recruitment of 1,868 doctors and nurses

Ignacio Pérez Catalán, Germán Peces-Barba, Margarita Marín Royo and Paloma Repila.

Internal Medicine estimates that between 10 and 20 percent of patients infected with Covid-19 develop disease prolongation (Persistent Covid or ‘LongCovid’) and estimate that the percentage could be even higher if exclusively those patients who have suffered a serious condition and who have been admitted were analyzed. Given this scenario, it is necessary to ask the specialists who are part of the Post-Covid monitoring services: How many toilets does a LongCovid unit in an average hospital require for optimal care for this type of patient?

According to the latest figures provided by the Ministry of Health, Spain has a total of 467 hospitals spread throughout the geography. The specialists consulted by this newspaper, internists and pulmonologists, have pointed out that it would be necessary one more doctor for each specialty to be able to adequately treat patients suffering from persistent Covid, while Nursing, which ensures that it is currently carrying out this work with only one professional, has put on the table the “urgent need” to have two more nurses per hospital. Therefore, according to estimates, the National Health System (NHS) would need to ‘sign’ four workers per hospital, two specialists and two nurses, for the proper functioning of these areas, which brings the total figure to 1,868 toilets throughout Spain.

About, Ignacio Pérez Catalan, specialist of the Internal Medicine service of the General University Hospital of Castellón and member of the Post-Covid tracking in conversation with Medical Writing points out that their unit has had two consultations for Post-Covid follow-up: one from Internal Medicine and the other from Pulmonology.

“In Internal Medicine, we are two specialists in charge of patient care But it must be taken into account that we do not have an exclusive dedication to the Post-Covid patient, but we also participate in the rest of the activities of the service. We have one morning a week to consult with the necessary physical space in case the appointment is in person. Surely the evolution of the pandemic itself will mark these needs, although these patients probably need multidisciplinary support in the first months / years of follow-up after the acute infection ”, explains the internist.


Monitoring and patient protocol ‘LongCovid’

In this thread, Germán Peces-Barba, vice president of the Spanish Society of Pulmonology and Thoracic Surgery (Separ), says that Covid has participated in the units a person from the Pneumology service, but that a colleague from the specialty has helped him to establish protocols.

“Depending on the hospitals, generally a person from the pulmonology service has participated within the team, which has been the link or coordination of the follow-up of the patients, but not necessarily this person has been solely responsible for the follow-up. The pulmonologist has participated in the team and has transferred the conclusions, but the protocols carried out have been carried out by other colleagues in the specialty because many times it was not approachable to perform it by a single doctor ”, argues Peces-Barba.

When asked about a number of pulmonologists who are required for the ‘LongCovid’ service, Peces-Barba points out that “they are few cases that remain with persistence of the Covid of the first wave enough to think of a number of specialists for service. In the first six months after the cases more doctors are required for follow-up, but after six months, very few ”.


Peces-Barba: “Depending on the hospitals, generally a person from the pulmonology service has participated in the team”


The expert agrees with Peces-Barba and explains that the evolution of the pandemic will mark the care needs for these patients. “In ‘LongCovid’ the intensity and quality of the symptom is so variable that it is an occupation that does not have a single specialty and an exact number of specialists to treat it cannot be determined. This is because patients who have had neurological, trauma, psychiatric complications, etc. have participated. Keep in mind that there are hospitals with 20 pulmonologists and hospitals with five specialists, so we cannot talk about figures because we do not know how the disease will evolve”He adds.

For its part, Margarita Marin Royo, head of the Pneumology service at the General University Hospital of Castellón and a member of the multidisciplinary group for the follow-up of Post-Covid patients, explains that determining the number of contracting pulmonologists for the ‘LongCovid’ service It will depend on each hospital and the number of specialists it has.

“In some hospitals there is a very precarious situation of Pneumology health personnel. If there are only three pulmonologists in a hospital and one takes care of Covid patients, they fall short for the other pathologies of the specialty”, Says Marín.


Request for pulmonologists in Valencia

The specialist points out that in her service she has had the participation of two pulmonologists hired to care for Covid-19 patients and that requires one more contract due to the high demand for the service.

In this regard, Marín says that he has joined the request of the heads of the Pneumology service of the Valencian Community to increase the staff to face the pandemic.

“The heads of the Pneumology service of the Valencian Community made a letter in which we claim that since Pneumology is the specialty where diagnostic techniques are carried out for patients suffering from Post-covid, with the predominant symptom of dyspnea, we are going to need more staff in pulmonary function testing labs and pulmonologists to meet the demands of patients who are expected to have respiratory sequelae, “says the expert.

“The first steps in the post Covid units have been taken”

Like the previous experts, Paloma Repila, spokesperson and deputy to the general secretariat of Union Action of the Nursing Union (Satse), considers that making an estimate of the number of professionals that a post-Covid unit requires is something “complex” and “Future”. In this regard, Repila appreciates that, in large centers, at least two or three nursing professionals are needed so that all work can be done. However, to date, these units are operating with only one nurse.


Repila: “In the first wave what we saw were deceased, but the Post-Covid horizon began to be seen”


“In doctors and nurses, the approach is of the minimum resource for the number of patients. I believe that estimates were made based on a first wave, which was very dramatic. In the post Covid units they are patients with sequelae, but, unfortunately, in the first wave what we saw were deceased, although the Post-Covid horizon began to be seen”Explains the nurse.

Repila considers that the first steps in the post Covid units have been taken, but that It is important that they be developed “urgently” given the large number of patients and the wide range of symptoms that are being encountered. A need for personnel that, he affirms, have suggested to the managers: “We have a very important niche in the professional units. If we don’t give these professionals a solution, there are fewer resources in the system”.

Two access roads

The so-called post-Covid units are not for hospital admission, but rather an area of ​​external consultations which is dedicated to monitoring patients who remain with sequelae. In this sense, the spokesperson for the Nursing Union explains to this newspaper that there are two access routes. On the one hand, these units are made up of patients whose symptoms have been complex and have been admittedTherefore, the route of admission is carried out from discharge, when the professionals do a follow-up, especially in the most serious cases.

On the other hand, they are patients who are ‘recruited’ through Primary Care, since a high percentage of the population has passed the Covid convalescence at home. “They don’t go to the hospital, so the entry way to these external consultations is done through their Primary School professionals, both doctors and nurses, who consider that its consequences are complex enough to require a specialist ”, he emphasizes.

The sequelae of the disease are numerous, as are the affected organs, so It is “very complex” to have outpatient clinics that screen such diverse patients. “It is very important that this area of ​​outpatient consultations has full-time trained and trained personnel, who are doctors and nurses, to make a first screening of all cases in order to prioritize. We are talking about nurses, auxiliary and support personnel, as well as clinical doctors, that is to say, internists, neurologists and pulmonologists ”. It is the internist who is in charge of carrying out a battery of basic diagnostic tests on the patient and, depending on the results, referring him to the corresponding specialist.

Given the diverse and broad group of workers who ensure the care and progress of these patients, the Satse spokesperson insists on the need to also involve psychology professionals, as an “indispensable” part of the follow-up. “It has to be included yes or yes within those post Covid units. These patients often have a disability that affects their day-to-day life and others even suffer from post-traumatic syndrome. The ‘damage’ is not only organic“, Add.

The “fundamental” work of Nursing

The spokeswoman for the Nursing Union remarks that the colleagues from the post-Covid units are carrying out a “very important” coordination and comprehensive logistics work. “We have never had an outpatient consultation that has to be related to the entire hospital. Nurses have the logistic role, in addition to the care role, ”he explains, underlining that, in these units, Covid managers are usually nurses, who monitor patients.

“We have taken a qualitative leap in this epidemic specific training and qualification has been valued that we have to have in special care and in case management “, concludes Paloma Repila, who puts on the table the” urgent “need to have a greater number of professionals to treat the increasingly numerous patients with persistent Covid.

Although it may contain statements, data or notes from health institutions or professionals, the information contained in Medical Writing is edited and prepared by journalists. We recommend that the reader be consulted with any health-related question with a healthcare professional.

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