Society 26/03/2021

ICUs now filled with younger, more critically ill patients

Intensivist doctors attribute this change to the British variant and warn of the beginning of a fourth wave

4 min
A nurse in the ICU of the Hospital del Vall d'Hebron.

Santa Coloma de GramenetThe occupation of intensive care units (ICU) is the only indicator in decline in Catalonia, after it has gone from 417 patients to 400 in the last hours. However, the concern in Catalan hospitals does not recede, but new alarm signals have been lit: critical areas are increasingly attending younger covid patients with more a severe and faster progression. In addition, since a few weeks ago, the rate of admissions to the ICU is higher than hospitalizations, when, until now, these two values were quite proportional: between 15 and 30% of patients on the ward or treated in the emergency department ended up in the ICU. Now, while conventional beds are being emptied of coronavirus patients - a month ago they accounted for 14.6% of those admitted and they now represent 10.9% -, critical beds are being vacated very slowly or even filled again quickly.

The health authorities do not offer a clear explanation for this change when until recently the curve of infections was going down. Intensivist doctors consulted by ARA, however, focus the attention on the British variant, and argue that the mutation is not only more transmissible - a single infection affects entire families - but would cause those infected to become sicker more severely and more quickly. This, in turn, makes bed release more difficult. Moreover, the experts send a clear message: Catalonia is facing a fourth wave, and until vaccination arrives the priority is for the population to take precautions and not to mix with other bubbles. Meanwhile, they say, the population is relaxing too much, and they fear that these days and Easter might cause an exponential growth of infections, admissions and deaths.

In previous waves, in the Hospital del Mar they had 150 people in the ward and about fifty patients in the ICU. This meant that there was a certain correlation between these two types of patients, since as there are more patients in wards or in semi-critical beds, the risk of entering the ICU increased. At this point, however, they have 52 in wards and 27 in critical. "The ratio of patients admitted to the ward and ICU is 1 to 2. Now, for every two hospitalizations we are admitting a critical patient", explains the head of intensive care medicine at the Hospital del Mar, Joan Ramon Masclans.

These patients are also younger. "If the average age in the first two waves and at the beginning of the third was 63, in the last week we have been admitted people aged 55. For the last ten days the average age has been dropping by ten points", laments Masclans who, although he has treated people under 60 throughout the pandemic, had not seen so many patients aged between 30 and 55 until now.

In the Vall d'Hebron Hospital, one of the main centers receiving patients in the country, this change has also been observed. "These are patients who spend a few hours in the ward before being admitted to the ICU, when before such a profile could spend one or two days in the regular beds", says the head of the ICU, Ricard Ferrer. The doctor points out that the experience in the ICU begins to confirm a greater virulence of the British variant. "The population admitted here is not more fragile than before, on the contrary, and the only plausible explanation is that the behavior of the virus has changed. This would be explained by the predominance of the British mutation", he says.

This change in the patient profile is not only observed in Barcelona, but is transversal throughout the country. "We still have patients from the third wave admitted for more than 30 days, over 60 years old, who are mixed with these new patients, younger but with obesity and hypertension, and who are admitted in a serious condition and have to be intubated", says the head of the ICU of the Josep Trueta Hospital, Josep Maria Sirvent. This coincidence in time, he says, explains why it is so difficult to empty the ICU. "We have not been able to start from scratch after the third wave and we already have the fourth on top, and with many patients hospitalized", adds Sirvent, who points out that the Trueta has 17 people in critical beds and Santa Caterina 9 more.

In Lleida, health workers directly speak of fifth wave of coronavirus. The head of intensive care medicine at the Arnau de Vilanova Hospital, Jesus Caballero, has warned that the situation that is being experienced is "reminiscent of the beginning of Christmas", with the difference that each time the patients are younger. "This week is being especially hard, with ten hospitalizations a day on average and half of them sent directly to the semi-critical area", said Caballero. These patients could lead to a greater hospital pressure in a matter of hours or days.

The risk of Easter

For experts, the way to solve this problem is to massively vaccinate and comply with containment measures very strictly. "Before the reopenings and Easter people have relaxed, but you have to be aware that the consequences of celebrating this holiday can be catastrophic. We are concerned about how we will be in two or three weeks when there are still a few months to be vaccinated", says Masclans. The doctor stresses that "we have to do it right" to avoid losing more lives and break more families. "I would pray for people to not meet nor have interaction with other bubbles this Easter. We know that when bubbles get together, they burst", Sirvent states.