Whether it is referred to as a second wave, or a sustained increase in new coronavirus cases, the epidemiological situation in Spain has worsened since the first week of July. In a month, the cumulative incidence of Covid-19 cases has risen by a factor of eight, from the 10 cases per 100,000 inhabitants that was recorded on July 7 to the 79.8 that the Health Ministry reported on Friday (no data is currently released over the weekend).
This rise in infections has led to an increase in serious cases that require hospitalization. If, at the beginning of July, there were around 150 Covid-19 patients receiving hospital treatment with an admission date within the previous seven days, this figure is now around 650 – 677 on Friday, the last day that data was released – which is more than four times higher.
According to the Carlos III Health Institute, approximately 5% of new Covid-19 cases end up being hospitalized
Spain’s hospitals are going through a tense period of calm as the number of new cases creeps up – there are currently 580 active outbreaks in Spain – and are getting ready for what could arrive in the coming weeks. Some are opening up Covid wards, others are considering restricting leave for their staff. All of them have contingency plans to begin suspending ordinary activity and to provide more beds. The lessons learned during the coronavirus lockdown that began in March in Spain will allow them to be more flexible going forward.
The situation is very different from region to region. Aragón is currently under the most pressure, with 514 beds occupied by coronavirus patients. Of these, 44 are in intensive care units (ICUs). The emergency services are treating between 150 and 200 people a day with Covid-19 or who are suspected of having it, although in recent days the situation appears to have stabilized, with “daily increases in the occupancy of beds of under 5%,” according to José María Abad, a healthcare director in Aragón. The region is considering suspending days off for healthcare workers and requesting help from retired medical staff. Several neighboring communities have offered their hospitals to Aragón should they need to send patients there.
The pressure is particularly notable in smaller centers, such as the hospital in Aranda de Duero, in Burgos, where the population has been confined since Friday. On Saturday four people with the coronavirus were admitted, in addition to the one patient already there, and all family visits have had to be canceled as a result.
As positive cases rise, so do hospitalizations, although they are registered with a couple of days’ delay, explains epidemiologist Jesús Molina Cabrillana. According to the latest data from the Carlos III Health Institute, approximately 5% of the new infections that are detected end up being hospitalized, based on data from May 10 to the present time. That’s to say, if there are 200 cases, 10 people will end up in hospital. The system first detects the mild cases, including those who are asymptomatic (50% according to the institute), but days later the more serious forms of the illness appear. Some 0.4% of those infected are admitted to the ICU and the same proportion dies.
This report, which was updated on August 6, has detected that the rise in hospitalizations began from early July onward, while ICU admissions and Covid-19-related deaths have increased from the last week of July. A month ago, the Health Ministry was reporting an average of seven ICU admissions over the previous week. Now the average is at 40.
For the first time an upturn in cases is being detected among people over-69, which is the section of the population that’s most vulnerable to the virus
The weekly report contains another new phenomenon: if the biggest increases in infections were previously being seen among young people, for the first time an upturn is being detected among the over-69s, which is the section of the population that’s most vulnerable to the virus. The trend is “worrying,” according to Molina Cabrillana, because this could have a greater clinical impact – i.e. more hospital admissions due to complications, and higher death rates.
The Murcia region, which has also seen more patients in recent weeks, has decided to no longer centralize Covid-19 cases in just two hospitals – Virgen de la Arrixaca in Murcia and Santa Lucía in Cartagena – to avoid the centers from becoming overwhelmed with cases. Instead, it is opening other hospitals to coronavirus patients.
On the Balearic island of Mallorca, the Son Espases hospital has designated a unit for coronavirus patients, while Andalusia, which has one of the lowest rates of infection – 27 cases per 100,000 inhabitants – has made additional hirings for the summer to guarantee that healthcare centers can deal with new infections, according to a spokesperson. Currently, there are 106 Covid-19 patients hospitalized in Andalusia, of whom 17 are in the ICU.
According to the latest data, released on Friday, the Valencia region – which has an cumulative infection rate of 46 cases per 100,000 inhabitants – had 160 patients admitted and 15 in the ICU, from a total of 2,073 active cases. Hospitals are preparing to receive more patients if needed. There are three field hospitals prepared in the region – in Valencia, Alicante and Castellón – with more than 800 beds. In Catalonia, the major hospitals in the regional capital, Barcelona, have contingency plans to provide new beds or open more wards if necessary. For now, the authorities report that they are absorbing the new cases without any problems.
In Galicia, the infection rates are currently far from those being seen in Aragón, Catalonia and Madrid, with 23 patients and just two ICU admissions. But the Galician hospitals are in a state of “cautious tension” ahead of the return of the virus. Drastic measures have not been taken, but reserves of material have been increased, with more beds available than usual for summer and well-organized systems to separate Covid-19 cases from other patients thanks to “structural reforms” that were carried out over the last few months, according to Ramón Barreiro, the spokesperson in Galicia for the CESM medical union.
“What does remain is the psychological burnout being suffered by medical staff,” he explains, “because this constant monitoring, this sensation that the virus is returning, is having a major impact.”
July 9 was a special day in the A Coruña hospital, as for the first time since the pandemic took hold, there was not a single Covid-19 patient in there. Just a month later, the center now has a dozen patients hospitalized, and its healthcare area accounts for more than half of the 591 active cases in the entire region. In the A Coruña comarca (a traditional territorial area in parts of Spain) the number of infections has doubled in just a week.
With reporting by Ferran Bono, Margot Molina and Sonia Vizoso.
English version by Simon Hunter.