“The danger is that we forget too quickly how we were a month ago,” says Agustín Utrilla on the phone. The medical director of the Ramón y Cajal hospital in Madrid attended the “furious” transformation of a building that he has been on for the last 38 years. He has managed to record 35 deaths in one day on his statistical sheet, on Saturday he scored four; on March 30 they reached 103 critics in the ICU, this weekend they had 57; 891 covid-19 patients occupied beds, a few days ago 346 did. The numbers reported the check of the virus to the health system in Madrid and the numbers already give it, since two weeks ago, of a gradual, cautious and somewhat uncertain recovery . And with its gaze fixed on some changes that the pandemic has caused and that they hope to make permanent.
That step “will be marked by the evolution of the virus, the confinement and how we get out of it, slowly,” recalls Rubén Flores, Head of Nursing at Gregorio Marañón, who points to May and June so that the changes that have begun stabilize, and autumn to more or less breathe normally. “We have one foot out, starting to redefine the hospital, recovering some healthcare; preparing circuits for coronaviruses and other pathologies. Although for all that it is necessary that the professionals return to their reference units ”, he alleges.
Visual guide to de-escalation: dates, phases and all the keys to return to normality
–As in the Marañón, it occurs in all hospitals in the Community of Madrid. When the pandemic arrived, the templates squared in front of it, although all the centers, large and small, managed to save clean areas. In the Ramón y Cajal, for example, 80 beds were kept. “There are more, such as surgical activity and some non-delayed consultations,” says its medical director. In Ramón y Cajal, the start day “of the reverse gear” was April 8: “Deep cleaning. The UME came with peroxide for the areas that could stop being for this infection. ”They already have the patients separated: one wing for coronavirus, another for the rest, with about 400 in each space.
Return from usual emergencies
The last two weeks have reflected a clear decrease in care pressure. Emergencies are the best mirror. In the Marañón, the medical and surgical specialties were reduced to a third, the majority, some as trauma or dermatology remained at 10% of the usual; oncological and neurological, over 50% and only nephrological and cardiac area maintained the figures during the worst of the pandemic.
The head of that service, Juan Antonio Andueza, wondered for weeks “where were the heart attacks, the strokes, the usual patients?” His team attended the second half of January to 7,396 people, the second of March to 4,010, “mostly covid.”
“Where were the heart attacks, the strokes, the usual sick?”
Juan Antonio Andueza, head of the emergency department of Gregorio Marañón
Admissions from his area were also a sign of what was happening: “In the second half of January, 892 patients were admitted, all of whom we saw, 12%, and in the midst of an epidemic, the second half of March, we entered 1,721, the 42 , 92% ”. Fewer patients attended, but tripled the need for admission. The same happened in Ramón y Cajal, on a normal day they attend more than 450 emergencies, of which around 25 are admitted, “with the pandemic if 150 arrived, we entered 100,” recalls Utrilla.
It is also the turn of the recovery of services such as obstetrics and gynecology, which were centralized in four hospitals at the beginning of the crisis (La Paz, Gregorio Marañón, Doce de Octubre and Puerta de Hierro-Majadahonda). In the Severo Ochoa, in Leganés, one of the small hospitals in Madrid most sparked by the virus, they did not even have a free corner and they taped the oxygen to the wall with patients waiting for admission. “We are already cleaning the maternity to be able to recover the area, we have fewer patients than what is usually a bad day in a normal context [unos 80] and we have already managed to free several areas for non-covid patients ”, explains the hospital.
Future changes
This regression will also touch the agendas, paralyzed for the non-urgent during the crisis. The Severo Ochoa assures that they have verified that “telematic assistance works”, which may mean a future change for health care. They have also had this perception in Marañón and Ramón y Cajal. “This flexibility has allowed us to continue attending to remote patients, and has made it visible that not everything in person is essential, we can move in that margin from now on, ”says Utrilla.
This lack of presence of patients, especially in emergencies, has also made clear something that has been warned for a long time: abuse of the system. Utrilla says that this “has to be useful to learn”: “If we have an entry rate of 10% having 500 patients, it means that only one in 10 really have something that cannot wait.” Responsible use, he explains, means optimizing resources.
And, less logistical but essential, the pandemic has recalled the value of some things pointed out by Luis Manzano, the head of Internal Medicine at Ramón y Cajal. The first, that of the work of professionals and the public health system: “I do not imagine working in a system that prevents me from caring for a patient because they do not have the papers in order”. Also that of accompaniment and closeness in an experience that he defines as “heartbreaking” and that ensures that, once again, “teaches him that the greatest human suffering is not caused by illness, but loneliness”. And the last, that of “attitudes as noble as solidarity, friendship and brotherhood among colleagues, and the affection and affection of the patients.”
Manzano wonders if what happened could have been foreseen and if preventive measures could have been taken and provided with resources of protective materials. “In my opinion, when one examines the past with a magnifying glass or with the retrospective mistakes and faults are easy to detect. ” He believes that the important thing is not to look for culprits, but to respond to a necessary reflection: “The way health care is managed in our country.” And it has to do with a fear shared by those who have suffered from the coronavirus tsunami. Andueza, del Marañón or Manzano y Utrilla, del Ramón y Cajal, repeat it several times throughout the conversation: a sprout. “So, let’s not forget the hell we went through a month ago,” says Utrilla.
New contracts and vacations for the health system
To discuss this return from the hospitals, the medical directors of the Madrid hospitals and the Health Minister Enrique Ruiz Escudero sat down in front of their computer screens – in addition to the Deputy Minister Ana Dávila and the Director of Human Resources in this area Raquel Sampedro-. Some of those who witnessed this virtual meeting tell us that it was an hour and a half “very technical” and quite “general”: an x-ray of the situation, a projection of the future without deadlines or guidelines … Although with various specifications.
Among them that the restrictions on the vacation period of health professionals that were imposed at Easter were repealed and that the period to enjoy these permits was extended until October (usually from June to August). They also decided that medical and Human Resources directors of the hospitals would give a number of people to hire from now on. “Now around 100 seniors end up, for example, in large hospitals. And the 100 new ones have not yet taken a place. Obviously, I want those 100 to stay, ”says Utrilla.
The issue will be resolved in a couple of weeks, although they have already been asked to continue the effort to make up for lost time with patients who are on the waiting list for specialties or surgeries. Rubén Flores, head of the Nursing service at Gregorio Marañón explains that planning the healthcare activity requires “a significant effort and the exhaustion and emotional stress of the staff must be taken into account, in addition to having to give vacations and libranzas ”. That, alleges the medical director of Ramón y Cajal Agustín Utrille, “we can only do it on the basis of hiring.” In his hospital there are 216 workers on suspicion or contagion, and 1,161 have already joined. It is very clear: “We cannot ask people who have been killing each other for two months, who have lived in isolation from their own families, who are exhausted, who only have 15 days of vacation or who continue working indefinitely day and night. I’m certainly not going to do it ”.
Information about the coronavirus
– Here you can follow the last hour on the evolution of the pandemic
– This is how the coronavirus curve evolves in Spain and in each autonomy
– Questions and answers about coronavirus
– Guide to action against the disease
– In case of symptoms, these are the phones that have been enabled in each community
– Click here to subscribe to the daily pandemic newsletter
–
Due to the exceptional circumstances, EL PAÍS is offering all its digital content for free. Information regarding the coronavirus will remain open as long as the severity of the crisis persists.
Dozens of journalists work tirelessly to bring you the most rigorous coverage and fulfill their public service mission. If you want to support our journalism you can do it here for 1 Euro the first month (from June 10 euros). Subscribe to the facts.
Subscribe-
