Half of Spain’s ICUs at high risk due to coronavirus spike

The explosion of coronavirus infections that began before the Christmas festive season has brought major pressure back to hospitals in half of Spain. New admissions now exceed the peaks of occupation during the waves registered in the spring and the summer of 2021.

While the situation is not the same everywhere, there are five Spanish regions – the Canary Islands, Navarre, the Basque Country, Aragón and Cantabria – where hospitalizations in regular wards are the worst they’ve been since the vaccination campaign began in Spain just over a year ago.

For intensive care unit (ICU) beds, the occupation is also growing. In 26 provinces, more than 25% of these spaces are occupied by a Covid-19 patient, meaning that the capacity of these units is at very high risk, according to the latest protocol from the central Health Ministry.

During the third wave of the pandemic in Spain, which was happening a year ago, Spanish hospitals saw more than 27,000 Covid patients in regular wards and nearly 5,000 in the ICU with the need for respirators. Now, while the infections are triple what they were a year ago, there are 14,000 patients in regular beds and 2,000 in ICU beds – roughly half of the number seen a year ago. The proportion of cases who deteriorate and end up in hospital is lower now than it was then.

The main difference now compared to then is vaccine coverage. A year ago, the campaign had barely started, and was moving slowly through care homes. Now, the majority of the population has received two doses of a Covid-19 vaccine and 90% of the over-70s have already been given a booster shot.

Despite this protection, the situation is still complicated in a number of Spain’s 50 provinces. There are 10 of these areas where more than 15% of beds are occupied by Covid-19 patients, which is above the very high-risk level for one of the indicators used by the Health Ministry. In 28 provinces, the figure is 10% (high risk). In ICUs, the situation is worse. In 26 provinces, one in every four ICU beds is occupied by a patient with Covid-19, which is above the very high-risk level for these units.

In some regions, there are more Covid-19 patients in hospital than there were during the worst moments of last winter. This is happening above all in wards in the Canary Islands, which saw a milder wave of the pandemic than the rest of Spain in the winter of 2021, as well as provinces in the Basque Country, Aragón and Catalonia. Some of these areas, such as Gipuzkoa, Álava, Huesca and Lleida, were already registering the worst infection figures in the country before the explosion of the more-contagious omicron variant. It is possible that some of the patients who are currently in hospital were infected then with the previously dominant delta variant.

The effects of this major wave of infections are also being seen in the ICUs. In Huesca, for example, there are 18% more patients with Covid-19 than in the worst moment of 2021, and Álava, Bizkaia and Girona have nearly as many ICU beds occupied now as they did then (nearly 80%).

The majority of hospitalized patients right now are infections that took place during the Christmas holiday, but this does not necessarily mean that they are all caused by the omicron variant. This data has not been officially made available yet in Spain.

In France, however, preliminary data from hospitals suggests that omicron is spreading rapidly, but that the two variants are still living side by side. At the end of December in the neighboring country, omicron admissions were at 54% of the total. Short hospital stays, of less than a day, are more common among those infected with the new variant compared to people who have delta, yet more evidence to suggest that omicron has less-severe symptoms. In the ICUs in France, meanwhile, patients with the delta strain continue to be the majority, while omicron represents just 19% of admissions.

As mentioned, there is still no data in Spain regarding the different strains, but doctors consulted by EL PAÍS say that the trend they are seeing is similar. The majority of admissions are due to the omicron variant and hospital stays are shorter than in previous waves. As for ICU patients, where most patients are unvaccinated, “those who are admitted continue to be very serious cases, and their stays are prolonged,” according to Gonzalo Tamaya, from the Hospital de Cruces in Barakaldo. Healthcare sources from a number of regions say that the majority of patients in the ICU were infected with the delta strain. It is yet to be seen if the number of severe cases will rise with omicron or if the vaccines and the milder nature of the variant will limit the pressure on ICUs.

Despite this data, the situation does not mean lower pressure on hospitals. As Antoni Trilla, an epidemiologist from the Clínic Hospital in Barcelona, explains, “when there is such a high number of infections, even if the illness is less severe, it is more complicated to manage.” In his hospital, for example, 35% of ICU beds are occupied by patients with Covid-19, which has prompted some surgeries to be rescheduled. “After [the current wave] overwhelmed the primary healthcare system, we are under more pressure each day, and we are banking on admissions continuing to increase. Although, thanks to the vaccines, we are expecting less of an impact on ICUs, where patients usually stay for several weeks.”

Among the new admissions, the vaccines are the main differentiator. In hospitals in Catalonia, which publish new cases and hospitalizations on a daily basis, including vaccination status, 1,405 people aged over 80 have been admitted into hospital since December 1. Among these, there are 910 unvaccinated people for every 100,000 and 240 vaccinated people for every 100,000 – nearly four times fewer. Among ICU patients the proportion is even greater: there are 28 of every 100,000 vaccinated people aged between 60 and 69, and 192 for every 100,000 unvaccinated in the same age range – seven times greater.

In fact, the profile of hospital patients has changed as the vaccination campaign has progressed. This is something that is being seen above all among seniors, who are more likely to get sick and need hospital care. At the start of the pandemic, the over-70s represented 50% of the total Covid-19 patients in hospitals. With the start of the vaccination campaign this proportion began to fall, and in May, when the majority of this group was vaccinated, barely 15% of Covid patients were in this age range.

The situation became more complicated once more in the autumn, before the third doses were being administered. During these weeks, the over-70s once again accounted for 50% of Covid patients in hospitals. In recent days, with a significant percentage of people with a booster shot, their presence among Covid patients has once again fallen.

Pressure on hospitals is expected to remain as coronavirus cases in Spain continue to climb. On Tuesday, the Health Ministry reported 134,942 new infections and added 247 deaths to the official toll, which now stands at 90,383. The 14-day incidence rate jumped 53 points on Tuesday to 3,042 cases per 100,000 inhabitants. Navarre and the Basque Country continue to have the highest transmission rates, with 7,253 and 6,425 cases, respectively.