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“What is the worst scenario?”asked President Sebastián Piñera at Monday’s meeting, while the Undersecretary of Assistance Networks, Alberto Dougnac, presented the document “Second wave of the Covid-19 pandemic plan: Initial proposal of the Undersecretariat of Healthcare Networks”.
The president’s question was answered in the following slides: with a contagion scenario similar to that of the first wave in the country and a peak of 6,608 cases between the end of December and the beginning of 2021, on January 14, 3,320 patients would be registered in the ICU, mainly due to Covid-19 and to a lesser extent due to other pathologies. But nevertheless, the maximum occupancy would be recorded on January 22, which would force the system to expand by “300 beds the maximum historical capacity enabled”, as stated in the document. That, in a projection of intermediate gravity.
In the catastrophic scenario, with a peak of 9,560 infections during the first week of next month, on January 12 the network could reach 3,402 ICU patients among Covid-19 and non-Covid-19 patients, exceeding the July maximum (3,216 beds). Of course, for the 28 of that same month, the maximum occupation of these units is projected, with 4,252 people hospitalized. “A maximum of 4,250 beds is reached in approximately 60 days from the beginning of the growth of the confirmed curve, exceeding the maximum authorized historical capacity by 1,000 beds,” the plan details.
The strategies to mitigate a possible excess demand, According to the Minister of Health, Enrique Paris, are similar to the handling of the first wave, like strengthening the integrated public-private network (which is projected to be maintained throughout 2021), the complexity of units other than ICUs and the establishment of differentiated flows within hospitals. Advance purchases are also added to secure drugs for patients requiring mechanical ventilation and increase quotas for home hospitalization.
And among the novelties that are detailed in the plan, they are already working on The Health Services have a “Covid Phone” that will work 24 hours a day and 7 days a week, and like several of the private providers, they will be able to coordinate the taking of samples for the PCR examination at home.
On the other hand, although one of the edges of the plan is the early opening of healthcare facilities -as in April-, the same document describes that one of the “critical nodes” is the delay in the works of primary care and hospital facilities. Thus, at the point of strengthening the strategy with private companies, the problems mainly point to the conversion speed of beds and payment opportunity claimed by the providers themselves.
The Usach Public Health academic, Claudio Castillo, comments that the government’s projections are not whimsical and are based on the behavior of the national curve and the European experience.
“What has been happening in Europe, and similar to Chile before, is that two weeks from peak cases there is the maximum demand for hospitalizations and deaths. And regarding that and the end of the year holidays, there must be an even greater contingency plan, because that can generate an increase in cases when families not living together are reunited in a single home. You have to look at the plans defined by the European countries: Religious activities were prohibited and the celebration could be with a maximum of 6 people -without counting children under 14 years of age- and with a maximum of two different family groups, that is, with a health bubble”.
From the intensivist doctors, the head of the Critical Patient Unit of Clínica Las Condes, Tomás Regueira, says that he is concerned that a demand greater than that of the first wave is already projected. And although, in that context, he says that although the plan is necessary, he emphasizes that “I don’t see why we can’t win this fight in public health, on the street. We have all the indicators, we have all the data to take action, whatever action is necessary to avoid a second wave. We have a ‘Step by Step’ plan that is well designed, but must be strictly adhered to, according to the corresponding indicators ”.
The former president of the Chilean Society of Intensive Medicine (Sochimi) points out that regrowth is avoidable, taking into account sanitary measures, both individual -such as the use of a mask, hand washing, avoiding crowds- and government in the face of massive milestones such as the eclipse or the end of the year parties.
“With the State of Exception, all the guarantees are available to avoid the second wave. When we start talking about the overload of hospitals, we are assuming that we are unable as a country to control the second wave. And if the demand of the health system is going to be equal to or greater than that of the first wave, we are going to face a worn out staff, people without the required capacity and an excess of mortality related to the quality of care that will be delivered to the patient. patient ”, he says
In the Metropolitan Region, where the largest number of complex health centers are concentrated, they have already begun to notice a slight increase in the flows of patients entering the Critical Patient Unit.
This is how he describes it Osvaldo Carrasco, director of the Central Post, who explains that “at this moment, the capacities of the UPC are distributed not only by Covid-19, but the normal demand of the Central Post has increased: accidents and patients with coronary and cerebrovascular problems. We are back to normal. But in this sense, we have also noticed in recent weeks a progressive increase in the test for consulting patients and an increase in the number of Covid-19 hospitalizations, which makes us think that the number is going to rise “.
Cherie Gutiérrez, medical director of Clínica Dávila, details that in the emergency service, “We have observed a slight increase, between 4% and 8% in the consultations of respiratory patients with suspected Covid-19”. Meanwhile, at the UPC, “in the last 10 days, we have also experienced a slight increase in employment, going from 27% of patients connected to mechanical ventilation due to coronavirus to 36% ”.
More stable is the situation at the Hospital de la Universidad Católica. There, its medical director, Ricardo Rabagliati, explains that “We have maintained a low but stable number of hospitalized Covid-19 patients with some weekly variations, there is no clear trend of constant increase or decrease. Urgency consultations for respiratory reasons have remained low, without any sustained increase for the moment, but they continue to consult covid patients who require hospitalization, but with less severity than what we observed in June-July ”.
