“I hadn’t seen so many double rooms together”

He arrives at the Hospital Clínic Universitario de Valladolid around 7.30 am and leaves when he can. In this year of pandemic he has learned, like the rest, to “stretch like chewing gum” because he has no other choice. The regional coordinator of Internal Medicine before the COVID-19, Carlos Dueñas, does not lose his temper despite marathon days in which more and more patients need 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 new contagion figures. “Extremely high” figures that no longer breathe and that strain every second in hospitals; and all with the psychological and physical fatigue of a pandemic that gives no respite, that leaves anyone exhausted, and more in the face of a tsunami that is about to reach hospitals and kills, because today’s infections are tomorrow’s centers. With all his imagination on the table and looking for beds where there are none, he laments, “Even if we open the gymnasiums and cafeterias of the hospital, if people are not aware, this can be a catastrophe,” he said. ‘unites that the pandemic is also being paid for by non-COVID-19 patients. That is why he calls for self-financing, and warns: “I had not seen so many double rooms together. These are the consequences of family reunions.”

It has become a mantra. The health system is saturated, the killings are overflowing, emergency overload, professionals exhausted … Are you at the bottom of the canyon, 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 with him since March last year. The problem is that I no longer know if they are needed as they should be set. 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 overloading and making things not work as well as they should. Castilla y León two weeks ago had about 600 patients admitted to COVID-19 and now we have 2,000. An increase of 1,400 patients in 15 days is brutal for hospitals to take on, and to this must be added that patients without COVID-19 continue to come; traumatic emergencies, heart attacks, strokes, digestive hemorrhages continue to arrive. We are on record daily income, doubling them and hospitals have a limited number of beds, we can invent them. We are all like this, Riu Hortega, Clínic, Palencia, Segovia … And this, with a limited number of professionals, and that no one is leaving work at three in the afternoon. The quality of care is diminished by the avalanche of patients we have, that’s how it is. And people need to understand that hospitals have a limited number of beds and we can’t keep up with that rate of revenue. If they don’t confine themselves and do things the way they should, hospitals will suffer a lot, we are already suffering.

They have already had to tell some patient, come back tomorrow; send people home who in other circumstances would have been hospitalized?

No, because in the end we end up inventing. If you have to look for beds under the stones, we end up looking for them as Palencia has done. If you need to enable the gym to care for patients, we enable it. But it’s not the same to see patients on a floor as in a gym; the quality of care is also diminished. Is it like that. Be stricter in emergencies when deciding on an admission, maybe yes, but if it’s indicated, you won’t be told no. You will have to look for a place wherever you are. Then, we reinvent ourselves, surgeries are taken out in private hospitals so that patients do not occupy beds. It’s what we’ve been doing, reinventing and looking for beds where there are almost none.

Given the numbers of infections that do not fall below 2,000, with the addition of the British strain, much more contagious and apparently also more deadly, are they fearing the worst in a fortnight?

As long as we continue with very high incidences, hospitals are going to be enduring a lot of healthcare pressure, and 15 days beyond the contagions go down, we will continue; and the ucis, one more month. When the incidence figure normalizes, we will still be in trouble in hospitals for almost a month. If we add to this the progressive increase in patients with suspicion of the British variant, by increasing transmission, 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 a maximum of about 200 patients in the plant and in the ICU up to 70, and now there are more than 160 and we still have two or three weeks to go 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 leave the following patients empty, to vent 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 Hospital de Segovia, which has been a little more rushed, has been referring patients to the ICU in Burgos, the Clinic and the Hortega River; Medina de el Camp, too, which has no ICU. Yes there is movement. And on the ground floor, apart from the transfers to the Rondilla Hospital – which has received patients from the Clinic, Hortega River, Palencia, Segovia, Ávila and Medina now! The Hospital de Palencia has had to send a patient with significant respiratory impairment to the Hospital de Burgos and the Clínic de Valladolid, because they could not take on all patients on the floor at peak times.

Was the Rondilla building enough, or do you fear going around the field hospitals?

It has a capacity of up to 200 patients admitted. With the full opening of the second floor, we have a capacity of 90 and we are with seventy-something. We probably reach 90-93 patients these days. If more beds needed to be opened due to hospital saturation, they would be opened when staff became available.

Another problem, why don’t professionals come out from under the stones?

We stretch like chewing gum and do what we can. We are not in the ideal situation, we have to double the number of patients we see, diagnose it; double the guards … Right now there are ten doctors working at Rondilla Hospital, and this is the smallest problem, it’s more that of the nursing staff, because there are no nurses. From here, I would like to thank the nurses who work 1-1-2 days a day who have just joined this hospital as volunteers on days off.

And how are these professionals, with an accumulated fatigue that no one escapes?

Bending shifts, multiplying guards, with many more patients in charge of each; with a pathology that does a lot of harm psychologically, because there are patients who get bad and who don’t find a solution because they don’t evolve well. This is very hard physically and psychologically. People are exhausted, as it will be; exhausted. But hey, we know what we’re up to and we’ve got a lot out of nowhere. We try to get people to rest a reasonable minimum, because this is a long-distance race … We’ve been around for almost a year and it doesn’t look like this is going to loosen up so soon.

In a normal situation, how many patients does a doctor treat, and how many do they touch now?

I give an example of the Clinic. In January a year ago, the Hospital had eleven Intensive beds, 71 are currently in operation, and the staff has increased by one person. At that time, in Internal Medicine there may be about 70 patients in a normal situation, and right now we have 80 COVID-19 and 60 non-COVID-19 patients, more or less with the same staff. We are seeing more than twice as many regular patients, and the same goes for Pulmonology and everywhere. It’s at least doubling the work in a bad time like January can be with the flu.

What bill is happening to the pandemic in the system and especially in these non-COVID pathologies that are still present; to surgical interventions?

They are paying for it. Having to dedicate many more effective ones to COVID-19 pathology, you have to get them out of other places. Right now, the Pulmonology and Internal Medicine services are dedicated, almost exclusively, to COVID-19 patients. Consultations for other related pathologies are stopped or delayed. Imagine what could be an undiagnosed lung cancer because consultations are delayed … But there are also professionals from other specialties who are collaborating with us, where the activity is also going down. Digestive collaborates, which is likely to result in studies, for example, of colon cancer and others being delayed; in Onlogía the same will happen. Surely we will delay diagnoses that have implications for prognosis. It is not the same to diagnose a colon cancer in an initial state, than in a more advanced stage, because the risks that have spread are already greater. This is so. In the first wave we all stopped it, and now we are combining what can be COVID and non-COVID care.

You who see it every day, are there young people in ICUs?

The average age of patients admitted to the ICU and on the floor is declining. I hadn’t seen so many double rooms together in this hospital as now. These are the consequences of Christmas family reunions. They are the husband and the wife, two brothers-in-law … And they are people, in general, younger than in the first wave.

We all have hope poured into the vaccine. What breath breath do you think you can give, and when can that breath come?

It will all depend on the percentage of vaccination and the doses we have in the short term. The sooner we have a vaccinated population the better, as long as there is no variant that skips the vaccine, and at the moment the only one in which it seems not so effective is the South African and, except in one case has in Spain, it seems we have no more. The respite is to be able to have at least 70 percent of the population vaccinated, we are told in the summer, but if it could be much better before. Israel is vaccinating en masse and is already noticing it in the contagion figures.

We stumbled twice no, three 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 analyzing the risk of transmission over economic risk, as they can be a little lighter when it comes to making decisions. Most toilets would have closed and confined everything a long time ago. And, on the other hand, people; there comes a time when bosses 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 break; the policies are complex, it is not easy to lock and key as in the first wave, and in the end everything has its consequences.

Finally, what else can be asked or said of the population?

That things are going well is not in the hands of either politicians or doctors. They must realize the situation, the danger to health in Castile and Leon of collapse. Let them be at home as long as possible, with the minimum number of people with whom they usually interact. Let them do a kind of self-confinement, because if not, there came a time when we still open the gyms and cafes of the hospital to put beds we will not be able to assist all patients. We will end up with Portugal. If people are not aware and responsible, this can be a catastrophe.