The six factors that explain why this regrowth could be worse than the previous one

“The availability of health personnel has decreased with respect to the first wave between 15% and 25%, and reaches 28% in some regions”, says the coordinator of critical beds of the Minsal, Luis Castillo, who these days is doomed to enable new critical beds to absorb the demand of Covid-19 patients.

With this gap and the ministerial instruction to double ICU quotas throughout the country, hospitals and clinics have turned to the search for professionals who can take over or join the newly opened units, while highly trained officials return from their licenses medical conditions, which have skyrocketed as a result of burnout or extreme work exhaustion associated with the year that the pandemic was completed in the country. But in many cases the search has been unsuccessful: Almost all of the industry is employed, and those who are not, do not have the skills to operate complex beds. And so, while in the first wave the fears were in having the necessary technical equipment – ventilators and respirators – to attend to critical patients, this time, the gap is in human resources and the solution is not immediate.

“The absence of qualified, specialized personnel in these units with years of experience, implies that the remaining personnel are overloaded. A percentage of the shifts that are left off are assumed by the same staff, doing double shifts, or sometimes triple shifts. And this has a limit, physical resistance, mental health, work fatigue, which in general threatens the good performance of work in the ICU ”, warns Castillo.

At the moment, the campuses are training intermediate resource personnel to take care of complex areas.

According to the figures reported this Friday by Health, 65.6% of hospitalizations in Intensive Care Units correspond to Covid-19 patients. However, the remaining 35% are the other “forgotten” pathologies in the midst of the pandemic: cerebrovascular attacks, pancreatitis or kidney problems, many of which are due to the postponement of treatments suffered by non-Covid patients during the last year, product of the emergency. And to them, other urgent emergencies are added, such as serious injuries after car accidents.

Thus, while in the first wave there was an “emptying” of patients, This outbreak came at a time when the occupation of the healthcare network – and of the ICUs, in particular – was at high levels of occupation.

The academic in Public Health, Claudio Castillo, warns that this aspect may complicate the healthcare capacity in the coming weeks. And that in the long term, care that will be postponed again will become a chronic problem once the most acute period of the pandemic is resolved. “The interruption of controls and treatments has an implication in avoidable hospitalizations. When they are interrupted, these hospitalizations for decompensated pathologies increase, ”says Castillo.

In this sense, an analysis by Clinicas de Chile warns that private centers stopped performing, on average during 2020, a total of 3.5 million medical care. “What has had a direct impact on the diagnoses and prognoses of serious chronic diseases, such as cancer, diabetes and strokes,” says the report.

It is still a discreet increase, which must be evaluated in a month, but the coordinator of critical beds, Luis Castillo, warns that there is an increase in the ICU stay of younger patients, which in a certain sense “atocha” the flow of hospital discharges and the availability of new beds.

“We have seen a modest increase in the mean stay of Covid-19 patients under the age of 60 who were admitted to intensive care. But it is still premature to say so, because we are only in the initial stage of the sickness volume curve. In another month we will be able to evaluate the data accurately ”, he specifies.

During the first wave, older patients with more aggravated symptoms resisted less invasive treatments, such as the mechanical ventilator and, in this sense, the risk of dying was higher, despite medical effort. Now, with younger inpatients, (the average age of hospitalized patients fell from 61 to 57 years), the stay is extended, because, although with sequelae, they can better withstand this type of therapy and be hospitalized for a month and more.

The head of the Critical Patient Unit at Clínica Indisa, the intensivist Sebastián Ugarte, describes that “we have 222 patients with coronavirus hospitalized at Clínica Indisa. This has been gradually increasing through the days. Now, the longest stay is just beginning to be noticed, because the age composition has gradually changed: the average age has decreased, but at the same time they are getting more serious and therefore they are connected to mechanical ventilation. And in the period of stay, an extension of 10.2 days to 12 is seen in our compound ”, he concludes.

After one year in “pandemic mode”, added to more “lax” measures in terms of mobility, in the opinion of the experts, they have resulted in a phenomenon that the Ministry of Health has described as “pandemic fatigue”, that is, fatigue and loss of adherence to the sanitary restrictions imposed. Added to this is the start of the vaccination campaign, which has been seen by many as the end of the health emergency that, however, is still active and expanding.

The infectologist Jeannette Dabanch explains that “we have a community that is vaccinated, that adheres to an important campaign, but we are leaving aside other measures that we know will protect us, I would say that the most important problem is physical distancing and reducing displacement. in crowded places. Mobility does not decrease. Regarding the decision to impose quarantines and border closures, I will disagree that there is no evidence, as many say. The best one is the SARS of 2002: the restrictions were tremendously effective and the outbreak control was achieved in six months, as the measures were respected ”.

His partner Claudia Cortés estimates that in addition to the fatigue among people, the authorities have delivered confusing messages: “First they quarantine us, but they keep the malls or gyms open. With that, people get confused, if we are worse, why can we go to restaurants? That risk communication has been bad throughout the pandemic. But for me, and regarding the situation we are experiencing now, the big problem is that the vacation leave was extremely lax, little oversight of the measures that should be maintained during the summer.

Judging by the report of the Public Health Institute of variants of Covid-19 that circulate in the country, there are at least four new strains – apart from the Wuhan and the European ones – that have already landed in Chile: the British, Brazilian, Californian and Nigerian.

Most of these “evolutions” of the virus have been described as more contagious and some more symptomatic, although mortality – at least in the British variable – has been emphasized, until now, that it is not higher.

However, in the healthcare network there are already well-founded suspicions that some of these, the most widespread, have begun to dominate in the new infections that are being reported.

The infectologist of the University of Chile, Claudia Cortes, comment that “That is what the world has seen and we are not different, the borders are still quite open, we are not going to have a different behavior in Chile.”

In fact, this Friday the Minister of Health, Enrique Paris, pointed out that this Saturday will be announced measures “of greater control and strictness” for the Chilean border. “We discussed that with President Piñera and we will announce it on Saturday,” he added. The reason? The Undersecretary of Public Health, Paula Daza, made contact with Brazilian scientists and today the Minsal has more information on the strain found in that country.

For Cortés, the solution is clear. The ISP and the university consortium should reinforce efforts in sequencing the virus carried by each PCR test to “be clear about what we are dealing with.”

In this scenario, the former Minister of Health Jaime Mañalich suggests that not only the tests taken at the airport be analyzed, but at least 1% of the local PCRs.

Chile has been one of the few countries with ‘three waves’ of infections: the one in June last year, the one we registered at the end of January, followed by a slight fall and the rise now, which will probably set the peak of the pandemic at the national level, surpassing last winter’s figures by a certain margin ”, analyzes the epidemiologist from the University of Chile, Gabriel Cavada.

And it is that in his opinion, one of the factors that has played against for an adequate control of this third wave of Covid-19, is that the decrease in cases -with the figures for October or November- was always moderate: Only once were less than a thousand cases registered, but the “baseline number” always fluctuated between 1,300 to 1,500 infections per day, which shortens the stretch towards a peak.

In this sense, the expert states that “the June wave had a baseline of 0 cases, if we mark the point from the beginning of the epidemic. Now we start from a baseline of 1,500 daily cases. This suggests that the peak could be quite comparable to the amount we observed during June (6,938) ”.

And although infections are expected to continue to rise, it is expected that In mid-April, the first effect of vaccines on healthcare pressure on the part of older people began to be noticed and that they were the first to be immunized, which is going to configure a new scenario: high infections, but with fewer serious cases that saturate the network.

“It is a virus ‘very thirsty’, but its water is running out thanks to vaccines”, analyzes Cavada.

Likewise, and for the next few weeks, the Undersecretary of Healthcare Networks, Alberto Dougnac, estimated that 300 new patients will demand a place in the ICU as a result of the rise in infections.