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“Some hospitals are already in a situation of disruption, while others who think they are still in August”criticizes the president of the Portuguese Society of Intensive Medicine, João Gouveia, who is very concerned about the situation that already exists in many units. The effort is very asymmetrical and “unbalanced” at the national level. “There cannot be hospitals that cut 30% of scheduled surgeries when others have already cut 80% ”, defends the doctor who also chairs the National Committee for Follow-up of Response in Intensive Medicine for covid-19.
Is the situation already a breakdown in intensive care units? What is the maximum capacity, anyway?
I don’t know what the actual total of beds will be, because every day we have more, but we depend a lot on human resources. In the first wave it was different, everything was closed. Now, some hospitals are already in trouble, while others who think it is still August and are committed to recovering waiting lists for surgeries and consultations. [não urgentes]. If we have 6,000 cases a day, considering that 0.5% go to intensive care, there are 30 new patients every day. At this point, there is only one possibility: the blanket covers your feet or your chin. We have to be able to obtain authorization until the measures take effect. It is necessary to suspend the programmed activity, stop the surgeries and mobilize the professionals [para cuidados intensivos]. If they want to continue with the scheduled surgeries and consultations, seriously ill patients will die. The effort must be common, the hospitals must be in solidarity. There cannot be hospitals that cut 30% of scheduled surgeries when others have already cut 80%. Also, some have not prepared or formed teams [ao longo dos últimos meses]. But it is not easy either, human resources are not born in trees, there are not enough doctors and nurses to form teams.
Does this mean, therefore, that the hospitals are not operating in a network?
There is a reference network that works with network axes and poles, which are the central hospitals, such as Santo António and São João, in Porto, the hospital centers of Coimbra, Viseu, those of North Lisbon, Central Lisbon and Western Lisbon. , the Algarve and the hospital in Évora. In theory, there should be references along the axis. But at the moment some are already at the maximum alert level and others are not. This means that there is an unbalanced effort and implies that some do not want to accept patients from another hospital because they think that the hospital has not yet done all that it could do. Hospitals need to raise the alert level [do plano de contingência], not necessarily for the last but eventually for the penultimate, and that they realize that they have to receive patients from other areas. THE CHUC [Centro Hospitalar e Universitário de Coimbra] it has 19 intensive care beds with covid patients, which is very little for a hospital with that capacity.
If we reach the limit, it will be necessary to choose which patients will go to intensive care. How is this choice made? The Council of Deontology and Ethics of Doctors has already ruled on this issue.
If we reach the catastrophe situation, there will be a reversal of the usual logic, we will have to go from the individual logic of giving everything for a patient to try to give everything to the largest possible number of patients. We select and evaluate those who can benefit the most. It is the logic of the common good. We have a technical and practical opinion on what to do in case of a catastrophe that has occurred since February, March, and that is on guard because we do not want you to panic. We are in consultation with the Order of Physicians, who will prepare an orientation. [técnica] more generalist, not so operative. Age is taken into account but a whole set of factors is also taken into account, such as the degree of frailty of the patient, whether there is kidney failure, respiratory failure, neurological dysfunction, whether or not he can walk alone.
The committee he chairs also called for the hiring of more physiotherapists for the teams and more spaces for palliative care.
Yes, we managed to have some physical therapists, depending on the hospitals. But getting quality palliative care has already proven more difficult. It was important that more spaces were created for palliative care. Without these spaces, patients die in intensive care or in wards. In some cases, we let family members spend time with the patient, but this is not always possible, it is sporadic.
