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.