For the last few days, the Spanish health system has been seeing scenes that doctors with three decades of experience are unable to describe without their voices trembling. Having to choose who they can save. Watching “one patient after another die.” Finding out that “colleagues are getting infected non-stop.” “I never thought that I would live through something like this, honestly,” explains a doctor from Madrid’s 12 de Octubre hospital. In the 10 days from March 16 to 25, according to internal data, more than 170 coronavirus patients died there.
The impact has been terrible. And there are still fears as to what could happen in the next eight or nine days, when the conditions of patients with early symptoms of the Covid-19 disease worsen and they need to be admitted to already-full intensive care units (ICUs). But despite all of the adversity, there are hopes among healthcare professionals that the worst is nearly over and that there are some indications that optimism is due.
“Fewer people are coming into the emergency room,” explains a doctor at Madrid’s La Paz hospital. “We have had more than 300 emergency cases in a day, and today we are under 200,” adds a staff member at the Severo Ochoa in Leganés. “The pressure has dropped slightly,” explains a spokesperson from the 12 de Octubre. “At the weekend we saw a fall, but we’ll have to wait a few days to see if the trend is confirmed,” they explain at the Vall d’Hebron hospital in Barcelona. “The number of incoming patients has stabilized after days of daily rises,” explains a chief of service at the Virgen del Rocío in Seville. “On Monday [March] 23 we treated 79 new patients for the virus. Yesterday that was down to 55,” explains the spokesperson from the Miguel Servet hospital in Zaragoza.
The situation is not the same in all of Spain, where the epidemic is moving at different rates depending on the region. But Juan Armengol, the president of the Spanish Medical Society for Emergencies (SEMES) admits that there is a “general impression” that the number of patients is falling, despite a lack of data. “It has fallen in the Madrid region at least, while in other regions such as Catalonia the rise has moderated or been halted,” Armengol adds.
The two dozen or so sources consulted for this article are cautious after “many days of tension and of living with the feeling that we are on the limit,” explains the chief of service at a major public hospital. “There are very tough days coming, with a lot of deaths on their way,” he adds. “But we trust that we have seen the light of the end of the tunnel and that gives us that strength that we were starting to lack.”
The case of the hospital in Torrejón de Ardoz is particularly revealing, as its chief of intensive medicine, María Cruz Martín Delgado, explains. “We were the first hospital to have Covid-19 patients in the ICU, so we are slightly ahead,” she explains. “In the last 48 hours we have seen that not only are emergency cases down, but that also admissions on the wards and to the ICU have fallen, from four or five a day to just two. Today we even received a patient from another hospital because we had a spare bed in the ICU. That would have been unthinkable a week ago.”
For Miquel Porta, a professor in Public Health at the Barcelona Autonomous University (UAB), this data “indicates that the measures adopted by the government are starting to bear fruit.”
The Spanish Cabinet approved a state of alarm on March 21 that essentially confined residents to their homes apart from essential tasks such as shopping and getting to their place of work. After the number of infections and deaths continued to rise, however, stricter measures went into place on Monday of this week suspending activity in all but essential sectors.
The immediate future, explains Armengol, “should see a continued fall in the infection rate. If that trend is confirmed, which would indicate that the isolation measures are taking effect, the fall in contagions should be even greater.”
The problems related to testing in Spain – faulty kits, changes in protocol – have tainted the figures for new infections as a faithful reflection of the progress of the epidemic. Other indicators, such as the number of hospitalizations, ICU patients and deaths have become more objective. In this context, the falls in the number of emergency admissions and ICU patients are of particular relevance.
“If emergency cases fall, everything else can breathe,” explains a chief at a Catalan hospital. “There are just a few days left for this to be noticeable. We just have to hold on for the coming days.”
Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts, said on Sunday that the ICUs would see their toughest moments at the end of this week or at “the beginning of the next.” The toughening of the confinement measures introduced on Monday are aimed at slowing the arrival of more patients in ICUs that are already at their limits.
Reducing the pressure on ICUs allows for better treatment of patients and a reduction in deaths, explains Martín Delgado. “When the pressure falls, it allows you to better deal with the more critical patients,” she says. “In better areas, with the more appropriate respirators for each case, with better personnel ratios, with more adequate professionals… That is more like a normal process. We are at the beginning of the beginning of getting back to that.”
English version by Simon Hunter.