The explosion of infections that began before the Christmas holidays has put pressure back on hospitals in half of Spain. Those admitted have exceeded the occupancy peaks of the two previous waves, that of spring and summer 2021. Although the situation is not the same everywhere, there are five communities (Canarias, Navarra, País Vasco, Aragón and Cantabria) with the worst figures for hospitalization in conventional beds since the start of the vaccination campaign. In critical units, occupancy also grows: in 26 provinces, more than 25% of ICU beds are occupied by a covid patient, which implies that the capacity of these units is at very high risk, according to the latest protocol of the Ministry of Health.
In the third wave, just now a year ago, Spanish hospitals had more than 27,000 covid patients on the ward and close to 5,000 needed intensive care in the ICU with a respirator (they mark the 100% reference in the following graph). Now, despite the fact that infections exceed triple those of a year ago, there are 14,000 patients in conventional beds and 2,000 in critical beds, around 50% of last year. The proportion of infected people who get worse and end up in the hospital is now lower.
The main difference compared to then is the vaccination coverage: in those weeks the vaccination campaign began slowly in the residences; now the majority of the population has received two doses of the vaccine and 90% of those over 70 have already received a booster.
Despite this protection, the situation is complicated in several provinces. There are 10 where more than 15% of the beds are occupied by patients with covid, above the threshold of one of the indicators that the Ministry of Health uses to declare a territory at very high risk. In 28, more than 10% are (high risk). In intensive care, the situation is worse: in 26 provinces, one in four ICU beds is occupied by a patient with covid, above the very high risk level for intensive care.
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ICU with ventilator
In some regions there are more patients admitted with covid these days than in the worst moments of last winter. This is happening especially in the hospital floors of the Canary Islands —which had a milder winter wave than the rest of Spain in 2021— and in the provinces of the Basque Country, Aragon or Catalonia. Some of them, such as Gipuzkoa, Álava, Huesca or Lleida, registered the worst infection figures in the entire country at the beginning of December, before the omicron explosion: it is possible that some of the patients who now occupy their hospitals were infected then from the delta variant.
The effects of this long wave of contagion are also already being felt in the critical units. In Huesca there are 18% more patients with covid than in the worst moment of 2021 and Álava, Bizkaia or Girona have almost as many occupied ICU beds as then (almost 80%).
Most of those currently hospitalized are infections that have occurred during the holidays, but this does not imply that all are due to the new variant, omicron. It is a fact about which there is no official information yet in Spain. In France, the first data available point out that in hospitals omicron is advancing strongly, but the two variants still coexist: at the end of December, hospital admissions by omicron were 54%. Short stays, of less than a day, are also more common among those infected with the new variant than with delta, a new sign that omicron has less severe consequences. In intensive care in that country, in addition, the delta and omicron variant continues to be the majority, representing only 19% of those admitted.
In Spain there is no data to find out, although the doctors consulted suggest that the trend is similar. Most of the admissions are due to omicron and their stays in hospital beds, shorter than in previous waves. In ICU patients, where the majority of patients are not vaccinated, “those who are admitted continue to be very serious, and the admission is prolonged,” says Gonzalo Tamayo, from Cruces Hospital (Barakaldo). Health sources and doctors from various communities point out that the majority of patients occupying ICU beds were infected with delta. It remains to be seen if serious hospital admissions with omicron will grow or if the vaccine and the lesser severity of this variant will limit the pressure on intensive care.
Even with these data, the situation does not translate directly into lower hospital pressure. As Antoni Trilla, an epidemiologist at the Hospital Clínic de Barcelona, points out: “When there is such a high number of infections, no matter how less severe the disease is, it is more complex to manage.” In his center, 35% of the ICU beds are occupied by patients with covid, which has caused some surgery to be postponed in a timely manner. “After the primary school was overwhelmed, we endured tighter every day and we hope that the income in the plant will continue to increase. Although, thanks to the vaccine, we expect less impact in ICUs, where patients usually stay for several weeks.
More income among the unvaccinated
Among those newly hospitalized, having the vaccine or not is the main differentiating element. In the Catalonia hospitals, which publishes new cases and hospitalizations daily according to vaccination status, 1,405 people over 80 years of age have been admitted since December 1. Among them, there are 910 unvaccinated per 100,000 and 240 vaccinated per 100,000, almost four times less. Among patients in the ICU, the proportion is even higher: there are 28 out of every 100,000 vaccinated between 60 and 69 years old, and 192 out of every 100,000 unvaccinated in the same age group, seven times more.
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ICU with ventilator
In fact, the profile of hospitalized patients has changed as the vaccination campaign has progressed. It is something that is observed especially among the elderly, who are more likely to aggravate and need hospital care. At the beginning of the pandemic, those over 70 years of age represented 50% of the total number of patients with covid in hospitals. With the start of vaccination, this proportion was reduced and in May, when the majority of this group was vaccinated, only 15% of patients with covid were this age. The situation became complicated again during the fall, before the third doses began to be given. In those weeks, those over 70 years of age once again represented 50% of those sick with the virus in hospitals. In recent days, already with a significant percentage with the booster dose, their weight has been reduced again among covid patients.
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