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Covid revisited, two years on: Survival rate 'over 90%' in 2022
09/03/2022
TWO years on from the Covid-19 pandemic entering Spain and with its first peacetime lockdown in centuries on the horizon, survival rate among those who catch the virus is now 'above 90%', according to medics.
National Spanish news reporters who visited intensive care in mid-March 2020 at one of the country's worst-affected hospitals at the time – the Ramón y Cajal in Madrid – have now gone back there to find out how the situation compares in the same month in 2022.
With the hitherto unnamed Coronavirus bursting into Spain just weeks after the Chinese city of Wuhan went into total lockdown, Madrid was completely devastated by uncontrolled contagion, with pop-up hospitals and mortuaries on industrial estates, beds in corridors, and almost every resident in the capital having lost at least one family member or friend from the disease.
Conversely, outside of Spain's largest cities, the impact of the first wave of the virus was almost anecdotal – official figures post-lockdown showing cases of towns of 25,000 with just 18 cases and three deaths, or of 11,000 inhabitants with two cases and no deaths, were very common.
In the beginning, though, figures by municipality or even region were not revealed, which was partly why the national lockdown was so successful: Everyone assumed everyone else was infected unless proven otherwise, and acted accordingly.
After the Spanish public was gradually 'released' through a four-phase 'unlocking', the national government praised the nation for its responsible, community-spirited behaviour – pulling together for the greater good, even whilst apart.
It was estimated that the first, total shutdown, where the only 'excuse' for being outside the home for three months was essential supermarket shopping, potentially saved millions of lives.
Over 100 and all intubated in 2020; just five and fully conscious in 2022
Journalist Carlota Chiarroni and photographer Jorge París from the daily newspaper 20 Minutos said the 'critical' nature of the scene before them two years back was 'palpable', with over 100 patients in the ICU, every single one of them intubated and face-down, and only one of them conscious with the rest either out cold or under heavy sedation.
The crisis was so severe and came on so quickly that the Ramón y Cajal even had beds in the operating theatres to accommodate all those who had to be admitted for urgent treatment.
Now, the media team say that of the 24 beds in intensive care, only five are occupied, all of them awake, and some of them waving to the visitors.
Head of the anaesthetics team Dr David Pestaña says: “This is no longer a hospital on the battleground in the midst of a war.
“Two years ago, out of every three patients admitted to hospital with Covid, you knew that one wouldn't survive, and it was just awful looking at the people being brought in and knowing immediately which ones were not going to make it. It was a horrible sensation.
“The first wave of the virus hit us full-on. Only those who were really seriously ill were admitted – those who were gasping for breath – it was frightening.
“Back then, practically everyone who came in had to be intubated.”
Fast-forward to March 2022, and Dr Pestaña says: “Not any more, though.”
More contagious, less fatal – and rarely the main cause of admission
Head of the ICU, Dr Raúl de Pablo, said: “We're much calmer now, although it's true that December and January were pretty bad.”
This was when the Omicron variant had reached Spain – a strain which is drastically more contagious, but less likely to be fatal.
The fact Omicron increased pressure on intensive care units was due to 'patients admitted with Covid' rather than 'patients admitted due to Covid', explains Dr de Pablo.
“They're not all patients with bilateral pneumonia,” says nursing supervisor Rocío González.
“Instead, they'd be patients with, for example, pancreatitis, but whose routine PCR test had given a positive result.
“Their admission was not due to Covid per se, but due to the pancreatitis.
“Nowadays, a patient with Covid is – without wanting to tempt fate, and in the majority of cases – just another patient with a 'respiratory complaint'.”
Dr de Pablo says mortality has plummeted in the past two years: “Nowadays, our survival rate is over 90%.
“People still do die, but far fewer than before, and the majority are already on a main ward because they're already terminal.”
Although the fatality rate of 174 patients nationwide in a typical day – down from about 393 a month ago – is not exactly a 'fraction' of the 900 at the peak of the first wave, the actual percentage is very small indeed, because of the Omicron being so much more contagious and a far higher number of people catching it, says Dr de Pablo.
ICU patients now are either unvaccinated, or with pre-existing conditions
The vaccine has made a huge difference: “About half of those who do not survive have either not been vaccinated, or have not had their full quota of vaccines; the other half have already-serious pre-existing conditions,” Dr de Pablo reveals.
“If you're fully jabbed and have no pre-existing health conditions, you're unlikely to end up in hospital if you catch Covid now.”
Medical workers' clothing is no longer full biohazard either – complete face screens, overalls, goggles and caps, with colleagues required to help each other put them on, dumping them in disinfectant immediately after use, and the floors cleaned with bleach after every footstep were the norm in March 2020, say nurses Natalia and Elena, but now, they use a more standard form of personal protection equipment (PPE) – gowns, masks, cloth caps and gloves – as is typically worn in operating theatres or ICUs at all other times.
“We don't go through the old ritual of dressing each other in space suits, because we now know the virus isn't transmitted through touching – time has taught us what we need to do and what we don't need to bother with or shouldn't do.”
Learning curve...but a harsh lesson
Dr de Pablo says: “As an example, we've learned how to treat and not to treat patients. Ventilators can cause damage, so we need to use plenty of caution and patient protection; we've brought forward the process of getting patients moving again, because it's crucial to getting them fit to discharge sooner and reduce the time they have to spend on mechanical ventilation.
“To that end, we've brought in more physiotherapists and rehabilitation staff to reduce the long-term effects that being in the ICU can have on patients – and on us.”
“Patients brought into intensive care with Covid suffer post-traumatic stress disorder [PTSD],” explains Dr Pestaña, “and front-line healthcare staff, too. What we've all been through has left emotional scars and open wounds.
“Even though the atmosphere in the ICU these days is completely different, even optimistic, the harshest memories remain branded on the staff.”
One auxiliary nurse, Marta, who was in charge of intubating the very first 'positive' admitted to intensive care, struggled to hold back tears as she recounted losing literally hundreds of patients in the early weeks.
With the very first explosion of Covid in the country, hospital staff were battling against a complete unknown - “We knew it wasn't the 'flu, but that's about all we knew,” said Marta.
The first 'positive' patient was 'the lady in bed 10'.
“I remember it perfectly. She grabbed our hands and begged, 'please, please, don't let me die'.
“Her name was Elsa. She regained consciousness, and was eventually discharged.”
Supervisor Rocío said 'crying in the car' after finishing their shifts had turned into 'the new normal', so as to put on a brave face in front of the family once they arrived home.
“Nobody can ever be prepared to face what we've had to face – staff were having regular nightmares,” she reveals.
Dr de Pablo said sometimes entire families were admitted at once, and 'you didn't know whom to call' when notifying next of kin, since everyone's next of kin was already there, being treated.
He even remembers a patient who was in intensive care for 196 days – six-and-a-half months – but who finally recovered and was discharged.
“All this seems so far away these days,” the staff said.
“We'll never forget, but it's all behind us now.”
Related Topics
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TWO years on from the Covid-19 pandemic entering Spain and with its first peacetime lockdown in centuries on the horizon, survival rate among those who catch the virus is now 'above 90%', according to medics.
National Spanish news reporters who visited intensive care in mid-March 2020 at one of the country's worst-affected hospitals at the time – the Ramón y Cajal in Madrid – have now gone back there to find out how the situation compares in the same month in 2022.
With the hitherto unnamed Coronavirus bursting into Spain just weeks after the Chinese city of Wuhan went into total lockdown, Madrid was completely devastated by uncontrolled contagion, with pop-up hospitals and mortuaries on industrial estates, beds in corridors, and almost every resident in the capital having lost at least one family member or friend from the disease.
Conversely, outside of Spain's largest cities, the impact of the first wave of the virus was almost anecdotal – official figures post-lockdown showing cases of towns of 25,000 with just 18 cases and three deaths, or of 11,000 inhabitants with two cases and no deaths, were very common.
In the beginning, though, figures by municipality or even region were not revealed, which was partly why the national lockdown was so successful: Everyone assumed everyone else was infected unless proven otherwise, and acted accordingly.
After the Spanish public was gradually 'released' through a four-phase 'unlocking', the national government praised the nation for its responsible, community-spirited behaviour – pulling together for the greater good, even whilst apart.
It was estimated that the first, total shutdown, where the only 'excuse' for being outside the home for three months was essential supermarket shopping, potentially saved millions of lives.
Over 100 and all intubated in 2020; just five and fully conscious in 2022
Journalist Carlota Chiarroni and photographer Jorge París from the daily newspaper 20 Minutos said the 'critical' nature of the scene before them two years back was 'palpable', with over 100 patients in the ICU, every single one of them intubated and face-down, and only one of them conscious with the rest either out cold or under heavy sedation.
The crisis was so severe and came on so quickly that the Ramón y Cajal even had beds in the operating theatres to accommodate all those who had to be admitted for urgent treatment.
Now, the media team say that of the 24 beds in intensive care, only five are occupied, all of them awake, and some of them waving to the visitors.
Head of the anaesthetics team Dr David Pestaña says: “This is no longer a hospital on the battleground in the midst of a war.
“Two years ago, out of every three patients admitted to hospital with Covid, you knew that one wouldn't survive, and it was just awful looking at the people being brought in and knowing immediately which ones were not going to make it. It was a horrible sensation.
“The first wave of the virus hit us full-on. Only those who were really seriously ill were admitted – those who were gasping for breath – it was frightening.
“Back then, practically everyone who came in had to be intubated.”
Fast-forward to March 2022, and Dr Pestaña says: “Not any more, though.”
More contagious, less fatal – and rarely the main cause of admission
Head of the ICU, Dr Raúl de Pablo, said: “We're much calmer now, although it's true that December and January were pretty bad.”
This was when the Omicron variant had reached Spain – a strain which is drastically more contagious, but less likely to be fatal.
The fact Omicron increased pressure on intensive care units was due to 'patients admitted with Covid' rather than 'patients admitted due to Covid', explains Dr de Pablo.
“They're not all patients with bilateral pneumonia,” says nursing supervisor Rocío González.
“Instead, they'd be patients with, for example, pancreatitis, but whose routine PCR test had given a positive result.
“Their admission was not due to Covid per se, but due to the pancreatitis.
“Nowadays, a patient with Covid is – without wanting to tempt fate, and in the majority of cases – just another patient with a 'respiratory complaint'.”
Dr de Pablo says mortality has plummeted in the past two years: “Nowadays, our survival rate is over 90%.
“People still do die, but far fewer than before, and the majority are already on a main ward because they're already terminal.”
Although the fatality rate of 174 patients nationwide in a typical day – down from about 393 a month ago – is not exactly a 'fraction' of the 900 at the peak of the first wave, the actual percentage is very small indeed, because of the Omicron being so much more contagious and a far higher number of people catching it, says Dr de Pablo.
ICU patients now are either unvaccinated, or with pre-existing conditions
The vaccine has made a huge difference: “About half of those who do not survive have either not been vaccinated, or have not had their full quota of vaccines; the other half have already-serious pre-existing conditions,” Dr de Pablo reveals.
“If you're fully jabbed and have no pre-existing health conditions, you're unlikely to end up in hospital if you catch Covid now.”
Medical workers' clothing is no longer full biohazard either – complete face screens, overalls, goggles and caps, with colleagues required to help each other put them on, dumping them in disinfectant immediately after use, and the floors cleaned with bleach after every footstep were the norm in March 2020, say nurses Natalia and Elena, but now, they use a more standard form of personal protection equipment (PPE) – gowns, masks, cloth caps and gloves – as is typically worn in operating theatres or ICUs at all other times.
“We don't go through the old ritual of dressing each other in space suits, because we now know the virus isn't transmitted through touching – time has taught us what we need to do and what we don't need to bother with or shouldn't do.”
Learning curve...but a harsh lesson
Dr de Pablo says: “As an example, we've learned how to treat and not to treat patients. Ventilators can cause damage, so we need to use plenty of caution and patient protection; we've brought forward the process of getting patients moving again, because it's crucial to getting them fit to discharge sooner and reduce the time they have to spend on mechanical ventilation.
“To that end, we've brought in more physiotherapists and rehabilitation staff to reduce the long-term effects that being in the ICU can have on patients – and on us.”
“Patients brought into intensive care with Covid suffer post-traumatic stress disorder [PTSD],” explains Dr Pestaña, “and front-line healthcare staff, too. What we've all been through has left emotional scars and open wounds.
“Even though the atmosphere in the ICU these days is completely different, even optimistic, the harshest memories remain branded on the staff.”
One auxiliary nurse, Marta, who was in charge of intubating the very first 'positive' admitted to intensive care, struggled to hold back tears as she recounted losing literally hundreds of patients in the early weeks.
With the very first explosion of Covid in the country, hospital staff were battling against a complete unknown - “We knew it wasn't the 'flu, but that's about all we knew,” said Marta.
The first 'positive' patient was 'the lady in bed 10'.
“I remember it perfectly. She grabbed our hands and begged, 'please, please, don't let me die'.
“Her name was Elsa. She regained consciousness, and was eventually discharged.”
Supervisor Rocío said 'crying in the car' after finishing their shifts had turned into 'the new normal', so as to put on a brave face in front of the family once they arrived home.
“Nobody can ever be prepared to face what we've had to face – staff were having regular nightmares,” she reveals.
Dr de Pablo said sometimes entire families were admitted at once, and 'you didn't know whom to call' when notifying next of kin, since everyone's next of kin was already there, being treated.
He even remembers a patient who was in intensive care for 196 days – six-and-a-half months – but who finally recovered and was discharged.
“All this seems so far away these days,” the staff said.
“We'll never forget, but it's all behind us now.”
Related Topics
You may also be interested in ...
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