Madrid will advance in the lack of confidence, as confirmed by government sources to this newspaper, but not as expected: it will be something similar to the so-called phase 0.5, which Barcelona has also proposed. This consists of allowing the reopening of commercial activity without an appointment and with capacity limitations, but it is not authorized to open the terraces or social or family gatherings of people who have not passed the quarantine together. The Community insists: “We are going to ask to go to phase 1”.
“Because the healthcare data support it”, “because the applied measures support us” and “because it would be a comparative grievance with respect to other communities”. Those are the three points of the argument to pass the phase in the de-escalation that the Community of Madrid leaked on Thursday night, shortly after President Isabel Díaz Ayuso published a tweet about the experts’ decision, which will be taken this Friday. : “The Ministry of Health does not seem to be willing for Madrid to go to phase 1, but it does not give technical reasons. We are summoned to another meeting tomorrow [por este viernes]. Madrid meets all the criteria: it has increased its capacity for beds and PCR, a lower rate of infections… ”.
In this file, the Community assures that “it has strengthened the control of suspicious cases through the implementation of a system for the detection and monitoring of infections and contacts, coordinated by Public Health, which also includes all hospitals public and private, AP [atención primaria] and SUMMA “, adds that” the extension of the contracts for Primary Care and SUMMA has been launched “and points out that” its development was the only point of improvement requested by the ministry to change phase “. That one point is not fulfilled.
The Government is inclined not to let Madrid go to phase 1
–The document from the Ministry cites Dr. María José Sierra, deputy director and spokesperson for the Center for the Control of Alerts and Emergencies: “It is necessary to have more insured and the Primary Care system working so that any suspected case can be diagnosed. This is necessary to pass phase. This Primary Care system must take a week rolled ”. According to the government of Isabel Díaz Ayuso, “the system would be operational for 8 days on May 18, the day that Madrid asks to change phase.”
On May 18, the protocol for this system to work would have been eight days in emails from health centers, but not eight days operational. The guide for professionals landed in health center emails on Sunday night and Monday was met by professionals. However, this reinforcement of the primary to which the Community of Madrid alludes has not been carried out.
This is the protocol of primary care with which Madrid will try to jump to phase 1
–Several primary physicians in the capital assure this Friday morning that at their centers, staff reinforcements, “not one has arrived.” In addition, the reorganization of this assistance has not been completed after the closure of Ifema, which absorbed a few hundred Family Medicine professionals, and around 70 doctor’s offices still remain closed during the week; Neither have the emergencies been restored at night or on weekends, and those professionals complain about the “absolute lack of personnel” this Friday.
Last year residents of this specialty still do not know anything about their future and their residency ends on May 26; the last year of Preventive Medicine and Public Health have not yet joined the team that has to start the procedure. And none of the doctors or nurses that this newspaper has contacted know who they are, where they are, and when the trackers will arrive.
Explains a nurse from a health center in the south of Madrid that “for that to happen on Monday, this search should have begun and, for that search, they should have provided staff to the centers. And it hasn’t happened. ” A family doctor summarizes: “Just because the guideline arrived in the mail does not mean that the protocol will be put in place, hopefully it will be next week.”
Another of those doctors, Antonio Cabrera, affirms that “human reinforcements” have not reached “almost any” center, and “they have received PCR, but it does not seem that in sufficient numbers for the forecasts and not all the PCRs of the same quality” . Some practices, he says, “have been limited to 20 a day.” In his, Daroca, in Ciudad Lineal, with more than 50,000 health cards, not a single more worker has been added yet.
Two weeks of request to phase 1
Last week, Madrid already made the request to pass the phase. He did it against the arguments of his former director of Public Health Yolanda Fuentes, who resigned because she was not willing to endorse the decision to request the de-escalation. The government of Isabel Díaz Ayuso ignored the recommendation of Fuentes, who had sent a report on May 5 with all the information that supported that Madrid should wait. And they presented that petition arguing that they had healthcare capacity and had put in place the necessary protocols to track and follow covid-19 infections.
The keys of the report of the former director of Public Health of Madrid: “It is not recommended to change phase”
–Seven days ago the region already met the criteria for hospital capacity, although both Fuentes and the Ministry’s Public Health experts observed that “prudence” was recommended regarding ICU beds, which were still highly occupied. How are those figures this Friday? We review here some of the numbers offered by the Community of Madrid.
Care data
This Friday, Madrid accumulates 66,005 positives for PCR, it has 1,927 patients in its plants, of which 358 are in the ICU. And there are already 14,018 dead. The region details that hospitalization has decreased (86%), patients in the ICU (73%), in the Emergency Department (93.82%) and in primary home follow-up (90%). In the ER, for example, they mention that the maximum was 2,654 patients (although they do not detail the day) and last May 13 it was 164; They also give AP numbers, going from 24,081 patients (also not dated) in one day to 2,244 on May 13.
The numbers began to drop on April 3, just after the peak of hospitalized and severe in intensive care units was reached. On March 31 it occurred in acute cases, with 15,227 patients admitted. Two days later, on April 2, the critical units did so, reaching 1,528 intubated patients. With the forks set by the Ministry, the region, with 6,642 million inhabitants, would have to be able to have, in a maximum period of five days, 24,575 to 26,568 hospitalized places and 996 to 1,328 ICU beds.
A UCI chief: “I’m afraid it will happen again”
–After the brutal restructuring that the hospitals carried out in a few days – some of them tripled their capacity in the plant and six times that of the ICU – the region could meet that requirement. In the acute hospitalizations, they could do it with those extensions made by the hospitals, with the medicalized hotels and the field hospital of Ifema, but not without them, as they affirm in their document. Before the pandemic, the region had 20,743 beds (13,654 public and 6,819 private) in its plants, according to data from the Community.
Regarding the capacity of the UCI, the Ministry assures that it has 1,350 and has reached 1,942. The data reflects another reality. Madrid entered the pandemic with 641 ICU places (500 public and 141 private) and if it was able to reach 1,528 seriously treated patients, it was because hospitals turned everything they could convert into critical units: operating rooms, resuscitation units, recovery units from anesthesia and even gyms.
The 30 most critical days in the history of the ICU: how they were reconverted to survive the collapse
–They used all the respirators they found within their reach, even unsuitable ones, such as transport ones, to try to save the lives of those battling covid-19 in their beds; and they never had enough critical hands, they needed the help of anesthesiologists, and many nurses from many other specialties stood up to deal with the virus, inexperienced.
But, even so, Madrid never reached 1,942 ICU beds. He could have done it if he had fulfilled the forecast they had for the Ifema field hospital: 500 ICU places. They managed to mount 16 critics, although only 13 were occupied.
PCR data
Also at this point in their argument they speak of new positive cases confirmed by PCR: “The number of patients with positive PCR reached 3,300 daily; and in the last week it stands at 150 on average ”. According to the data offered daily by the Community itself, the average is somewhat higher if you take the number of the laboratory results that come to them daily, which does not coincide with that of the samples collected and analyzed in the last 24 hours.
For a few weeks, Madrid has been cleaning their series and updating them, since they assured that they had delays in the results of the laboratories of up to four weeks; therefore, since last May 2, the Community offers in its own register the number of positives that arrive each day (including those with delays) and to the Ministry it sends the positives of the last 24 hours. With the total numbers, the average would be 260; and 76 if the last 24 hours are added. These data are the result of the ability, so far, of the Community to carry out PCR tests. Without more personnel and more material, which is the main demand of the toilets, it is impossible to do more.
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