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“The situation obviously changed,” says the president of the Society for Intensive Medicine (Sochimi), Tomás Regueira. The reports of the guild of doctors who work in the critically ill units show the breakdown of the trend called “plateau” or of the “long and flattened” contagion curve, which until recently the health authorities were talking about.
The rise in positive cases, initially explained by the increase in testing, has generated greater hospital demand, since according to Regueira, social distancing “was lost” in recent weeks. Thus, in the Metropolitan Region, 86% of ICU beds are occupied, according to the latest Sochimi report.
-When the testing of asymptomatic patients began, which increased the figures, it was said that they did not produce greater hospital demand. Why does it increase, then?
-The explanation is given by the greater social contact of people, and that has to do with the restrictions imposed by authority, but also with the personal behaviors that we all take.
-Was there a certain “communicational relaxation” of the authority in the attitude towards the Covid-19?
-The behavior change of the disease can be attributed to the loss of social distancing, necessary to keep the disease in a situation of greater control.
-How is the week projected with the health services of the Metropolitan Region bordering 90% of ICU occupancy?
– At the moment we are a single public-private network. The centralized bed management unit is the one who coordinates the transfers of patients, technological and human equipment. However, the response capacity has a limit, difficult days are coming and we are worried. We ask for the greatest coordination and management capacity possible.
-Mechanical fans are coming, but a critical bed is not just the respirator. Do we have the clinical human resources for your use?
-The intensive health teams in Chile are of excellent performance and this is demonstrated in the lethality that we have had so far in the ICU, which has been extraordinarily low compared to other countries. Of course, it is essential to activate alternative teams now that are capable of responding to the demand that will increase in the coming days. The reality is that health teams, as time progresses, wear out, tire and get sick too.
-It seems that we are already at the peak of which there was so much talk …
-I do not know. I would say not yet. During this week we are going to see a greater accumulation of cases than we have seen so far. We have not yet reached the “crest of the wave”, hard days are coming this week.
-Do we have to prepare for an increase in the average of daily cases, ICU occupation or deaths?
-We are going to see more patients requiring ICU beds. If that is going to be associated with more mortality and more complications, it will depend on the management capacity of the Ministry of Health (Minsal) as a whole and of each center in particular. If at the macro level we manage to manage transfers adequately, we manage to put patients in centers that still have beds in the Metropolitan Region; And if at a micro level we manage to expand each center’s bed capacity, recruit new professionals, open new units in the wards, we will be able to expand response capacity. If we don’t implement it this week, we will have complications.
-The outbreak in the eastern sector is quite controlled, but the ICU occupation rose. Does it have to do with transfers to the private network?
-The occupation in private clinics in the eastern sector is around 55% or 60% and now we are at 85%, and it is explained by the transfer of patients, which is the right thing to do. But this backup capacity given by the private network has a limit, it is not infinite. About 50 patients were transferred Friday night. The north and south zones no longer have the capacity to respond at this time, the micro management must allow more beds to be opened, but as long as that does not happen, a lot is being diverted to the east zone, which still has a back to receive.
-Do we have to backtrack to the return to elective surgeries?
-In emergencies, consultations have dropped to 70%. So, heart attacks or strokes, where are they? There is hidden mortality of patients who are not consulting. But from my intensive point of view, I hope that no one comes and no one is operated to have all the beds available. It seems that, at this time, we should go back and limit limiting outpatient visits and elective surgeries.
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