Non-urgent operations postponed, visitors barred, field hospitals being prepared

The government of the Valencian Community has postponed all non-urgent operations and has barred visitors to hospitals across the region in the face of an alarming increase in admissions due to Covid.  The Valencian Ministry of Health has taken the decision to postpone all non-urgent surgical activity and diagnostic tests in public hospitals across the Valencian Community.  The Ministry has also issued orders that all available ICU beds are to be readied and that visits to patients are now prohibited.

The new restrictions are part of a document, “’Organizational measures for health care in response to covid-19” issued by Health Minister Ana Barceló and revealed last night (Friday 8th January) by the CESM medical union.

Given the current situation in terms of hospital bed and ICU occupancy, the Ministry of Health confirmed it has suspended all scheduled non-urgent surgical activity including surgery without admission.

Diagnostic tests and other non-urgent scheduled admissions are also postponed, except in the case of cancer treatments. Health workers have been instructed to prioritise attendance by patients through non-contact consultations by Primary Care staff.

“Significant increase in cumulative incidence”

According to the general director of Healthcare, Mariam García Layunta, the situation in the Valencian Community is the same as in the rest of Spain and Europe, in that officials are “recently noticing a significant increase in the accumulated incidence”.

García Layunta said, “The number of cases is increasing, and that is, logically, creating an increase in the pressure on our hospitals, both for admissions to general wards and to ICU”.

García Layunta confirmed that the health departments, as they did during the first wave, are applying their contingency plans, which basically consist of “expanding spaces and doubling beds in order allow for greater healthcare capacity in the ward and in ICU.”

“This means that at this moment we still have sufficient capacity to respond to the demands we are having and we also have other facilities that we did not have in the first wave, such as the field hospitals that are ready to be installed,” she explained.

She also recalled that back in November, the Minister of Health issued a resolution so that the resources of private hospitals would be made available to public healthcare in a public-private collaboration.

Field hospitals being prepared

The spectacular increase in positive cases in recent weeks is straining hospital capacity to such an extent that sources from the Ministry of Health confirmed that field hospitals in the three provinces – Alicante, Valencia and Castellón – are being prepared for a possible saturation of the system in the forthcoming weeks.

Other instructions from the Ministry include an order that transfers of non-covid critically ill patients will be carried out to private hospitals, preferably according to the geographical proximity to the patient’s home.  In addition, all hospital beds must be ‘enabled’, which includes the doubling up of individual rooms and the use of spaces usually dedicated to other activities.  This is the case, for example, in Elche General Hospital where beds have been installed in the hospital chapel and in Vega Baja where operating theatres are being converted to secondary ICUs.

Elche General Hospital: Beds installed in hospital chapel

Hospital La Fe in Valencia, and the General Hospitals of Alicante and Castellón have been instructed to prepare all necessary infrastructure so that field hospitals are operational in the shortest time possible.

Surgical patients that are not in a position to be delayed will be referred. If they are oncology patients, they will be referred to the IVO (Valencian Oncology Institute) or if this is not possible, these patients and the remainder of urgent surgical cases would be referred to private hospitals.

The instructions for admitting covid patients indicate that both suspected and confirmed cases can be housed on the same ward until capacity is reached.  When hospital occupation is high enough, two patients can be placed in the same private room (if both cases are confirmed positive).

Furthermore, in health departments with two hospitals, covid cases will be confined, as far as possible, to the same hospital.

Non-urgent diagnostic tests are suspended, as are non-urgent scheduled admissions, except in the case of rapid cancer screening (breast cancer, colon cancer, etc).

Visits to patients are prohibited

The Health Ministry has prohibited visitors.  However, hospitals will allow, if necessary, the presence of a single companion as a caregiver to patients deemed chronic or long-stay, minors or dependents, as well as women giving birth.

Likewise, an exception will be considered in special cases such as complex social situations or end of life care, or if it is considered that the physical presence of a companion or volunteer is necessary.

Across the board, any person with respiratory symptoms or fever must refrain from accompanying a patient to a hospital or health centre. In addition, hospitals must contact the families of patients at least once a day to report changes and allow, as far as possible, contact through tablet-type devices, provided for use by the hospital if the patient does not have one of their own.

End of life care

Due to the latest restrictions, new instructions for end of life care indicate that in a terminal situation, the patient should be transferred to an individual room that is silent and as far away as possible from the other rooms, whenever circumstances allow.  In this situation, access will not be granted to any family member with suspected Covid symptoms.  If a family member is allowed, a device may be provided so that the visitor can put the rest of the family in contact with the patient. In the case of covid patients, the necessary protection will be provided to the visitor during the visit.