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“In the most catastrophic scenario, by the first week of January we could have 9,560 new daily cases”, explains the Minister of Health, Enrique Paris, by detailing the different projections that have been prepared to prepare the health care network for a possible outbreak of coronavirus.
The authority reported yesterday, during the report on the evolution of the pandemic, that the plan prepared had already been presented to President Sebastián Piñera. This, in a scenario in which there are already increases in infections in nine regions of the country.
Thus, the minister reveals to Third there are three epidemiological contexts on which this strategy is based: desirable, medium and catastrophic. This, based on the outbreaks of the pandemic, and the disparities in its effects, which were already seen in the United States and Europe.
The date of the increase in cases in the country? According to the projections prepared by the experts of the Health and Assistance Networks cabinet, the “regrowth” could be plausible in early summer, during the second week of January, which would begin with a slight takeoff of the epidemiological curve towards the end of December, marked by the end of the year holidays.
In the scenario that the portfolio owner defines as desirable and that postulates a situation of stability of the cases, “The possibility is that between January 10 and 12 we will have more or less 2,452 patients in ICUs, but between Covid-19 and non-Covid-19 patients. And that is associated with a patient peak of 3,026 new daily cases ”.
In an advocacy context “media” of a second wave, in a panorama similar to what happened in France and in European countries, in general, the Minister of Health states that “We have calculated it with 6,600 patients per day, which would lead us to a possibility of between 3,200 and 3,500 patients in the ICU. That is to say, that exceeds by 300 the beds that we had enabled, at most, on July 9, 2020, which were 3,216 ”.
While, in the worst epidemiological scenario, similar to the gigantic increase in cases as occurs in United States, the minister contemplates that with 9,560 daily cases “between January 12 and 28 we would have about 3,400 to 4,200 ICU beds occupied between Covid-19 and not Covid-19, which means almost 1,000 more beds compared to the peak.”
The Secretary of State, who warns that these are projections, details that these are the guidelines that currently allow anticipating the occupation of beds, two weeks in advance, when an increase in cases is detected.
The plan is to go evaluating, with this capacity that we have to anticipate the prognosis by two weeks, and to gradually convert beds and transfer patients, ventilators and monitors. The critical point is the staff. We have to think about the universities, scholarships, medicine interns. The good thing about this is that we are preparing more in advance and based on knowledge that we already have.
Enrique Paris, Minister of Health
In detail, Paris states that the plan is similar to what was already carried out during the first peak of infections, like strengthening the integrated public-private network, the expansion of beds, the complexity of units other than ICUs and the establishment of differentiated flows within hospitals. To this are added measures to ensure drugs for the most complex patients, accelerated opening of some health establishments that are under construction and increase the quotas for home hospitalization.
In this sense, the Undersecretary of Assistance Networks, Alberto Dougnac, detail that “If it is necessary to strengthen human resources in the face of an increase in demand for care, that will be done, without any doubt.”
The authority states that, due to the context of the pandemic, the number of health officials has already been increased by 20,000 people and that, as of today, 17,000 continue to work in intensive care units.
Regarding the acquisition of personal protection items, Dougnac addresses that Cenabast has “Sufficient stock to face a second wave”; Of course, the undersecretary admits that “the purchase of supplies and essential drugs for patients in intensive care is being planned to allow an increase in demand.”
Regarding new purchases of mechanical fans, meanwhile, the holder of Healthcare Networks indicates that With 3,500 devices available and another 200 anesthesia machines that can be used as mechanical ventilators, “we are well supplied”, ruling out, for the moment, a massive purchase of these teams with a view to regrowth.
“We are prepared, we have fans, equipment, but the personnel must be supported with replacement, because they are exhausted”, admitted Paris, alluding to one of the concerns that has been extended in the country’s intensive care units: the fatigue that health teams drag after the first wave.
In this regard, the national secretary of the Medical College, José Miguel Bernucci, is emphatic: “There are many personnel who have not taken their holidays waiting for the epidemiological situation to calm down ”.
The doctor of the Central Post office suggests that, hopefully, “we could have learned about the experience of the northern hemisphere and our own experience, with what has happened in the south of the country, but from what we know so far, the focus turns to put on the hospitable more than on the preventive. Cutting the chain of transmission avoids infections, saves human lives and at the same time is much more efficient ”.
On the other hand, the intensive care physician and past-president of the Chilean Society of Intensive Medicine, Thomas Regueira, affirms that the strategy detailed by Health is intra-hospital, an edge that must be planned anyway before regrowth, but that “This fight is won in public health, in the streets, not in hospitals. It is in the hands of each person and the government, and in the strategies that do not allow us to relapse ”.
From the clinical side, Regueira points out that the greater demand of medical teams added to emergency intensive care units to alleviate the increase in patients, could have effects on the mortality of the virus. “Before the pandemic we had 900 intensive care beds, now we have 2,200 and 1,850 are occupied. We are talking about how we would face a regrowth with capacity already expanded. When the minister suggests that beds should be increased, this will be at the expense of intermediate care, pediatrics, cardiology, wards and increases mortality ”, Explain.
Meanwhile, the academic in Public Health of the Usach, Claudio Castillo, asserts that “It would be a mistake to put ‘hospitalcentric’ first. What is required here is a health strategy, the focus has to be preventive, strengthening the TTA strategy. On the other hand, health teams are tired, in many cases they got sick and have sequelae from Covid-19. The student reinforcements have had to go back to their classes and training has stopped, you don’t have an additional mass to make the replacement ”, he warns.
