Dear Editor,
The evolution of SARS-CoV-2 infection has been characterised by a succession of incidence peaks or waves (Fig. 1 ). Each of these has represented a stress test and a series of challenges and experiences for the entire health system. I would like to share the most relevant ones from one particular tertiary hospital.
Fig. 1.
Evolution of patients admitted to hospital during the COVID-19 pandemic. The number of patients is given in 0–24 h intervals. The main characteristic of each wave is stated.
The first wave was characterised by a rapid rise in incidence, which led to a 438% increase in ICU capacity and a doubling of the number of beds to a total of 2054.1 This crisis management was conducted in coordination with the rest of the health systems in the territory by means of 2 parallel transformations that demonstrated the potential flexibility of the health system. The first involved mobilising most of the resources, both human and material, to care for infected patients, bringing non-COVID activity to a standstill. The second was to create hospital space in an unprecedented manner. At the same time, information systems and advances in data management were key to monitor data in real time and generate predictive models.2
During the second wave, inpatients had more severe disease compared to the first wave.3 On this occasion, the organisational challenge consisted in the coexistence of patients with and without COVID-19. Strategies for containment and prevention of nosocomial outbreaks of COVID-19 were developed,4 such as mass screening of professionals and patient groups. Telemedicine received a boost, with over 200% more telemedicine visits than in 2019. The flexibility that emerged earlier made it possible to create circuits and spaces for the patients concerned. However, it was not possible to cope with all the staff absences, resorting to an increase in nursing staff and the diversification of professional roles, which gave rise to multidisciplinary teams.
The third and fourth waves can be analysed together because of their similar characteristics and their continuity over time. The big challenge during this period was mass vaccination initiated in hospitals. Vaccinating as many people as possible in as short a time as possible was a major organisational effort. Information systems, once again, were crucial in identifying and prioritising vaccination. In parallel, the delta variant of the virus emerged, bringing changes in the epidemiology and severity of the disease.5 The laboratory had to respond with next-generation sequencing of patient samples, in addition to the PCR diagnostic work, decisive throughout the pandemic.
At the end of the pandemic, a common challenge emerged: COVID-19 patients with other underlying clinical conditions, in addition to maintaining quality of care in other departments. In the fifth wave, patients were on the whole more severe, there was an increase in the ratio of ICU admissions compared to the first wave, as well as a decrease in the median age of those admitted, 7 years compared to the first wave. There was also an increase in the number of pregnant women with severe pneumonia admitted to the ICU, who had a very low vaccination rate. In the sixth wave, there was a large increase in incidence in the community. This, together with coexistence with other seasonal respiratory infections such as influenza, led to the return of stress to the ED and to a lesser extent to hospitalisation. In the seventh wave, patients were characterised by advanced age and decompensation when they developed COVID-19 in conjunction with high temperatures. A large proportion of the population vaccinated, knowledge of the disease and its treatment, and the adequacy of an adaptable system made it possible to care for more patients than in previous waves. From this point on, transmission remained sustained and did not affect ICU occupancy.
The context of variability and change of the SARS-CoV-2 pandemic has meant that health systems, traditionally rigid, have had to adapt and become more flexible, with an enabling strategy, emphasising territorial coordination, diversification of roles and spaces, new technologies and multidisciplinary work. This has allowed a sufficient response to meet the demand of the population and has given rise to a care model that is better able to respond to changing health care needs.
Ethical considerations
The author states that it does not apply to this paper.
Funding
The author declares that he did not receive any funding for the preparation of this article.
Conflict of interest
The author expresses that he has no conflict of interest.
References
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