Exhausted and with few beds free, doctors struggle amid second wave

Better prepared, yes, but with few beds remaining and exhaustion rife: this is how doctors are tackling an explosion of Covid-19 cases in the intensive care unit of one hospital in Buenos Aires Province.

The frenetic workload in this corner of the hospital, dedicated to critical Covid-19 patients, has not changed more than a year after the disease arrived in Argentina.

"The patient had a heart attack," explains one nurse to the doctor as he begins his watch, bothered by the incessant beeping of the monitors and the hiss of artificial respirators.

"This is very hard," agree the doctors and nurses, who work around the clock to save lives in the ICU unit of the El Cruce Dr. Néstor Carlos Kirchner public hospital in Florencio Varela, one of the poorest areas in the south of the province.

"We have not stopped since March. At this moment we are seeing a resurgence of the [contagion] curve and an increasing need for beds, especially for young people and those in very serious situations," explains Dr. Nestor Pistillo, the head of the ICU unit.

The advanced hospital has 44 beds for critically ill patients. They are "100 percent busy," 24 of them with coronavirus patients, says the hospital’s administrators. As it did last year, officials are once again planning to open separate "modular" health centres to treat an overflow of cases.

"If this increase continues, other measures will have to be taken, supported by a crisis committee," says Dr. Ariel Sáez de Guinoa, the hospital’s director.

Collapsed ICUs

"The main problem that serious patients have, due to Covid, a prolonged length of stay. We have had patients who were hospitalised for more than 70 days," says Pistillo.

"The beds are finite, the moment intensive care collapses there will be a serious problem because there will be people, younger and younger [people], who are at risk of losing their life," he adds.

With a soaring contagion curve, those running ICUS are anticipating the worst. A new daily record of 27,001 daily was recorded on Tuesday, with cases now regularly topping 20,000 every 24 hours.

As of Tuesday, ICU beds were 71 percent occupied in the Buenos Aires Metropolitan Area (AMBA) and at 62 percent capacity nationwide, according to official data.

The second wave is rampant. In Buenos Aires City, coronavirus patients admitted to the public health system increased by 27 percent between April 5 and 11.

Argentina has reported the Brazilian P1 variant on its territory even as its vaccination campaign has made slow progress.

"We have suspended some of the surgeries, but that has an additional problem: we are ceasing operations for brain tumors, heart surgeries, organ transplants – that means that if a person does not die from Covid, they die from another disease," explains Pistillo.

He also worries about a shortage of staff to deal with the next wave.

"Staff cannot be replaced. One can have a respirator but it’s like having a Formula One car: you need a pilot to operate it,” he adds. “These patients are going to be hospitalised for a long time. Quality of care is what defines the difference between life and death.”

‘I want to take my daughter home’

From outside the ICU ward, a woman looks through the glass at her daughter, holding up a hand and wiping away tears. Her daughter, just 43, is an induced coma.

"Help me doctor, I want to take my daughter home," she calls out as other visitors pray silently for their loved ones.

Rafael Porcel's is a rare happy face in the waiting room: his mother is being transferred out of ICU.

"We thought there was no hope, but now after seven days [of intensive treatment] she is getting better," he said.

Many of the patients who enter the ward pass away. Of those who do recover, many are left with serious health issues, such as brain damage, respiratory problems or kidney failure.

The hospital developed a "humanised care" programme in which family members are included in the patient's treatment.

"Intensive therapy is a place that has no light, that has no notion of time,” explains 33-year-old physical therapist Yazmín Saad, her voice breaking. ““It’s about not losing sight of the fact that it’s not only the patient that needs to be cared for.”

The last year has been tough on her. “When I get home, I close my eyes and those moments of intimacy in which you tell a patient that you are going to be connected to a mechanical ventilator... which means you may be the last person they see,” she says, her voice trembling.

"I will never forget the things those patients tell me in those moments. They are much more than a patient in need of respiratory assistance: sometimes they are a father, a mother, the love of someone’s life".