‘I hadn’t seen so many wedding rooms together’

He arrives at the Hospital Clínico Universitario de Valladolid around 7:30 am and leaves when he can. In this year of a pandemic, he, like everyone else, has learned to “stretch like gum” because he has no choice. Regional Coordinator Internal Medicine Against COVID-19, Carlos Dueñas, does not lose his humor despite marathon days in which more and more patients have to be treated; look for alternatives and have an emergency 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 the number of new infections. “Very high” figures that no longer delay and burden hospitals every second; and all with the psychological and physical fatigue of a pandemic that will not give up, leaving everyone exhausted, and especially in the face of a tsunami on the verge of reaching hospitals and UCIs, because today’s infections are in the centers tomorrow . With all his imagination on the table and looking for beds where there are none, he regrets, “Even if we open the gyms and hospital canteens, if people don’t know, this could be a disaster,” adding that the non-COVID pandemic -19 patients also pay it. That’s why he calls for self-development and warns, “I hadn’t seen so many wedding rooms together. They are the consequences of family reunification ”.

It has become a mantra. The health system is saturated, the UCIs are overflowing, the emergency room is overloaded, the professionals are exhausted … You, sitting at the bottom of the barrel, do you see this situation in a society that has evolved in theory? What else do they have to tell us?

The messages are clear and have been there since March last year. The problem is, I don’t know anymore if they penetrate the way they should. The reality is that hospitals are willing to take on a limited number of admissions and not so many that it becomes overloaded and keeps things from working as well as they need to. In Castilla y León, about 600 patients were admitted to the COVID-19 plant two weeks ago, and now we have 2,000. An increase of 1,400 patients in 15 days is cruel for hospitals to assume, and we must add that patients without COVID-19 keep coming; trauma emergencies, heart attacks, strokes, digestive bleeding continue to occur. We are on record for the daily income, doubling and hospitals have 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, this is so. And people need to realize that hospitals have a limited number of beds and we cannot keep up with this income. If they don’t lock themselves up and do things as they should, the hospitals will suffer a lot, we are already suffering.

If they had to tell someone who is sick, come back tomorrow; sending people home who would otherwise have been hospitalized?

No, because in the end we invent ourselves. When we have to look for beds under the stones, we look for them like Palencia did. If you have to call in the gym to guide patients, we make that possible. But seeing patients on a floor isn’t the same as in a gym; the quality of care is also declining. It’s so. Be stricter in the emergency room when deciding on a shot, yes, but when indicated, it won’t say no. We will have to find a place for them everywhere. So we reinvent ourselves, operations are taken to private hospitals so that patients don’t occupy beds. This is what we have done, reinventing ourselves and finding beds where there are hardly any.

Given the number of infections that don’t drop below 2,000, with the addition of the British strain, much more contagious and apparently more deadly, fear the worst in 15 days?

As long as we continue with very high incidences, the hospitals will be under a lot of pressure on health care, and 15 days after the infections have cleared, we will continue; and the ucis, another month. When the incidence rate is normalized, we will have problems in hospitals for nearly a month. If we add to that the gradual increase in the number of UK variant suspected patients as transmission increases, we will have more income. Everything also goes against hospitals and primary care.

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 the maximum of about 200 patients in the ward and in the ICU to 70, and now it is over 160 and we still have two or three weeks of travel with a high number of admissions. There are hospitals in the community like León, which already has higher grades than in the first wave, or Palencia, or Ávila …

Have referrals between hospitals already started to make way for the following patients, to relieve small centers?

Transfers have been organized via the UCI coordinator from areas where they are tighter, to more liberated areas and there is a lot of movement. The Segovia Hospital, which has been in a bit more haste, has referred patients to the ICU to Burgos, the clinic and the Río Hortega; Also Medina del Campo, which does not have an ICU. Yes, there is movement. And on the floor, apart from the transfers to the Rondilla Hospital – which has received patients from the Clínico, Río Hortega, Palencia, Segovia, Ávila and Medina del Campo-, the Palencia Hospital has had to send to Burgos Hospital and the Clinic from Valladolid was a patient with significant breathing problems, because they could not include all patients on the ward during peak times.

Will the Rondilla building suffice, or do you fear a return to field hospitals?

It has a capacity of up to 200 admitted patients. With the total opening of the second factory, we have a capacity of 90 and we are about 70. We are likely to hit 90-93 patients today. If it was necessary to open more beds due to the saturation of the hospitals, they would be opened as soon as staff became available.

Another problem, because professionals don’t get out from under the stones?

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

And what about those professionals, with a built-up fatigue that no one misses?

Doubling of shifts, more guards, with many more patients in charge of each; with a pathology that causes a lot of psychological damage, because there are patients who become ill and for whom you cannot find a solution because they do not evolve properly. This is very difficult physically and psychologically. People are exhausted, how can they be; exhausted. Anyway, we know what we decide to do and we draw strength where there is none. We try to give people a reasonable minimum rest, because this is a long distance race… We’ve been there for almost a year and it doesn’t look like this will diminish so quickly.

How many patients does a doctor see in a normal situation and how many do they now touch?

I have given an example from the clinic. In January of a year ago, the hospital had eleven intensive care beds, currently 71 are working and the workforce has been expanded by one person. Right now, in internal medicine, there are about 70 patients in a normal situation, and at the moment we have 80 COVID-19 patients and 60 non-COVID-19 patients, more or less with the same staff. We see more than twice the usual patients, and the same is happening in lungology and everywhere. It’s like little to double up on your job in a bad time like January with the flu.

What bill does the pandemic transfer to the system and especially the non-COVID pathologies that are still present; to surgical procedures?

They pay for it. Since you have to spend a lot more money on COVID-19 pathology, you have to distract them from other sites. At present, the departments of Pneumology and Internal Medicine are devoted almost exclusively to COVID-19 patients. Consultations for other related pathologies are stopped or delayed. Imagine what an undiagnosed lung cancer could be because consultations are delayed … But there are also professionals from other specialties who work with us, where activity is also declining. Digestion works together, which probably means that research into colon cancer and others, for example, will be delayed; the same will happen in Onlogy. We will certainly postpone diagnoses with prognostic implications. Diagnosing colon cancer at an early stage is not the same as it is at a more advanced stage, because the risks it carries are already greater. This is so. In the first wave, we put it all in, and now we’re combining what COVID and non-COVID care can be.

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

The mean age of patients admitted to the ICU and ward is decreasing. I had not seen as many wedding rooms together in this hospital as now. They are the consequences of Christmas gatherings with the family. There are the husband and wife, two brothers-in-law … And they are humans, generally younger than in the first wave.

We all have our hopes for the vaccine. What breath do you think you can give, and when can that breath come?

Everything will depend on the vaccination rate and the doses we get in the short term. The sooner we have a vaccinated population, the better it will be, as long as there isn’t a variant that skips the vaccine, and at the moment the only one where it doesn’t seem as effective, the South African and, except for one case in Spain it seems we don’t have any more. The delay is to have at least 70 percent of the population vaccinated, they tell us in the summer, but if it could be earlier, much better. Israel is vaccinating en masse and is already noticing this in the infection figures.

We did not stumble with the same stone twice, three times. What are we doing wrong, whose fault is it, where is the problem?

It is a little bit of everything. When politicians begin to analyze risk from transmission versus economic risk, they can probably be a little more lenient in decision-making. Most toilets would have been closed a long time ago and everything locked up. And on the other side people; There comes a time when heads turn, they stop receiving information from COVID-19 because they are saturated. There will come a time when they have to go out to breathe. It all comes together a bit. The population is probably saturated and needs a breather; The policy is complex, it is not easy to stop like in the first wave, and everything has its consequences in the end.

Finally, what more can you ask or say to the population?

It is not in the hands of politicians or doctors that things are going well. They need to realize the situation, the danger to health in Castilla y León from collapse. That they stay at home as long as possible, with a minimum of people they usually associate with. Let them do some sort of confinement because if not, there will come a time when even if we open the gyms and hospital canteens to impose beds, we cannot help all patients. We will end up as Portugal. If people are not aware and responsible, it can be a catastrophe.