Covid already jams primary emergency rooms and threatens ICUs

Holidays trigger contagion and pressure is expected to increase in the coming days

The tension has been palpable for weeks in primary healthcare clinics and on hospital floors. The covid tsunami threatens a third wave that is much more aggressive than the second - according to the health authorities' predictive models - and it does so at a time when the system is already almost exclusively dedicated to the virus between diagnoses, care and the vaccination campaign. After a month of December with several overlapping holidays and an increase in social interaction, between 3,000 and 4,000 infections per day are being confirmed in Catalonia. Yesterday, the number of positive cases reached 20,000 per week. In addition, there are 2,356 people hospitalized due to Covid, 15% more than a week ago, and in intensive care units (ICU) there are 459 patients, 30 new admissions in one day. At this point, more than 80% of Catalonia's structural beds for the critically ill - close to a thousand - are occupied, half of them by Covid patients.

Health professionals do not hide their concern in the face of a new onslaught of the epidemic, which they describe as "unpredictable". "We are in the scenario we imagined due to Christmas, but we do not know how it will end or what the impact of the coming weeks will be", the assistant medical director of the Germans Trias i Pujol Hospital, David Parés, admits.

"Since the December bank holiday we are diagnosing a lot once again, and now everything will continue. We have the frustrating feeling that the virus contingent is never reduced, but rather grows and grows", nurse María José Gordillo, from the primary healthcare centre CAP Comte Borrell in Barcelona, summarises, and adds that this increase in cases was predictable. "It is the chronicle of a death announced a month ago", she says. Primary healthcare centres have been seeing a trickle of visits and emergencies for suspicious cases for weeks, but it is now that they have seen an acceleration.

In the left side of Barcelona alone, where Gordillo works, up to 300 cases have been diagnosed daily in the last seven days, representing a third of the cases detected in the last week in the capital. Healthcare pressure has increased across the country in primary healthcare: one in every ten tests they do is positive.

In the last two days, "the number of confirmed suspects has increased considerably", Iris, who is a nurse in the coastal area of Barcelona, says. "Most of the emergencies are now covid, we hardly have normal emergencies", she says, and partly attributes this increase to social relaxation during Christmas, New Year's and the Epiphany. In the consultations, many of the patients who expect to receive a negative test result, although they finally obtain a positive one, admit that the origin of the contagion could be a meeting with family or friends, as detailed in the visits. "The avalanche] coincides with the effect of the Christmas holidays", Iris said.

Keeping an eye on beds for the critically ill

"In general, most cases are mild and we indicate isolation at home, but lately we are seeing patients with severe pneumonia again", Gordillo warns. The nurse explains that on Thursday, with very little time to spare, she had to refer two patients with breathing difficulties directly to the hospital. She also admits being concerned about an increase in cases where positive, elderly patients are asking to activate home care and palliative care because they refuse to die alone in a hospital. When the demand for this resource grows, Gordillo says, it becomes "inevitable" to compare it with the harshness of the first covid wave.

Between March and May, many very ill patients would pile up in clinics. They had to be urgently transferred to a hospital. In the case of CAP Comte Borrell, they were referred to Hospital Clínic. The professionals feared that history could repeat itself. "We are receiving more serious patients again, and as their age increases, it is more likely that they will end up being admitted", Pedro Castro, coordinator of the Clinic's Intensive Care Area, says.

According to the doctor, the number of hospitalisations is rising - some from primary care and others going there directly - and everything suggests that this week the occupation will intensify even more, especially in ICUs, where a quarantine of critical patients is already being attended to this week. The health authorities and the heads of service and professionals consulted by the ARA agree on this prognosis, and admit that they have been reorganising the spaces for days and getting ready for an avalanche of patients.

The health system lives a delayed pandemic: it takes between five and seven days between infection and diagnosis in primary healthcare and about ten days between detection and hospital admission of those who are sick. The forecasts already warned that the first week of January would see an increase in admissions, and that after the day of the Epiphany ICUs would be full again. The first suspicion has already become a reality, with around a hundred hospitalisations a day, and now all eyes are on the beds for the critically ill, where it is estimated that occupancy will rise above the threshold of 600 exclusively for covid.

Aragonès: "Schools will be the last service to close"

The acting president of the Generalitat and national coordinator of ERC, Pere Aragonès, defended yesterday the return to schools from tomorrow on. "Schools must be a preserved asset, and the last public service to be closed", he demanded at a press conference. After epidemiologists and several experts asked the Government to delay the return of students to their classrooms in order to avoid contagion from covid-19, Aragonès said that "schools are safe" and "an area of social protection for the most vulnerable students". In addition, he said that the Government is "attentive to the entire epidemiological situation" in order to guarantee "fundamental public services such as education". Additionally, the director of IrsiCaixa, Bonaventura Clotet, also requested yesterday in an interview for the podcast Filling the sink of Catalan News that Catalan schools be closed if cases of the new variant of covid-19 discovered in the United Kingdom are detected in one of every ten educational centres, according to the ACN.