At the heart of the pandemic

By Julia R. Arévalo

Madrid, Apr 3 (efe-epa).- There are just a few thousand medical workers at the heart of the pandemic in Spain: the intensive care experts, who are most exposed to the coronavirus, have to make the most heart-wrenching decisions and will be unable to save the lives of countless patients because of a lack of resources.

In the coming weeks and months, it is they who will need the most support from a society that has yet to come to terms with the true scope of this pandemic.

According to official figures, around 15 percent of patients with COVID-19 require intensive care for between 18 and 24 days, much longer than the average 4.6 days people spent in Spanish ICUs before the crisis erupted.

As April began, Spain had over 110,000 confirmed cases, half of which had been hospitalized. About 11.3 percent of those, some 6,092 people, had been admitted to ICUs.

With 4,400 ICU beds available (according to figures from 2017), Spain only has 10 for every 10,000 people, a third of the rate in Germany. Available spots in ICUs are the only means of survival for critically ill coronavirus patients, but newborns, burn victims and heart patients, among others, still desperately need them as well.

Barely 3,000 doctors and a few thousand nurses manning Spanish ICUs must carry the weight of the national crisis on their shoulders and face the most unbearable moral dilemma the pandemic has presented.

Health authorities have tried to increase the number of beds for coronavirus patients by erecting field hospitals in every available place, including at the sprawling IFEMA exhibition grounds in Madrid, where they expect to install 5,000 beds.

But after installing 1,300 this week, Antonio Zapatero, the director of the field hospital, warned: “We’re lacking intensive care workers.” Without them, setting up ICUs will make little difference.

“Furthermore”, he said, “ICU workers are among those who have been most affected by the virus”.

“It’s not even possible to cover the needs of the hospitals themselves with specialized personnel. As more and more intensive care workers fall ill, they are being replaced by anaesthetists and ICU pediatricians. But the quality of care cannot be the same,” says an ICU specialist at a hospital in Toledo, a neighboring province to Madrid.

The center in Toledo has tripled the number of ICU beds “and even then, it is absolutely impossible to admit all of the patients who need it.

“They stay in the hospital, they’re given mechanical ventilation, but they all pass away.”

The acute respiratory syndrome caused by COVID-19 requires the critically-ill patient to be intubated and rotated several times a day. They are highly contagious and complex maneuvers, requiring at least four workers per patient.

“It’s really difficult, especially with no professionally trained nurses,” the specialist adds. Recent studies warned that 75 percent of ICUs in the country needed more nurses.

Amid the emergency, other specialists have been freed up of their daily tasks and minor surgeries to lend a hand. Orthopaedic surgeons help rotate the ICU patients, pneumologists make sure people who cannot be intubated have ventilators, while other colleagues manage requests for analyses or field daily calls to family members to inform them of the status of their loved ones in isolation, whom they cannot visit.

PRIORITY: PATIENTS WITH THE BEST CHANCE OF SURVIVAL

The Spanish Society For Intensive, Critical and Coronary Units (SEMICYUC) has issued ethical decision-making guidelines for its more than 2,600 members amid the pandemic.

“When deciding how to assign resources, criteria of suitability must be applied and factors such as a patient’s age, if they have underlying health conditions, the severity of the illness, whether other organs will be compromised and reversibility (whether reverse treatment would be possible) should be considered,” the guidelines advise.

The recommendations say that doctors should “prioritize those who have the best chance of survival and enjoying a minimum quality of life”, and rule out intubation for all patients over the age of 80 or with underlying health conditions.