QCOSTARICA – Overcrowded hospitals, staff with fatigue, inability to transfer patients to centers with greater capacity, lack of medical equipment and congested emergency services.
This is the critical situation faced by the hospitals of the Caja Costarricense de Seguro Social (CCSS) due to the increase in COVID-19 infections in recent weeks.
The conditions were exposed by 40 directors of medical centers in a 13-page note addressed to the Caja’s executive president, Román Macaya, and the general manager, Roberto Cervantes, on September 6.
The fatigue of health professionals is so high that, according to the document, medical centers struggle with frequent disabilities and hiring more staff is not a viable option, since the labor market is exhausted and the available people do not meet all the requirements.
The anguish of hospital heads is supported by statistics.
During the first week of September, an average of 156 patients per day was admitted to hospital for covid-19, of which 35 patients per day entered intensive care units.
In other words, the hospital system had to juggle to receive 6.5 COVID-19 patients per hour in that week.
And the deaths. Every hour a patient dies from reasons associated with SARS-CoV-2, the CCSS reported Thursday. Since March 2020, 5,721 people have died from causes related to covid-19.
Between August 31 and September 5, 72 people could not be transferred to hospitals with greater capacity due to lack of space, of which 35 were in critical condition.
“With absolute respect, we request that, in the current scenario, the concerns of this collegiate body be transmitted by you, as our superior authorities, to the President of the Republic, the Minister of Health and the President of the National Commission for Risk Prevention and Emergency Attention, so that, in safeguarding the health of the citizens, the respective measures are taken,” said the bosses in the letter.
They add that they are “extremely concerned” about the elimination of restrictions by the Health authorities.
During this month (September), the daytime vehicle restriction for weekends have been lifted and the soccer fans (maximum 3,000 limit) have been allowed back in to the national stadium for national team games.
At the end of each game, the captain of the national team, Bryan Ruiz, asked the Ministry of Health to allow more fans for the October games.
“The release of restrictions generates counter-messages at the communication level from all spheres.”
On this aspect, the group of doctors reproached the effects of reducing restrictions.
“There is also a loss of interest in the community and an attitude of denial of the implications of the pandemic. The efforts made by the CCSS at the communication level require the support of other institutions, both in the health sector and in other sectors, with messages consistent with the current reality,” said the letter.
Six major concerns
The six points that most concern hospital directors are:
- The availability of human resources and work materials.
- Epidemiological behavior.
- The advancement of vaccination.
- The circulation of the delta variant in the country.
- The increase in respiratory infections during the rainy season.
- The behavior of people.
They emphasize that the CCSS has little chance of expanding the number of beds to care for patients with covid-19 in serious condition.
“The scope for action in terms of the supply of intensive care beds is narrow and to date it is close to its limit capacity”, stated the directors.
As of September 6, they added, 458 of the 499 beds available for seriously ill patients were occupied.
“In one or two weeks there will be no more room for expansion, unless the case curve stabilizes or decreases,” they added.
Even if the institution had the capacity to install more beds, this action would not improve care, since doctors, nurses, and assistants would be divided among a greater number of patients.
To these circumstances are added the contagion projections for the coming weeks.
The CCSS analyzes indicate that, in the next eight weeks, the number of cases of covid-19 will increase.
Even in the most optimistic scenarios, in the second half of September there will be 600 people in intensive care units. The CCSS ICU optimal capacity is 359 patients.
Another factor that adds pressure to the health system is the demand for care from patients with other pathologies.
Macaya acknowledged the complications that hospitals face and fears that dreaded moment when doctors will have to decide who to care for and who not to because of saturation?
“We are already in a critical situation, but what is coming, let’s hope, will not lead us to such heartbreaking decisions, but I cannot say that this is not coming,” said the CCSS president.
“We are already seeing symptoms of system stress, one of the most critical that we have experienced in this pandemic, we have to be clear that we have to turn the curve and we have to get vaccinated,” he added.
In an interview with La Nacion Thursday morning, Macaya indicated that they are evaluating the possibility of sending non-covid-19 patients to private medical centers.
To be clear, covid-19 patients are being treated in private hospitals, mostly foreigners and hose with insurance, and those who can afford private care.
However, he emphasized that the most powerful weapon against covid-19 is not in hospitals, but in the behavior of people with respect to the virus.
“What is being discussed now is what is the most simplified procedure to make use of these beds. At this moment we have two waves: that of covid cases and those of non-covid cases. This situation is different from the situation in previous May.
“In May we had a covid wave, but there was no non-covid wave.
“At this moment, with the opening of activities, we have traffic accidents, all kinds of trauma due to violence or accidents and there is the decompensation of many chronic patients. That is saturating the emergency services,” said Macaya.
Roberto Cervantes, general manager of the CCSS, said that on Wednesday, September 8, he had a meeting with the Ministry of Health and the National Emergency Commission to discuss this issue.
“Some of the requirements are going to be changed to make them more flexible, I think that today (Thursday) this is ready to start,” said Cervantes.
Precisely on Thursday night, the institution asked the Ministry of Health to reactivate the use of beds in private hospitals.
The initial plan of the CCSS is to send patients with diseases other than coronavirus to those hospitals but asks Health to evaluate the possibility of transferring people with covid-19.
Among the requirements is having tested negative for covid-19 in the last 48 hours, not requiring a hospital stay longer than five days, and having a defined diagnosis, among others.