The intensive care units (ICU) in Spain are shaking again.
History repeats itself.
As in the spring, when they were stunned to attend an avalanche of patients with an unknown virus that they did not even know how to treat.
The UCI staff have once again been on their guard - if it ever stopped being so - to face the second wave of the pandemic.
Perhaps more self-confident;
also more tired.
The ICUs in Catalonia already have more covid patients than other pathologies
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With a soaring contagion curve and almost 2,500 ICU beds occupied with covid patients, EL PAÍS enters two critical care units at different points of the epidemic, but consecutive.
Covid and non-covid patients still coexist in the ICU of the Sant Pau hospital in Barcelona;
the unit is coping, but helplessly assists the constant trickle that threatens to re-saturate the service.
In Madrid, the ICU of the Torrejón hospital crystallizes what Sant Pau predicts for within three weeks: beds full of patients with coronavirus, saturated services and other units invaded by the ICU to meet an unstoppable demand.
Two moments of the same threat: the collapse of the ICU.
Again.
A slight beep from the vital signs monitor sneaks out of a box in the ICU of Sant Pau hospital.
From the unit's control table, in the center of a ring made up of translucent rooms with sliding doors, a nurse looks up.
False alarm.
All in order.
The patient remains stable, asleep, silently battling covid-19 and oblivious to the swaying that her life lines draw on a screen.
The ICU is calmer than in spring.
At least apparently.
The bustle is what it is in a critical unit, but the situation remains under control.
There is time to calmly discuss a case, comment on the condition of a patient, even talk or laugh.
In the ICU of Sant Pau there are 30 beds, but four more have already opened, just in case.
The trickle of tickets due to covid-19 is incessant and there are already a score of admitted in the service.
“It has been a spring from hell.
In summer, there have been three weeks of calm and since mid-July, things have started to get complicated.
Now it is not hell, but we are in purgatory ”, sums up Dr. Jordi Mancebo, head of the Sant Pau ICU.
The Generalitat confirmed this Friday that, according to its data - which differ from those of the Ministry of Health because they are collected from the computer system, not from hospitals directly -, for the first time since the second wave, there are more covid patients than non-covid patients admitted to their ICUs: 447, 52%.
The Ministry of Health reported this Friday that 26.59% of ICU beds in Spain are occupied by patients with covid-19.
But this percentage could be higher because Health measures the income on the beds enabled by the hospitals at that time.
And the epidemiological situation in Spain - 485 cases per 100,000 inhabitants - has already forced the expansion of critical beds beyond ICUs.
38.44%.
That is the percentage that Health sets for the occupation of the Madrid ICUs.
But it is not real.
Calculated on the “elasticity” of the hospitals, this figure does not reflect the saturation that these units of Madrid hospitals have already reached.
There they count not only the critical areas, but also the resuscitation areas, the recovery areas after anesthesia, the operating rooms enabled to care for seriously ill patients.
The reality is that there are 484 patients occupying these beds, 96.8% of all those in the community, 75.5% if the capacity of the private ones is added.
To Elena González, intensivist at the Torrejón hospital, a "how are you?"
It makes him start a silent but uninterrupted cry that continues throughout the story.
There is only one thing that gives him some peace of mind: "That for now we can continue treating non-covid patients."
Although he does not know for how long.
They have 26 patients with covid-19 on the ward and 11 seriously ill in a 16-bed service that, in this second wave, has already seen 61 patients.
A month ago they activated the elasticity plan and two weeks ago they had to request the transfer of a critical patient to another center: there was no room.
In the Torrejón ICU, a device on the wall marks the noise level while the beeps from the dozens of devices that are connected to the patients alternate in a kind of arrhythmic rattle that comes and goes as the glass slides of the boxes.
Inside, an awake patient on noninvasive ventilation;
another prone, upside-down, with only the soles of the feet visible;
one more blinks confused and motionless;
another totally asleep, oblivious to the world.
This Friday, there were only coronavirus patients in this unit.
Critics of other pathologies had taken over the post-anesthetic recovery unit.
Inside the box, little or nothing has changed: patients with very serious covid-19 rest on the bed in silence, asleep and intubated while a ventilator breathes for them.
Same age, same clinical picture, same time admitted.
The difference, if that, is mortality.
Much less, say the toilets.
"In spring we were working in war situations and now we can offer a clearly better quality of care: there are many patients, but we still have time to take care of them with trained professionals and this makes the results, in the end, better", says Mancebo .
“But they keep coming at very bad times.
Nobody knows what it is to see people appear without being able to breathe, gasping, "said the intensivist from Torrejón.
For.
She wipes away her tears almost by the handful.
She nods because she's angry.
Breathe and continue: “Then I go out into the street and I feel that what we do is worthless.
I see that everyone does what they want and I think 'are you stupid or what?'
Here young people continue to arrive, in their twenties, drowning, and there are some who are without a mask, 20 in a house, partying ... Then I, here, I see one person die and another and another ”.
Impotence is shared in all ICUs.
“When you see that someone does not comply with the rules on the street, it makes you a little angry.
I have not been going to eat with my parents or in-laws since March because we would have to remove our mask.
It is a risk ”, explains Mar Vega, nursing supervisor at the Sant Pau ICU.
The health workers fear of contagion is the same, but the experience is a degree.
And that shows in the fall ICUs.
Personal protective equipment is no longer all tight-fitting diving suits.
In Sant Pau they are green waterproof gowns that combine with flower and colored hats, double gloves and imposing plastic glasses.
“The biggest fear in the first wave was infecting you or yours.
That more patients come and we don't have enough staff to attend to all of them because, unfortunately, we also get sick, ”says Vega.
Luis entered the ICU of Sant Pau on Tuesday, fatigued and with a feeling of suffocation.
All the chronic diseases that he carries took him directly to the ICU, as a precaution.
"The change has been radical.
I'm already much better, ”she says 18 hours later, clutching her peach juice.
On the other side of the room, a woman, still intubated, opens her eyes when she hears the voice of the physiotherapist.
In the ICU they lose a lot of mobility and strength.
You have to exercise your muscles.
She alone raises her hand, then her arm.
The physiotherapist smiles behind the mask: she is improving.
In the box next to it there is a spare bed.
“There was a lady, they transferred her to semi-critics.
You don't know how he cried when he left.
What joy! ”, Says a nurse.
They do not know how long it will take to fill, but they predict that little.
The threat of collapse looms over the ICU every day.
Ariana González, a nurse from these units, has been working in them for 12 years, now she is working in Torrejón.
He never imagined that he could experience something like this.
Neither the first time nor in this second wave, because it is difficult for him to understand, like the rest of the health workers, how it has returned to this point where they have to juggle every day to provide the care “that patients need and deserve” .
They knew the virus would return, but not in the summer.
“It came again, suddenly.
And we've been like this since August.
We could barely breathe a little for a month or a month and a half.
We are very tired ”, says this specialist.
The Sant Pau nurse agrees: “Since July there have been patients.
The doors were opened, welcome holidays, but the virus is not gone.
The most difficult thing is to think that you are going to live the same thing again.
Physically we have rested somewhat, but emotionally not ”.
The satiety of the toilets gains weight in the second wave.
“We only ask to continue having beds so that we can accommodate everyone, the covid and the non-covid, we cannot leave anyone out again.
We have to live with this virus.
That people understand it, that they stop buying tickets to end up here ”, claims the intensivist from Torrejón.
At 600 kilometers, the fear is the same.
“80% of our beds are occupied.
The intention of all hospitals is to maintain cohabitation between covid patients and common pathologies.
The coexistence of these two realities makes the system extremely stressed, ”says Mancebo.
This time there is no problem of beds or respirators, but all fear for the lack of personnel.
"The risk we have is that the personnel severely punished in the hell of the first wave, do not get sick and can endure what comes in the coming months," adds the intensivist.
The emotional fatigue of the toilets weighs too much "We are people, not superheroes", ditch Vega.
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- Guide to action against the disease
