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Tomás Regueira chaired the Society of Intensive Medicine until last year. He also led the ICU of Clínica Las Condes, from where he was unexpectedly disengaged, in the middle of the pandemic, and causing a stir. Now, the professional, who for the first wave became a counterpart of the Minsal, in data and figures, now collaborates with the Undersecretariat of Healthcare Networks in the opening of new quotas to attend critical patients.
What does your work consist of?
I am an advisor to the Undersecretary of Healthcare Networks, Alberto Dougnac, who entrusted me with supporting data management. Every day we must have exact, consolidated and revised numbers of how many patients there are, how many died, how many beds are left, etc. Also, if we have many patients in one place, manage to take them elsewhere or take them out on the Hercules plane. Those numbers had to be improved and the ones we already have are accurate and in real time. Now I am planning the most complex phase of this second wave, where the requirement for beds is very high.
What is happening with this second wave?
We have a very high number of infections and that translates into patients who are going to need intensive care beds. Why do we have so many infections now? Undoubtedly, because the previous weeks or months we had excess mobility, meetings, an absolute loss in the perception of risk regarding the disease. Perhaps as health teams we have not been able to transmit with enough force the war that is being lived inside the hospitals and clinics of the country. Therefore, there is a dissociation between what happens here, and that is dramatic, because 100 or 120 people are dying a day, and on the other hand, a huge lack of knowledge or empathy on the part of the population.
Why did the profile of people who come to ICUs change?
The type of patient is younger and arrives more serious. It must be intubated more frequently than in the first wave. Why is there this new profile of the disease? We do not know. There is a lack of information regarding the variants that circulate in the population and that we have asked the Institute of Public Health. We understand that the prevalent strain is still the original one, but we need to know how much it weighs in critically ill patients or what percentage of them have the new variants. This study is being carried out, but, without a doubt, we have community circulation of the new variants.
What is known about the Brazilian variant?
We know that in several states of Brazil the circulation of the variant virus, that is, the P.1 strain, is predominant over the others. There, 80% of the infections are of the Brazilian strain, against 20% of the original, which means that the Brazilian strain tends to predominate due to aggressiveness and contagiousness. We know that community transmission of the Brazilian strain exists in Chile, but we do not know in what proportion. We need a sample that allows us to understand the proportion of patients with this variant and also to test intubated patients, to know if, in addition, it is a more serious strain.
How would you characterize this wave, compared to the first?
In the first wave we had to expand to 3,200 beds. For that we turn to colleagues who are not from the specialty, we set up beds in unusual places, in all parts of the hospital. Today we have 3,900 beds. So this second wave is much, much worse than the first, in terms of resources to respond to what is happening.
What is the current situation of critical beds?
The hospital system and its health teams have made an enormous effort, and we from the Undersecretariat have been able to put pressure on the system to anticipate the requirements. We know how many patients will come to get an ICU bed in the next seven or 10 days. Therefore, we know that we have to find those beds. How? We are going to the field every day, especially in the Metropolitan Region, since this is where the most important battle is being led now, because before it was in regions. During these visits we see the realities of each center and we are forced to ask for even more efforts to be made in converting beds. This means a tremendous, continuous and permanent effort by the health teams, which we know are leading this war that does not seem to be seen outside of hospitals.
Does the saturation of the hospital system affect care?
Obviously, our mortality has increased. This means that we have lost quality in the work we do in these critical units that we are creating, despite the best efforts made by all health personnel. And here the most important thing is not to keep opening beds, but to close the chain of contagion. So it is a sign of hope that all the changes to the Footsteps plan have been announced. We are not against personal freedoms, what we would most like is for all of us to have freedom of movement. But, unfortunately, this health reality prevails above all things: more than a hundred Chileans are dying a day from this pandemic.
How is the projection of the pandemic in the coming weeks?
What is going to happen in three more weeks, nobody knows. What will be the impact of the vaccine progressively, the impact of the variants, how the population will behave with respect to the new sanitary restriction measures implemented, we do not know. Therefore, what we can do is project to seven or 10 days, because we know that the beds that are going to be needed are due to what has already happened. And the patients who were infected yesterday or the day before will go to look for beds in 10 more days. What I can say is that within 10 days we need to have around 4,000 to 4,100 patients admitted to the ICU, which in practice forces us to create 4,200 or 4,300 beds, which we are going to have to look for in health centers , asking for more efforts, with all the unfair that that means. We trust, we hope that the quarantine measures that will be intensified now will impact on closing the stopcock of contagions. Because, obviously, the hospital bed creation system has a limit that we have already exceeded a long time ago.
How has the situation evolved within the ICUs?
In recent days, the net admission of patients to the ICU, that is, all those who arrive and subtract all those who leave, is positive in about 40 patients. However, every two and a half days the system is having to create 100 beds, and that is unsustainable in the short term. It’s like rebuilding the entire ICU system in Chile prepandemia in 25 days. What people have to understand is that no one is against personal freedoms, but unfortunately we come to this situation in which the contagion curve has been associated with this level of pressure in the health system. Therefore, we now absolutely need to cut the chain of contagion.
Yesterday the eight thousand daily cases were exceeded for the first time in the pandemic. Can medical teams withstand this high number of new infections?
The health teams that are on the field need everyone to participate in this war that is lived day by day with our patients, their loved ones, because reducing infections is finally a personal decision, to the extent that it is not vitally necessary. , of staying in the house and not meeting.
