care units after four or five days on the ward, now they are admitted directly from the emergency department.

The biophysicist from the Computational Biology and Complex Systems Research Group (BIOCOM-SC) Clara Prats also believes that the mutation detected in the United Kingdom, which is now dominant on the European continent, could be responsible for this trend, but she points out that there is still not enough evidence to fully demonstrate its influence due to the effect of restrictions. "As its presence increases, the percentage of ICU admissions increases. With the same number of hospitalised cases, there are more admissions to critical care," argues Prats.

In the coming weeks cases are expected to grow, despite the real impact of Easter still being unknown. Health authorities and health professionals are still waiting to know the effects of the holidays. If it is confirmed that there has been more mobility, contagions and hospitalisations will increase. And, in a few days, units that have already been full for weeks may collapse.

In addition, the age of patients admitted to the ICU has also fallen: they are between 50 and 70 years and the average age is around 60. It is precisely those aged between 55 and 70 who are most at risk of being admitted to intensive care because of covid, and only a very small proportion of this age group has been vaccinated. "Despite the fact that vaccination is picking up pace, the population most susceptible to being admitted to the ICU has not been protected. We do see less mortality and soon we will see less conventional hospitalisations, because those over 80 are very protected, but in ICUs we will still have to hang on a while longer," explains Caballero