De-Escalation in Hospitals: Spain’s Medical Challenge to Create ‘Clean Zones’ and Avoid Rebounds

HOSPITALS around the nation have begun cleaning floors for non-infected patients, and, in some cases, will resume surgeries but until ICUs are vacated the plan will not be able to move forward.

Hospitals throughout Spain have undergone a comprehensive metamorphosis since the outbreak of the epidemic to put themselves at the front lines of the fight against the coronavirus.

The flattening of the curve has stabilised the rate of hospitalisations and ICU admissions, which are already below 2 per cent. This Wednesday there were 940 new admissions and 73 new patients in critical care units. Despite this positive data, there is still a lot of caution among professionals as they fear for a second rebound.

However, the healthcare system is preparing for a progressive return to normality that is slowly looming and will last for many weeks. This is the next health challenge which Spain faces: to return attention to the patients that the epidemic has left in a waiting limbo.

Madrid, one of the epicentres of the pandemic, has planned to concentrate all infected patients who require hospitalisation in Ifema, which will extend their service “for as long as necessary.”

“We will leave Ifema for Covid-19 and the hospitals will gradually de-escalate, starting with the least complex,” explain sources from the Ministry of Health.

In large hospitals, such as Gregorio Marañón, the staff has already been informed that surgical activity, such as scheduled operations on the waiting list, will not resume until May.

In hospitals, the emergency spaces (gyms, libraries, corridors …) which were previously enabled to respond to the flood of coronavirus patients have gradually been de-escalated and are being reorganised to expand the number of'”clean zones’ free of Covid-19 on hospital floors.

This is common practice in all autonomies. The tents mounted outside, such as the Severo Ochoa (Leganés), have already closed although it has been decided to not dismantle the entire structure as a precaution. There is a latent fear that cases may increase again among professionals as they return to work in these upcoming weeks.

The best measure of de-escalation is the steady rate of hospitalisations and ICU admissions. This is the most “solid” and trustworthy data to study the evolution of the pandemic, explained the coordinator of the Centre for Health Alerts and Emergencies, Fernando Simon, on Wednesday.