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

He arrives at the University Clinical Hospital in Valladolid around 7.30 am and leaves when he can. In this year of a pandemic, he learned, like the rest, to “stretch like a gum” because he has no choice. The regional coordinator of internal medicine against COVID-19, Carlos Dueñas, does not lose his temper despite the marathon days when more and more patients have to be treated; look for alternatives and have an emergency plan for emptying clean plants; open dirty, decide what to do with non-COVID-19 patients and thus minute by minute, under the threat of the number 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 non-stop pandemic, which leaves everyone exhausted and especially in the face of a tsunami that is about to reach hospitals and killed, 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 gymnasiums and cafes of the hospital, if people are not aware, this could be a catastrophe,” adding that the pandemic non-COVID patients- 19 I pay him, too. Therefore, he asks for self-completion and warns: “We had not seen so many marriage rooms together. These are the consequences of family reunions. “

It has become a mantra. The health system is saturated, the killings are overflowing, the emergency room is overloaded, professionals are exhausted … You, who are at the bottom of the barrel, thinking about this situation in a society, in theory, evolved? What else does he have to tell us?

The messages are clear and have been since March last year. The problem is, I don’t know if I’m getting in properly. The reality is that hospitals are prepared to receive a limited number of hospitalizations and not so many that they become overloaded and cause things to not work as well as they should. Castilla y León two weeks ago had about 600 patients admitted to the COVID-19 factory and now we have 2,000. An increase of 1,400 patients in 15 days is brutal for hospitals, and to this we must add that patients without COVID-19 continue to come; Traumatic emergencies, myocardial infarction, strokes, digestive bleeding continue to occur. 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 that, Río Hortega, Clínico, Palencia, Segovia … And that, with a limited number of professionals, and no one leaves work at three in the afternoon. The quality of care is diminished by the avalanche of patients we have, that’s right. And people need to understand that hospitals have a limited number of beds and that we can’t keep up with this rate of revenue. If they do not limit themselves and do things right, hospitals will suffer a lot, we are already suffering.

They had to tell someone sick to come back tomorrow; do you send home people who would otherwise have been hospitalized?

No, because we end up inventing ourselves. If we have to look for beds under stones, we end up looking for them like Palencia did. If you need to activate the gym to participate in patients, we activate it. But it’s not the same to see patients on the floor except in a gym; the quality of care is also diminished. It is so. Be stricter in the emergency room when deciding on an admission, yes, but if it is indicated, it will not say no. We will have to find a place for them anywhere. So, we reinvent ourselves, the surgeries are taken to private hospitals, so that patients do not occupy beds. That’s what we did, reinventing ourselves and looking for beds where there is almost nothing.

Given the number of infections not dropping below 2,000, with the addition of the much more contagious and apparently even more deadly British strain, are you afraid of the worst of the last fifteen days?

As long as we continue with very high incidences, hospitals will endure a lot of medical pressure and, 15 days after the decrease in infections, we will continue; and killed, another month. When the incidence figure is normalized, we will have problems in hospitals for almost a month. If we add to this the gradual increase in patients suspected of the British variant, as the transmission increases, we will have more income. Everything goes against hospitals and primary care.

Can we return to the situation in April, to the worst moments of the pandemic?

If we continue like this, yes; we are already close in number. In April, the clinic reached a maximum of 200 patients in the ward and in the ICU up to 70, and now there are more than 160 and we have another two or three weeks of travel with a large number of hospitalizations. There are hospitals in the Community, such as León, which already has higher numbers than in the first wave, or Palencia or Ávila …

Have referrals already started between hospitals, to make room for the next patients, to free 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 in Segovia, which was a little faster, sent patients to the ICU in Burgos, the clinic and the Río Hortega; Medina del Campo also has no intensive care. Yes, there is movement. And upstairs, in addition to transfers to Rondilla Hospital – which received patients from Clínico, Río Hortega, Palencia, Segovia, Ávila and Medina del Campo – Palencia Hospital had to send some patients to the Hospital of Burgos and the Clinic of Valladolid with significant respiratory impairment because they could not afford all patients in the ward at peak hours.

Will the Rondilla building be enough, or are you afraid to return to field hospitals?

It has a capacity of up to 200 inpatients. With the full opening of the second factory, we have a capacity of 90 and we are seventy-something. We will probably hit 90-93 patients these days. If more beds were to be opened due to hospital overcrowding, they would be opened as soon as staff were available.

Another problem, because professionals do not come out from under the rocks?

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

And how are those professionals, with an accumulated fatigue that no one lacks?

Doubling the exchanges, multiplying the guards, with several patients taking care of each; with a pathology that does a lot of psychological damage, because there are patients who get sick and for whom you can’t find a solution because it doesn’t evolve well. This is very difficult physically and psychologically. People are exhausted, as they can be; exhausted. But hey, we know what we decide to do and we pull where it doesn’t exist. We try to make people rest a reasonable minimum, because this is a long distance race … We have been there for almost a year and it does not seem that this will relax so soon.

In a normal situation, how many patients does a doctor see and how many touch now?

I gave an example from the Clinic. In January a year ago, the hospital had eleven intensive care beds, currently 71 working, and the staff has grown by one person. At this time, in internal medicine there may be about 70 patients in a normal situation, and at this time we have 80 patients with COVID-19 and 60 non-COVID-19 patients, more or less with the same staff. We see more than twice that of regular patients and the same happens in pulmonology and everywhere. It’s not enough to double your work in a bad period like January with the flu.

What bill is the pandemic that passes into the system and especially in those non-COVID pathologies that are still present; to surgery?

They pay for it. Having to dedicate a lot more money to COVID-19 pathology, you have to get rid of them from other sites. At this time, the Pulmonology and Internal Medicine departments are practically dedicated exclusively to patients with COVID-19. Consultations for other related pathologies are stopped or delayed. Imagine what lung cancer was not diagnosed because the consultations are delayed … But there are also professionals from other specialties who collaborate with us, where the activity is also declining. Collaborates digestively, which means that studies, for example, on colon cancer and others are delayed; the same will happen in Onlogy. We are sure that we are postponing the diagnosis which has prognostic implications. It is not the same to diagnose colon cancer at an early stage, but at a more advanced stage, because the risks it has spread are already higher. That is right. In the first wave, we all stopped it and now we combine what can be COVID and non-COVID care.

You, who see him every day, are there young people in the ICU?

The average age of patients admitted to the ICU and in the ward is decreasing. I haven’t seen so many marriage rooms together in this hospital like now. These are the consequences of family Christmas gatherings. I’m the husband and wife, two brothers-in-law … And there are people, generally younger than in the first wave.

We all have our hope for the vaccine. What breath do you think you can breathe 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 it will be, as long as there is no option to skip the vaccine, and at the moment the only one that seems to be less effective is the South African and except for one case in Spain, it seems we no longer have. The answer is to be able to vaccinate at least 70% of the population, they tell us in the summer, but if it could be earlier, much better. Israel is vaccinating heavily and is already seeing it in the infection figures.

We didn’t stumble 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 the economic risk, they can be somewhat easier when making decisions. Most toilets would have closed and closed everything a long time ago. And, on the other hand, people; There comes a time when the heads change, they stop receiving information from COVID-19 because they are saturated. There comes a time when he has to go out and breathe. Everything comes together a little. The population is probably saturated and needs a breath; Policies are complex, it is not easy to close like in the first wave and, finally, they all have their consequences.

Finally, what else can you ask or tell the population?

That things are going well is not in the hands of politicians or doctors. They need to be aware of the situation, the danger of collapse for the health of Castilla y León. That they are as long as possible in their homes, with the minimum of people they usually interact with. Let them do some kind of self-restraint, because if they don’t, there will come a time when, even if we open the hospital’s gyms and cafes to put them to bed, we won’t be able to help all the patients. We will end up like Portugal. If people are not aware and responsible, this can be a catastrophe.