There are fewer and fewer coronavirus patients in Spanish hospitals. This Wednesday, the rate of covid patients in intensive care units (ICU) entered the low risk threshold (below 10%), according to the parameters of the Ministry of Health. This indicator rose to 23.94% on January 24, record care pressure during the sixth wave and on the border of very high risk (25%). Then began a gradual decline that was also recorded on the floor (admissions that do not require intensive care): also this Wednesday, the proportion of hospitalizations for coronavirus compared to the total left the medium risk level and entered in the low level (below 5%), after reaching 15.25% on January 19. With the Health traffic light as a reference, it then reaches the very high risk level.
The sixth wave “has been very complicated” for hospitals, explains Ricard Ferrer, head of the intensive medicine service at Vall d’Hebron hospital and member of the board of directors of the Spanish Society of Intensive Medicine (Semicyuc). “It was by far the longest wave. It started with the delta variant in November and accelerated in December with omicron. The Christmas operation was particularly complicated, with many victims and isolated personnel. There came a time when some patients were infected with covid in the hospital itself,” says Ferrer. “The sixth wave was no joke. It put a lot of pressure on hospitals. Without such high vaccination rates – 91.1% of the population over the age of 12 have at least two doses – its effects would have been terrible,” said María José García, spokesperson for the Satse nursing union.
This wave of infections was the one that reached the highest. The cumulative incidence of cases every 14 days per 100,000 inhabitants reached 3,418 cases as of January 21: this means that out of 100 inhabitants, three have been infected in the last two weeks. Among the youngest, this rate has climbed to almost one infected for every 10 people in certain territories. The very high levels of vaccination, the fact that millions of people had already transmitted the infection and, to what extent, the lower severity of the omicron variant prevented hospitals from collapsing.
“With these levels of contagion, without vaccines, it would have been much more difficult in hospitals,” adds Ferrer. That’s not to say they haven’t been under pressure, but the revenue-to-infections ratio has been much lower in this wave than in previous ones. For example, on February 1, 2021, at the height of the third wave, there were 4,894 people admitted to intensive care for covid. On that day, the cumulative incidence was 865 cases per 100,000 population over the previous two weeks. However, at the height of the sixth wave, with four times the incidence (3,418), there were half of those admitted to intensive care (2,202). The level of infections has soared largely because, unlike previous waves, governments have imposed virtually no restrictions.
Ferrer believes that this wave of infections, unlike previous ones, had a longer impact on the service than on the ICUs: “The exception in this wave is that the decline in the ICUs has been faster than in the service” . This is due, in the opinion of the head of the intensive care medicine service of the Vall d’Hebron hospital, to the fact that ómicron has been less aggressive than the previous variants, although it has been transmitted more. This impression is backed up by data: While peak daily ICU admissions have hovered around similar numbers to the fifth and fourth waves, hospital admissions have been much higher. In the sixth wave, 19,617 people were admitted to the plant, compared to 10,578 who reached the fifth.
The same logic (higher transmission with a lower proportion of critically ill patients) explains why the health service that has suffered the most, according to the Satse spokesperson, is primary care medicine. “That’s where the hit of this wave was concentrated. The fact that many citizens did not need to be admitted to hospital meant more work for the health centers, which found themselves very saturated,” explains García.
It is difficult to calculate how many people died throughout the sixth wave, as some people who died in recent months could have been infected in previous waves. But a rough calculation, based on the number of covid deaths reported in late November so far, shows around 12,000 deaths. In mid-February, the Minister of Health, Carolina Darias, estimated the lethality of the sixth wave at 0.15%. In other words, for every 1,000 people infected, 1.5 die. Global case fatality data has declined as the pandemic progressed: in the summer of last year it was 2.1%, at the start of the sixth wave it was 1.7% and now it is 0.9%.
“More Hospital Muscles”
With the sixth wave falling, García doesn’t feel like the toilets feel relieved in their job. “In general, we now think of the coronavirus to measure how hospitals are doing. And it doesn’t work like that. The waiting lists have increased these months in a gigantic way. Diagnostic tests for life-threatening diseases have been delayed. We need more staff and they took away almost all of the staff we had gained as reinforcements due to the pandemic (as of October communities had dispensed with at least 21,000 health workers hired in reason of the health crisis)”, indicates the representative of the nurses. Ferrer makes a similar reflection: “During the pandemic, we improved in equipment, in Stock, in pharmacy… Where we have not made progress is in human resources. It’s all based on lots of overtime and sacrifice. In the first waves it was different, it seemed something exceptional. This latest wave has been devastating.
“The thought that has settled in public opinion,” continues the head of the intensive medicine service at the Vall d’Hebron hospital, “is that there will be no more restrictions in Spain. specialists who insist that they are still needed, but politicians and the line of thought do not go in this direction. But the virus continues to circulate. Ferrer believes that the only way to make the flu of the pandemic and the lack of restrictions is that “with more muscle in the hospitals; it’s more profitable than closing bars or restricting social interactions. It is not necessary to wait for the hospital to collapse to act. He bets that the reinforcement resuscitation services adapt to other functions as long as the pandemic does not worsen: “It’s like the firefighters. You don’t need them all the time, but they should be there the day you need them. And you have to keep in mind that there are still people who don’t get vaccinated and others who don’t get a booster. If they don’t help us, each new wave will stress us out.
Differences by territories
Catalonia is the community whose ICUs suffered the most during the sixth wave. They are now more than 40% occupied by coronavirus patients, when the very high risk is marked at 25%. Factory data was also extremely high, reaching as high as 18%. In this section, the worst records are marked by Madrid, which has reached almost 20% hospital occupancy due to covid, with ICUs at 28%. This is a slightly lower figure than Melilla, Euskadi, Aragón or Navarre, which also had around 30% of coronavirus patients in intensive care.