Half of the Spanish provinces have the capacity of ICUs at very high risk

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, the spring wave and the summer wave of 2021. Although the situation is not the same everywhere, there are five communities (the Canary Islands, Navarra, the Basque Country, Aragón and Cantabria) with the worst hospitalization figures in conventional beds since the start of the vaccination campaign. Occupancy in critical care units is also growing: 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 patients with covid on the ward and about 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 are more than triple those of a year ago, there are 14,000 patients in conventional beds and 2,000 in critical beds, around 50% of those of last year. The proportion of infected that get worse and end up in 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, they are more than 10% (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.

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 plants of the hospitals in 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 at the beginning of December, before the omicron explosion, the worst contagion figures in the whole country: 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 contagions are also already noticeable in 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 ICU beds occupied as then (almost 80%).

Most of those hospitalized today 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 data of which there is no official information yet in Spain. In France, the first data available point out that omicron is making strong progress in hospitals, but the two variants still coexist: at the end of December, hospital admissions per 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 are no data to find out, although the doctors consulted point out that the trend is similar. Most of the income is per 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 are still very serious, and the admission is prolonged,” says Gonzalo Tamayo, from the Hospital de Cruces (Barakaldo). Health sources and doctors from several communities point out that most of the patients who occupy ICU beds were infected with delta. It remains to be seen whether serious hospitalizations 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, epidemiologist at the Hospital Clínico de Barcelona points out: “When there is such a high number of infections, no matter how severe the disease, it is more complex to manage”. In its center, 35% of the ICU beds are occupied by patients with covid, which has caused some surgery to have been postponed in a timely manner. “After the primary school overflowed, we endured each day tighter and we expect that plant revenues 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 the newly hospitalized, having or not having the vaccine is the main differentiating element. In the Catalonia hospitals, which publishes daily new cases and hospitalizations according to vaccination status, 1,405 people over 80 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 ICU patients the proportion is even higher: there are 28 out of 100,000 vaccinated between 60 and 69 years old, and 192 out of 100,000 not vaccinated in the same age group, seven times more.

In fact, the profile of admitted patients has changed as the vaccination campaign has progressed. It is something that is observed especially among the elderly, more likely to aggravate and need hospital care. At the beginning of the pandemic, those over 70 years of age represented 50% of all patients with covid in hospitals. With the start of vaccination, this proportion decreased and in May, when the majority of this group was vaccinated, only 15% of the patients with covid were this age. The situation became more complicated during the fall, before the third doses began to be given. In those weeks, those over 70 years of age 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.

The differences in hospitalizations between age groups according to the rhythm of the vaccination campaign grow when the data of vaccinated and unvaccinated are compared. In Catalonia, important differences are observed between both groups. Since December 1, 1,405 people over 80 have been admitted to Catalan hospitals: 910 unvaccinated per 100,000 and 240 vaccinated per 100,000, almost four times less. Among the patients who require a bed in the ICU, the proportion is even higher: only 20 out of every 100,000 vaccinated between 70 and 79 years have been admitted to critical care units since December, while among the unvaccinated in this group there have been 180 for every 100,000, nine times more.

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