Epidemiological data and health care resources
The peak of daily cases was on March 20 (10,845) and peak of deaths was
on April 02 (950). On July 17, 260,255 cases were confirmed with 28,403
deaths, an 11.2% lethality slightly behind the UK, Italy, and France,
according to the data provided by the Ministry of Health (MOH). Two of
most populated CC. AA., Madrid (6,7 million) and Catalonia (7,6 million)
were the most severely affected, according to aggregated data (72,168
and 62,057 confirmed cases, respectively).
By mid-July 2020, 125,797 patients required hospitalisation (165 last
seven days), 11,721 were admitted to the ICU (11 the last week) with
28,409 deaths (8 the last week). The global number of deaths it is
believed to be underestimated, due to the initial lack of testing,
according to the excess mortality of any cause (57%) from March 13 to
May 22 (Daily mortality surveillance system – Monitoring of Mortality -
MoMo 2020, Health Institute Carlos III) (13) (Figure 2).
Health care workers (HCW) were the population subgroup with the highest
risk of infection, along with the elderly, reaching 20% of the global
number of cases. On May 11, 40,961 HCW positive cases were reported to
the National Network of Epidemiological Surveillance RENAVE (14)
reaching 52,575 by June 25, as per the MOH. Many retired doctors and HCW
were recruited due to system overload.
The main area of system collapse was the intensive care. The latest
official data regarding the provision of critical beds in our country
dates from 2017, with 4,519 beds in public and 1,137 in private
hospitals, according to the MOH (15). Contingency plans were drawn up,
and intensive care capacity expanded acutely to more than double or even
7-fold in some cases (16) with new ICU beds set up in libraries,
rehabilitation facilities, operating rooms and recovery rooms. Madrid
and Catalonia had almost triplicated their number of ICU beds, from an
average of 600 to 1,500 on April 2 during the peak (from 460 to 1,528 in
Madrid).
Specific intensive care beds for cardiac surgery are mostly included in
the areas of intensive care and resuscitation; however, 13 independent
monographic units have been identified (17) the availability of which
has been seriously affected by the current crisis of COVID-19,
responsible for 40% of the occupation in critical units, according to
some estimates. Cardiac surgical programs suspended elective procedures
aiming at reducing the burden on the health care system and increasing
resources, mainly ventilators and ICU beds. Untested positive COVID-19
patients might have been then operated on. No information is available
on eventual impact on outcomes.
Furthermore, most patients were reluctant to report to hospital
facilities during the pandemic, as evidenced by up to a 40 % reduction
of percutaneous coronary interventions in acute coronary syndromes or 81
% in structural procedures in Spanish centres (18).
With the ”flattening of the curve,” the numbers began to drop, the
burden on the health care systems was alleviated, and resources were
sufficient to restart elective procedures. However, safety is also a
concern, and precautions should be extreme to avoid nosocomial
SARS-CoV-2 transmission and ensure HCW protection. Even more,
non-detected COVID patients undergoing cardiac surgery can jeopardize
their prognosis, due to respiratory insufficiency and thrombo-hemorragic
complications.