The regional coordinator of Internal Medicine against the Covid: “I had not seen so many rooms of married couples together”
He arrives at the Hospital Clínico Universitario de Valladolid around 7.30 am and leaves when he can. In this year of a pandemic, he has learned, like the rest, to “stretch like gum” because he has no other choice. The regional coordinator of Internal Medicine against COVID-19, Carlos Dueñas, does not lose his humor despite marathon days in which more and more patients have to be treated; look for alternatives and have a contingency plan to empty clean plants; open dirty, decide what to do with non-COVID-19 patients and, thus, minute by minute, under the threat of the numbers of new infections. “Very high” figures that no longer give respite and that stress hospitals every second; and all with the psychological and physical fatigue of a pandemic that does not give up, that leaves anyone exhausted, and especially in the face of a tsunami that is about to reach hospitals and ucis, because today’s infections are tomorrow in the centers. With all his imagination on the table and looking for beds where there are none, he regrets: “Even if we open the gyms and hospital cafeterias, if people are not aware, this could be a catastrophe,” to which is added that the pandemic non-COVID-19 patients are also paying it. That is why he calls for self-completion, and warns: “I had not seen so many marriage rooms together. They are the consequences of family reunions ”.
It has become a mantra. The health system is saturated, the ucis are overflowing, emergency room overload, professionals exhausted … You who are at the bottom of the barrel, do you conceive of this situation in a society, in theory, evolved? What else do they have to tell us?
The messages are clear and have been since March of last year. The problem is that I no longer know if they penetrate as they have to. The reality is that hospitals are prepared to take on a limited number of admissions and not such a high number that it ends up overburdening and causing things not to work as well as they have to. Castilla y León two weeks ago had about 600 patients admitted to the COVID-19 plant and now we have 2,000. An increase of 1,400 patients in 15 days is brutal for hospitals to assume, and to that we must add that patients without COVID-19 continue to come; trauma emergencies, heart attacks, strokes, digestive bleeding continue to arrive. We have a record of daily income, doubling them and hospitals have a limited number of beds, we can invent them. We are all like this, Río Hortega, Clínico, Palencia, Segovia… And that, with a limited number of professionals, and no one is leaving work at three in the afternoon. The quality of care is diminished by the avalanche of patients that we have, this is so. And people have to understand that hospitals have a limited number of beds and that we cannot keep up with this rate of income. If they don’t confine themselves and do things the way they have to, the hospitals are going to suffer a lot, we are already suffering.
Have they had to tell someone who is sick, come back tomorrow; send people home who otherwise would have been admitted to the hospital?
No, because in the end we end up inventing ourselves. If we have to look for beds under the stones, we end up looking for them as Palencia has done. If you have to enable the gym to attend patients, we enable it. But it is not the same to see patients on a floor than in a gym; the quality of care is also diminished. It is so. Be more strict in the emergency room when deciding an admission, yes, but if it is indicated, it is not going to say no. We will have to find a place for them anywhere. So, we reinvent ourselves, surgeries are taken to private hospitals so that patients do not occupy beds. This is what we have been doing, reinventing ourselves and looking for beds where there are hardly any.
Given the number of infections that do not drop below 2,000, with the addition of the British strain, much more contagious and, apparently, also more deadly, do you fear the worst in fifteen days?
As long as we continue with very high incidences, the hospitals will be enduring a lot of healthcare pressure, and 15 days after the infections decrease, we will continue; and the ucis, one more month. When the incidence figure is normalized, we will still have problems in hospitals for almost a month. If we add to that the progressive increase in patients suspected of the British variant, as transmission increases, we will have more income. Everything goes against hospitals and Primary Care, too.
Can we go back to the situation in April, to the worst moments of the pandemic?
If we continue like this, yes; we are already in close numbers. In April, the Clinic reached the maximum of about 200 patients in the ward and in the ICU up to 70, and now there are more than 160 and we still have two or three weeks of travel with a high number of admissions. There are hospitals in the Community such as León, which already has higher figures than in the first wave, or Palencia, or Ávila …
Have referrals between hospitals already begun, to make room for the following patients, to relieve small centers?
Through the UCI coordinator, transfers have been organized from areas where they are tighter, to more liberated areas and there is a lot of movement. The Segovia Hospital, which has been a little more in a hurry, has been referring patients to the ICU to Burgos, the Clinic and the Río Hortega; Medina del Campo, also, who does not have an ICU. Yes there is movement. And on the floor, apart from the transfers to the Rondilla Hospital -which has received patients from the Clínico, Río Hortega, Palencia, Segovia, Ávila and Medina del Campo-, the Palencia Hospital has had to send to the Burgos Hospital and the Clinic from Valladolid some patient with significant respiratory involvement, because they could not take on all the patients on the ward at peak times.
Is the Rondilla building going to be enough, or do you fear the return to field hospitals?
It has a capacity of up to 200 admitted patients. With the total opening of the second plant, we have a capacity of 90 and we are with seventy-something. We will probably hit 90-93 patients these days. If it was necessary to open more beds due to saturation of the hospitals, they would be opened as soon as staff became available.
Another problem, because professionals don’t come out from under the stones?
We are stretching like gum and we do what we can. We are not in the ideal situation, we have to double the number of patients we see, diagnose them; doubling the guards … Right now there are ten doctors working at the Rondilla Hospital, and that is the least problem, it is more that of the nursing staff, because there are no nurses. I want to thank, from here, the nurses who work days at 1-1-2 who have just joined this hospital as volunteers on days off.
And how are those professionals, with an accumulated fatigue that nobody is missing?
Doubling shifts, multiplying guards, with many more patients in charge of each; with a pathology that causes a lot of damage psychologically, because there are patients who get sick and for whom you cannot find a solution because they do not evolve well. This is very hard physically and psychologically. People are exhausted, how can they be; exhausted. But hey, we know what we decide to do and we draw strength from where there is none. We try to get people to rest a reasonable minimum, because this is a long-distance race… We’ve been there for almost a year and it doesn’t seem like this is going to ease up so soon.
In a normal situation, how many patients does a doctor see, and how many do they touch now?
I put an example of the Clinic. In January of a year ago, the Hospital had eleven intensive care beds, at this moment 71 are working, and the staff has increased by one person. At this time, in Internal Medicine there may be about 70 patients in a normal situation, and right now we have 80 COVID-19 patients and 60 non-COVID-19 patients, more or less with the same staff. We are seeing more than twice the usual patients, and the same is happening in Pulmonology and everywhere. It’s like little to double your work in a bad time like January with the flu.
What bill is the pandemic passing to the system and especially to those non-COVID pathologies that are still present; to surgical interventions?
They are paying for it. Having to dedicate many more cash to COVID-19 pathology, you have to detract them from other sites. Right now, the Pneumology and Internal Medicine departments are practically exclusively dedicated to COVID-19 patients. Consultations for other related pathologies are stopped or delayed. Imagine what a lung cancer that has not been diagnosed can be because consultations are delayed … But there are also professionals from other specialties who are collaborating with us, where activity is also decreasing. Digestive collaborates, which probably has an impact on delayed studies, for example, of colon cancer and others; the same will happen in Onlogy. We are sure to delay diagnoses that have prognostic implications. It is not the same to diagnose colon cancer in an initial stage, as in a more advanced stage, because the risks that it has spread are already greater. This is so. In the first wave, we all stopped it, and now we are combining what COVID and non-COVID care can be.
You who see it every day, are there young people in ICUs?
The average age of patients admitted to the ICU and on the ward is decreasing. I had not seen so many marriage rooms together in this hospital as I do now. They are the consequences of family Christmas gatherings. There are the husband and wife, two brothers-in-law… And they are people, generally younger than in the first wave.
We all have our hopes for the vaccine. What breath do you think you can give, and when can that breath come?
Everything will depend on the percentage of vaccination and the doses that we have in the short term. The sooner we have a vaccinated population the better it will be, as long as there is no variant that skips the vaccine, and at the moment the only one in which it seems that it is not so effective is the South African one and, except for one case in Spain, it seems that we do not have any more. The respite is to be able to have at least 70 percent of the population vaccinated, they tell us that in summer, but if it could be earlier, much better. Israel is massively vaccinating and is already noticing it in the infection figures.
We have not stumbled twice, three times with the same stone. What are we doing wrong, whose fault is it, where is the problem?
It’s a bit of everything. Probably, when politicians start to analyze the risk of transmission versus economic risk, they can be somewhat lighter when making decisions. Most of the toilets would have closed and confined everything a long time ago. And, on the other hand, people; There comes a time when heads change, they stop receiving information from COVID-19 because they are saturated. There comes a time when they have to go out and breathe. It all comes together a bit. The population is probably saturated and needs a breather; Policies are complex, it is not easy to shut down as in the first wave, and in the end everything has its consequences.
Finally, what else can you ask or say to the population?
That things go well is not in the hands of politicians or doctors. They have to realize the situation, the danger to health in Castilla y León of collapse. That they are as long as possible in their homes, with the minimum of people with whom they usually interact. Let them do a kind of self-confinement, because if not, there will come a time when even if we open the gyms and hospital cafeterias to put in beds, we will not be able to assist all patients. We will end up like Portugal. If people are not aware and responsible, this can be a catastrophe.