Doctors warn Madrid 'in slow motion' towards repeat of Covid crisis

Doctors warn Madrid is walking ‘in slow motion’ towards a repeat of its ‘nuclear bomb’ Covid crisis in March

  • Spain has recorded average of 10,000 new cases per day over the last week
  • Madrid accounts for 31% of all those cases, striking fear into the capital’s medics
  • Spain has borne brunt of Europe’s outbreak – it has the highest per capita deaths
  • One doctor in Madrid said: ‘It’s like the situation in March but in slow motion’

Doctors have warned that Madrid is walking ‘in slow motion’ towards a repeat of its ‘nuclear bomb’ Covid crisis in March.

Spain has recorded an average of more than 10,000 new cases per day over the last week, the worst figures in Europe and the fifth highest infection rate in the world.

Nearly a third of those falling sick are in Madrid which is striking fear into the capital’s medics after it bore the brunt of Europe’s spring outbreak – Spain has the highest per capita death rate on the continent.

On September 4, Madrid recorded 4,852 cases, its highest ever number of infections in a single day, and the city today has an R-rate of 1.08 – any number greater than one means that the contagion is multiplying.

MADRID: A graph of Madrid’s daily coronavirus cases showing a sharp rise since the beginning of August, with larger spikes than it experienced in March – although testing has now increased

MADRID: Madrid’s R-rate stands at 1.08 – any figure over 1 is considered to be detrimental to public health because it means that the contagion is growing as it spreads

SPAIN: The national coronavirus tally has surged in recent weeks, with an average of 10,140 new cases per day over the last week

SPAIN: The national R-rate today sits just above 1, meaning that the virus is growing 

Although, the figures compared to the initial outbreak must be counterbalanced by Spain’s increased testing capacity, the uptick is concerning medics.

‘In a way, it’s like the situation in March but in slow motion,’ said Dr. Carlos Velayos, who works as an intensive care unit physician at the public hospital in suburban Fuenlabrada. 

The hospital is expanding its ICU capacity from 12 to 24 beds by the end of September, as all of them are currently filling up with coronavirus patients. 

EUROPE’S SURGING DAILY CORONAVIRUS CASES

SPAIN: 10,140

FRANCE: 8,684

RUSSIA: 5,559

UNITED KINGDOM: 3,286 

UKRAINE: 2,953

*All figures based on latest seven-day average reported 

Source: Reuters  

With 1,281 patients in ICUs as of Wednesday, Spain has roughly as many beds devoted to treat grave patients of COVID-19 as France, the United Kingdom, Germany and Italy together.

And 359 of them are in the Madrid region, which for the past week has accounted for roughly one-third of a national average of 8,200 new infections per day.

Spain’s virus caseload, above 600,000, is one of the world’s highest and more than 30,000 have died in the country for the new virus.

Velayos said that prediction models were telling hospital administrators in Madrid that some ICU wards could reach peak capacity in the second half of September. But little or nothing has been done to avoid returning to extended shifts among many health professionals that are still recovering from the stress of the pandemic’s first wave.

‘In March, it was like a nuclear bomb that brought the health system as a whole to a collapse in a matter of weeks,’ Velayos said. ‘We might not be there yet, but that´s not a reason not to be worried. We have allowed the outbreaks to reach a level of being uncontrollable.’

Medical workers are this time better prepared, with lessons learned on how to treat incoming patients more effectively and they have means to better protect themselves against contagion. But operating rooms in the Madrid region, which has a population of 6.6 million, are already being turned into ICUs and surgeries have been postponed, while hospitals compete to hire professionals for the expanded capacity.

Regional authorities say that the health system still has room to manage the incoming flow of patients, but following warnings by medical personnel like Velayos, officials are now reacting with stricter measures that could include selective lockdowns in parts of the city as early as next week.

The five countries with the highest average number of daily cases recorded in the last week in Europe

Current infection rates in Europe according to the European Centre for Disease Control (ECDC), with Spain and France among the worst-affected countries in the recent rebound 

The restrictions, if finally adopted, will center on urban areas where the coronavirus is spreading faster, officials announced Wednesday. That’s suburban towns like Fuenlabrada, but also working-class neighborhoods in southern Madrid where contagion rates have been steadily soaring since August.

They also happen to be areas where less affluent residents and mostly migrant families cram into small apartments and commute on public transportation to manual work in other quarters of the Spanish capital.

COUNTRIES REPORTING MOST NEW CASES/DEATHS EACH DAY

CASES 

INDIA: 93,199

US: 38,897

BRAZIL: 31,599

ARGENTINA: 10,960

SPAIN: 10,140

DEATHS

INDIA: 1,162

US: 854

BRAZIL: 808

MEXICO: 456

ARGENTINA: 207 

*All figures based on latest seven-day average reported

Ángela Cantos lives in the Vallecas neighborhood, one of the hot spots in the recent wave of outbreaks. She said that if her neighborhood is locked down, ‘then Madrid will be paralyzed.’

‘Who is going to cook and clean in other districts if they close down here?’ she said.

The regional deputy health chief, Dr. Antonio Zapatero, said Wednesday that ‘Madrid wants to flatten the curve before the arrival of autumn and the complications that cold weather could bring,’ adding that the ‘drastic measures’ to be taken will be decided by the weekend.

Zapatero also said that people have relaxed protection measures by holding large gatherings, often forgetting about social distancing or masks. He also announced that police will monitor compliance of mandatory self-isolation since at least 90 people have been found to be skipping quarantines after testing positive for the new virus.

The country brought contagion under control earlier this year with a three-month lockdown, one of the strictest anywhere, but since it relaxed restrictions in mid-June, outbreaks have spread throughout the country.

The Spanish government says the country is now doing more tests and that more than half of the newly infected show no symptoms. But health centers are starting to struggle to cope with the number of virus tests required and responding to patients. In hospitals, 8.5% of the country´s beds are now treating COVID-19 patients, but in Madrid that share jumps to one in five beds.

In terms of ICUs, official data shows that 38% of the region’s beds have coronavirus patients, although some hospitals are already at 90% of their capacity before rolling out emergency plans for new beds, like they did in spring.

‘Madrid is maintaining a steady level of infections, but we have to take into account the impact of the pandemic in primary care, in hospitals, which is totally sustainable at the moment. But we have to make that line of infections decrease,’ said Zapatero, who back in March was tasked with Madrid’s makeshift hospital of 1,500 temporary beds in an exhibition center.

Europe’s daily number of cases (shown on this chart) has reached record levels, according to WHO figures, although deaths have so far remained relatively stable 

This time, officials are hoping they don’t have to reach that point. The regional government is spending 50 million euro (£45.5 million) to build by the end of October a massive permanent new ‘epidemics hospital’ with more than 1,000 beds. 

It’s also promising more resources for primary care, since health centers have now become the new bottleneck of citizens concerned that they may have contracted the virus.

EUROPE WARNED TO BRACE FOR HIGHER MORTALITY RATE 

The WHO warned Europe this week to brace for higher mortality rates over the autumn as cases soared on the continent.

Spain, France, the Netherlands, Malta, Greece, Slovenia and Ukraine are all reporting more cases than ever.

In the last seven days, Spain has reported an average of 10,140 cases each day, France 8,684, Russia 5,559, the United Kingdom 3,286, and Ukraine 2,953.

The countries reporting the highest average deaths over the same period were Russia 114, Spain 59, Ukraine 54, Romania 38 and France 36.  

‘It’s going to get tougher. In October, November, we are going to see more mortality,’ WHO Europe director Hans Kluge said on Monday.

‘It’s a moment where countries don’t want to hear this bad news, and I understand,’ Kluge said, adding that he wanted to send the ‘positive message’ that the pandemic ‘is going to finish, at one moment or another.’ 

In addition to performing most of the testing, first-row doctors in Spanish health centers have now taken the burden of contact tracing.

‘The problems in primary care are not from the past six months,’ said Dr. Olaya Muñoz, who works in a health center in the heart of Madrid. ‘COVID has just been more stress for a system that was malfunctioning for at least a decade.’

Muñoz finds time to talk, while catching her breath, as she walks uphill to visit two elderly patients at home. After that, more than 40 appointments await her back at her community health center. Although these days they do most of them by phone, she can’t devote more than an average of six minutes per patient.

‘The workload is just unbearable,’ she said.

Dr. María Cruz Martín Delgado, spokeswoman for Spain’s intensive care specialists’ association known as Semicyuc, says that a collapse in primary care couldn’t only lead to more asymptomatic cases to go undetected but also poorer or no treatment of other illnesses that eventually could lead to more patients downstream, in hospitals and ICUs.

What Martín wants is a clear protocol from authorities at the national and regional levels on how to proceed.

‘We need to know what is the point when we need to turn down other patients, because we doctors can’t take all responsibility again having to respond to an emergency when we are not given the resources to do so,’ she said.

Velayos, the intensive care specialist from Fuenlabrada, said that the work overload in March and April was widely acknowledged among his colleagues ‘as part of an exceptional situation that needed to be met with all the world´s generosity.’

‘But right now we are talking about a situation becoming chronic, where stress is going to be the norm and routine,’ he said.

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