Covid: ICU admissions rate slow down but mortality up

Health Department confident that extending restrictions will ease congestion in the health care system

The coronavirus epidemic is losing strength in Catalonia. The circulation of the virus is slowing and the epidemiological indicators are beginning to approach the values set by the health authorities to control transmission: lowering the  rate of infection so that no more than 80 new infections are generated out of every 100; reducing the number of daily infections to 1,000; and reducing the pressure on intensive care units (ICUs), so that they have a maximum of 300 patients. But we're not there  yet. "We are slowly achieving our goals", said the coordinator of the covid-19 monitoring unit in Catalonia, Jacobo Mendioroz, who explained that the epidemiological evolution is in line with that predicted by the Government mathematical models.

However, although the infection curve is falling daily and in three weeks new diagnoses have dropped 33% (this Friday there was a total of 2,801 new infections), Catalonia is yet to get over the peak. This is expected later this week if restrictions stay in place. "There are more discharges than hospital admissions, and the rate of ICU admissions has stabilised," said Secretary General of Health, Marc Ramentol. Of the nearly 1,100 critical care beds available in Catalonia in the public and private sectors, 58% have coronavirus patients. In conventional hospitalisation plants there are about 2,600 covid patients, occupying 24% of the total capacity of the public network.

Hospital admissions continue to rise, but at a slower rate. In the first week of the month, the number of new ICU admissions jumped from 478 to 547, a 14% increase. In the second week, however, the number of admissions only grew by 7%, to 580.

In the Hospital Universitari Arnau de Vilanova in Lleida, for example, this weekend the third floor, dedicated exclusively to covid-19, will be closed due to the decrease in admissions of patients with this pathology. The average number of admissions at the end of last week was about ten a day, while this Friday there have been four, according to the head of the coronavirus unit at the centre, Dr José Luis Morales-Rull.

479 deaths in seven days

However, Mendioroz stressed this Friday that the mortality figures are still "high". This Friday, the Health Department counted 71 more deaths. That takes the total between November 3 and 9 to 479. The epidemiologist explained that in order to reach the peak in mortality, a drop in incidence (fewer infections) is first necessary, as well as reaching the peak in hospitalisations and admissions to intensive care units.

Now, for example, primary care is also noticing that fewer covid-19-related consultations are being conducted, according to the health department. This reduction is particularly noticeable in the emergency department, where visits have been reduced by 15% compared to the previous week. This may be a response to the fact that the infection rate (R), or speed of spread of the virus, remains below 1, although it is still not as low as the 0.80 desired by health authorities. This Friday it dropped by a little further to 0.85. "It is a homogeneous decrease throughout the territory, except in some specific, smaller areas," explained Mendioroz. The accumulated incidence in the last fourteen days is also declining: this week 686 positives are being detected per 100,000 inhabitants.

Between November 3 and 9, a total of 315,321 diagnostic tests were performed (184,543 PCR and 130,778 rapid tests), 10% of which were positive. Of these tests, 10,753 (3.4%) were performed in nursing homes, where improvements are incipient. "The data do not allow us to be very optimistic," said Ramentol. At this point, 16.5% of Catalan nursing homes have at least one case, when last week it was 19%, but there are still 2.6% of positive residents. A week ago 2.9% of the elderly in nursing homes were affected by the virus.

Forecast of 400 critical beds occupied

The Health Department is working on the assumption that the extension of the restrictions for ten more days will allow the pressure of care to start to drop, first from the conventional beds and days after the ICU. According to the models developed by Health officials, the Computational Biology and Complex Systems Group (BIOCOM-SC) and the Catalan Agency for Healthcare Quality and Assessment (AQuAS), the Catalan healthcare system could have approximately 400 critical patients and 2,000 in conventional beds on 23 November, the day the restrictions end.

The Health Department has defended the extension of the restrictions, claiming they are necessary to reduce cumulative incidence. With community transmission, i.e. a cumulative incidence of over 1,000 cases, contact tracing does not work. However, once this figure is reduced, restrictions may be lifted and the track and trace system which was in place before the second wave hit in October reinstated. 

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