'We can't have a waiting room for 50 people, now we can fit 15'

Like wider society, hospitals are slowly, carefully, taking steps towards a new normality.

Facilities and care are changing again, but unlike the whirlwind transformation witnessed when the coronavirus pandemic took hold in Catalonia, the return is cautious, amid heightened biosecurity measures and the ever-present threat of new Covid-19 outbreaks.

Senior medical staff from three Barcelona hospitals – Vall d'Hebron, Sant Pau, and Clínic – told the Catalan News Agency (ACN) of their experiences of the health crisis, the challenges faced, and the longer-term impact of Covid-19 on patient care.

Hospitals transformed

"Honestly, the hospital was transformed in two weeks. If someone had told us, we wouldn't have believed them," explained Dr Rocío Cebrián, assistant director of care at Vall d'Hebron Hospital.

"Within two weeks it was a completely different hospital, aimed at tackling what was coming through the door, which was Covid."

Patients with Covid-19 currently occupy around 10% of beds at the General Hospital at Vall d'Hebron, down from a high of 95% at the peak of the coronavirus crisis.

The decline for intensive care units (ICUs) has been slower. The hospital's standard capacity of 56 ICUs almost quadrupled to 200 during the worst phase of the pandemic. That is now down to about 80 ICUs, two-thirds of which are for Covid-19 patients.

Tension and pressure

Dr Miquel Sánchez, Emergency Room director at Clínic Hospital in central Barcelona, described the professional toll of dealing with the coronavirus pandemic.

"At the start I wanted to see it as a challenge. There was a lot of management of staff, emotionally. I hope this is an experience we don't have to relive." 

Of Clínic Hospital's 43 wards, 7 are currently for patients with Covid-19, down from 32 wards at the peak of the pandemic in Catalonia. At one stage, 80% of activity in the Emergency Room involved dealing with coronavirus.

"In the last week of March in the Emergency Room there was a tension and pressure on care like I had never seen in my life. We almost collapsed. I know nobody likes that word, but it got to a point where we were barely able to provide hospital beds for the patients coming in."

Dr Xavier Borràs, medical director at Sant Pau Hospital recounts a similar experience.

"The Covid phase has been a terrible phase. Medical staff are fans of lockdown, of everyone staying at home. We are a lot happier with these kinds of messages because we’ve had a rough time." 

The challenge of keeping safe

All three hospitals are now trying to negotiate a path that will let them take care of more non-Covid patients again, while keeping the virus at bay.

For Sánchez, keeping people safe is more testing than ever. "I think the main challenge for us as healthcare professionals is safety, that people coming to hospital are protected, that it’s a safe environment, that staff are safe." 

Although coronavirus cases are falling sharply, there is no certainty that levels will stay low as confinement measures are eased.

At Vall d'Hebron Hospital - which recently completed the first transplant in Catalonia and Spain involving a patient who had recovered from Covid-19 - Cebrián says the de-escalation is complex. "One, you’re going more slowly, and two, you don't know how much Covid will remain, and so you adapt, bit by bit."

The 'new normality'

Taking care of Covid patients has obviously had huge knock on effects on other aspects of care, as Borràs explains.

At Sant Pau Hospital "we cannot take risks and we have to proceed with caution. Take heart surgery for example, we're doing emergency heart surgery but we can't operate at normal levels because after heart surgery, patients must always transfer to intensive care." 

Sánchez says that hospitals will move towards a 'new normality' at a pace determined by safety.

"Everything has to happen more slowly. Where we could visit 100 patients, now maybe we will only be able to visit 30, and where we could do 100 checks, now only 20."

"Everybody has understand that it is for everyone's safety," he said, “because otherwise we would put absolutely everybody at risk again."

Cebrián says that at Vall d'Hebron they have noticed that patients are afraid of getting infected when coming to hospital and are making efforts to reassure them.

Like all hospitals in Catalonia, Vall d'Hebron has separate areas for Covid and non-Covid patients. "The message is that patients should be calm. We have strengthened safety measures for both patients and staff." assured Cebrián, adding that in outpatient areas strict hygiene measures are in place, and safety distances are always guaranteed.

On top of that she explained they are "screening for Covid all patients who are admitted to hospital or need surgery, so we’re actively checking that patients don’t have Covid." 

The nature of patient care will change in the future, explains Borràs. Telephone and video consultations will be increasingly common. "The rules and conditions around biosecurity have changed. We can't have a waiting room with 50 people together. Where before 50 people would fit, now we can fit 15."