The president of the Community of Madrid, the popular Isabel Díaz Ayuso, inaugurated the Isabel Zendal Nursing Hospital this Tuesday.
A center whose construction began on July 7 and has not yet been completed, defined first as a pandemic hospital and then as an emergency hospital, because there is no precedent in Europe and its future use is uncertain.
It will not open completely, but one of the pavilions, with 240 acute beds, 16 ICU beds and 32 intermediate care, 27% of the planned capacity.
Without patients, who will begin to arrive after the December bridge.
They will not fill all acute and critical care beds, it is planned to open between three and four intensive care beds.
And with an incomplete workforce, about 90 of the 669 needed will start working.
This is the current reality of the center, with a not very concrete immediate future.
What will happen in the medium and long term?
How does this project affect the Madrid health system?
The evolution of the coronavirus pandemic in recent weeks maintains a downward trend in which the number of new positives is reduced and, more slowly but also continuously, that of hospital admissions and ICU occupancy.
This Tuesday, Madrid hospitals had 1,474 patients admitted to acute care units and 343 to the ICU, an occupation of 11.5% and 76% respectively.
Far below the peak in the first wave of the pandemic - with more than 1,500 critics in intensive care units and more than 15,000 in hospitalization - and also below the second, which accumulated 3,328 in acute and 505 in ICU between late September and early October.
While these curves descended, the Isabel Zendal rose on a plot in Valdebebas, next to Ifema.
First, with the sole objective, according to the Community, of welcoming coronavirus patients;
later, for a few weeks, also open to “any healthcare need”.
With the current epidemiological context, the recent history of the Ifema field hospital and the Madrid casuistry, three experts in hospital management and infrastructure analyze and give some clues about this space in which the Community has already invested more than 100 million euros .
The hospital concept
"Calling it a hospital is not adequate, nor does it fulfill the functions or technical characteristics that it must have," says José León Paniagua, an architect doctor at the Carlos III Health Institute with long experience in hospital design and construction since the old Insalud.
He gives an example with the proportion of ICU beds and acute care in a hospital of the same size: “In one with 1,000 beds, 10% are ICUs of various specialties and in the care of covid patients, that of this center is not understood [16 ICU and 32 intermediate care], it is a ridiculous number ".
In the end, he continues, “it is a traditional hospital, from the 19th century, where 90% were beds and the rest other things.
In a current hospital 25% is hospitalization and the rest other areas ”.
A hospital must have not only hospital beds, but also other areas such as those dedicated to teaching and research, emergencies or nuclear medicine
The Community itself does not refer to plants or areas, but to "pavilions" or "modules".
The configuration, argues the expert, "is very similar to Ifema, which is the type of installation that responds to this type of health situation: temporary or already built, large-scale."
José Antonio Moreno, surgeon, former manager of several hospitals such as Gregorio Marañón, head of studies at the School of Health and Social Services of the Canary Islands from 1998 to 2004 and president of Gihsa, a consulting firm specializing in health, lists the areas that a health center would have. this capacity (1,056 beds), dedicated to diagnosis and treatment, with an extension similar to that of hospitalization: "Teaching and research, emergencies, radiology, radiotherapy, nuclear medicine, laboratory, day hospital, rehabilitation and diagnostic examination and treatment cabinets for almost all specialties, medical and surgical ”.
"Pandemic" Center
The concept of "pandemics" is unknown to specialists because there are reasons why there is no precedent.
"Most of the countries have healthcare units specialized in infectious diseases," says Moreno.
“The use of buildings is normally defined by a functional plan [a technical explanation about the utilities, requirements and other issues that define the functional aspects of a space], mandatory since the General Health Law of 1986. There is no program here because it is impossible, because a pandemic cannot be measured and, to the extent that you cannot measure a problem, you cannot give a definite answer, ”explains Paniagua.
José Luis Martínez Almeida, Mayor of Madrid, during the inauguration of the Hospital Nurse Isabel Zendal.
In video, statements by the inauguration of the Hospital Nurse Isabel Zendal PHOTO: EFE / VIDEO: ATLAS
A pandemic cannot be measured and, to the extent that you cannot measure a problem, you cannot give a definite answer
Jose Leon Paniagua
José Ramón Repullo, professor of health planning and economics at the National School of Health, alludes to the fact that “this operation can only be understood from politics and image.
It is basically incomprehensible from the perspective of governance and health management ”.
The future
According to the opening reported by the Community, the Zendal will begin to host a few dozen patients after the December bridge in pavilion number two;
while, of the other two, one is going to be free, for future use, and the other is not equipped.
Repullo's forecast is that patients will enter “IFEMA mode”: “A series of mild cases, of isolation or quarantine, which could have been housed in unused areas, in hotels or in tents attached to general hospitals, with greater rationality clinic and much lower costs ”.
The [Zendal] patients could have been housed in unused areas, in hotels or in tents attached to general hospitals, with greater clinical rationality and much lower costs
José Ramón Repullo
But, what will happen if that is the maximum occupation of the center?
For Paniagua, as it does not have a functional program, "there will be multiple proposals, it is a container that can turn into chaos if the real needs that exist are not planned."
For the moment, the Diaz Ayuso Executive has predictably added a multipurpose building which will house the coordinating centers of the Madrid Health Service and Summa 112 and the Regional Public Health Laboratory.
In addition, it is reported in the dossier of this center, "the infrastructure is characterized by its versatility" and this "allows to be prepared to face, not only a possible outbreak of covid, but to face any type of epidemic, emergency or catastrophe ”.
“Can everything be done?
Yes, but he is not currently prepared for that, ”Paniagua alludes to the lack of areas such as surgery.
Moreno recalls the first wave: "It took us by surprise and the shortcomings of the National Health System almost made us wreck, due to lack of sufficient and adequate resources."
And he assures that “even if it was only used for infectious diseases and after dominating the pandemic it remained half empty, its existence would be advisable in anticipation of other future needs.
Madrid needs to increase health resources ”.
Paniagua points out: "There are previous decisions about the structure and distribution that were not made, here is the issue of haste and deadlines, there has been no reflection on all this and a possible reconversion."
Even if it was only used for infectious diseases and after dominating the pandemic it remained half empty, its existence would be advisable in anticipation of other future needs
Jose Antonio Moreno
Transformation feasible?
With the current characteristics, the Isabel Zendal would need to change to become a hospital.
Moreno alludes to the pavilion that is currently unused: "And the entire center is easy to transform."
He is convinced that this center "is necessary to bring Madrid's hospital resources closer to the national average of beds in operation".
The region, he explains, “is at the tail of beds per inhabitant.
Today's huge waiting lists justify its provision as a general hospital ”.
For this specialist with more than half a century of experience, with the increase of more than 1,000 beds that the Zendal would represent at full capacity, “plus the 12,769 it currently has, it will reach 13,769 (2.04 per 1,000 inhabitants) still below of the national average (2.4) ”.
That is the reason why a new public hospital of these dimensions "is not a nonsense but a necessity."
Matiza: “Taking advantage of it to equip it with units suitable for infectious diseases is a wise move.
Dedicating it exclusively to them would be a mistake ”.
It could be partially a center for the homeless, what greater emergency than the homeless?
Jose Leon Paniagua
Paniagua is heading to another place related to the possible future of the La Paz hospital, for which several experts recommended raising it again in front of the plot that is currently in front of Isabel Zendal: “It could serve as non-healthcare support to that hospital, such as distribution and logistics center, basically it would be for administrative use ”.
And also, he proposes, “it could be partially a center for the homeless, what greater emergency than people who do not have a roof ?, abandoned for a long time by the system.
Maybe not for everyone or definitely, but it could be put to good use in this way. "
He does not see as a feasible solution to convert it into a hospital: "With that size, it would have to reduce the number of beds to house the rest of the necessary areas, there would be around 220 [a size similar to the Infanta Leonor, in Vallecas]".
Long-term investment
"Investing in hospital construction is not a problem," argues Moreno: "The problem is in maintenance costs, which exceed the investment in their construction every year.
We can verify this in the seven new hospitals in Madrid [the ones that Esperanza Aguirre built during her tenure] ”.
For Paniagua, the expense that a Zendal reconversion would require is "an intervention that would not make sense", and amounts to at least "50% of what has already been invested" to carry out this possible transformation.
If both experts had to decide where to take the more than 100 million euros that Zendal already accumulates, they are clear.
"It is probably more necessary to increase resources in primary care (home) and secondary care (health centers with 24-hour emergencies and observation beds)," says Moreno.
"They could have been dedicated to reinforcing primary school, personnel and consumables."
It is probably more necessary to increase resources in primary care (home) and secondary care (health centers with 24-hour emergencies and observation beds)
Jose Antonio Moreno
The "current doubts about the real functionality" of this center, adds Repullo, are the same as those of its future after the pandemic: "Inconceivable [functionality] at this time."
He believes that the arguments with which the Community defends the project are “picturesque”: “For example, the one that is next to an international airport.
Boasting of this quality leaves everyone perplexed, since a hospital is related and justified by the population it covers and protects, and the isochron distances [or lines of equal accessibility, which allow identifying differences in the ease of access access in the areas of influence of health centers and analyze the spatial distribution of accessibility to them] to population centers are what determine their viability and size ”.
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But "brick is more attractive, because it gives a higher yield in votes," says Moreno: "Spain is the country in the European Union that spends the least on healthcare (6.4% of GDP).
This is the main problem that political leaders in health must face to guarantee the right to health of the Spanish ”.
And he concludes: “Building a hospital, once the decision has been made, is the responsibility of health managers.
But politicians do management and managers (some) do politics.
That's why they both do it poorly, too often. "
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