What do you remember about the first days?
The first days were chaotic. A chaos in the sense that we were faced with an unfamiliar situation. We had received information a few days earlier about what had happened in Italy and then in Madrid, and we were already starting to see that the same thing would happen here.
On a more personal level, the feeling was one of being on the point of collapsing several times. Of arriving home and thinking that there would be no way of coping the next day.
The Hospital was prepared for caring for the first suspected cases, but it soon became overwhelmed. At what point did you see that the threat had turned into a pandemic?
The Hospital Clínic had, and has, a great deal of experience with imported diseases and we have the Ubuntu code, isolation wards, both in the Accident & Emergency Department and the Intensive Care Unit. And so, we weren’t worried about the complexity of an infectious patient. What we were concerned about was the magnitude of the tragedy, the fact that after few days of patients starting to arrive, the number arriving was higher than the capacity of the wards that we were able to prepare to care for them. We had a ward opening schedule that became overwhelmed. At one point, we had to prepare two wards in a single day.
This made us start to worry that we wouldn't be able to cope if the situation got worse. So, we quickly to set to work and installed oxygen points in the corridor on the 4th floor, because we saw that there would come a time when there wouldn't be enough room for all the patients in the A&E Department. We wouldn't have beds prepared, but at least we would have a place to look after these patients.
After the first case diagnosed at the hospital, the crisis committee was convened on 26 February.
Exactly. That was the right thing to do. I don’t know why we were so fast, because after that we really did have to rush and make quick decisions, but not at that point. We had the first case on 25 February and on 26 February we set up the crisis cabinet. This was the right thing to do.
What was the aim of setting up the cabinet? Who were its members?
The crisis cabinet is a coordination body, for sharing what is going on and seeing which decisions need to be made in the short, medium and long term.
I think that we got the composition right too. We’ve been able to make a few changes, but basically there are the two people with direct responsibility for care, the nurse director and the medical director; the critical care coordinator, who is also in charge of the operational committee - the decisions made by the crisis cabinet are taken to the operational committee to be implemented as quickly as possible. There is also the head of Preventive Medicine and Epidemiology, because being a disease of these characteristics it was essential. Then there is the head of A&E, because this was the entry point; the director of people, since occupational risk prevention is at the heart of all our work; the director of Quality and Clinical Safety, the deputy director at the Plató Centre, and a representative of the surgical services. All of them are very important for the reorganization of the healthcare activity, and the head of Communication, because one of the things that seemed most fundamental was to maintain a policy of full transparency. We communicated all the decisions to everyone, because that was the best way of sharing or of aligning the whole institution.
You have chaired the crisis committee since then. How was the hospital prepared? How were the decisions made?
Now it is more structured than it was in the first wave. Then, they were very hot decisions, but based on a key principle: it was worth making quick decisions, even if we had to correct them the following day. We weren’t very used to this trial and error approach, and it has really helped us a lot. Being aware that we might make mistakes, but that we had to do something. So, the decisions that were made were analysed immediately and corrected if necessary. Over the course of these two years, we have gradually made this more structured and procedural. I think that the key point has been the speed at which the decisions have been made and, above all, the fact that we are not afraid of making mistakes.
Medicalized Hotel, there was no more room for patients in the hospital. How did you decide to set up this unit?
We quickly saw the need for a new unit, seeing how the number of infections was rising. And also because of another no less important aspect, which is that we didn't want to turn the hospital into a "COVID hospital". So, even though the activity was obviously reduced because the capacity was what it was, we continued to have non-COVID patients. This is an idea that I conveyed from the very outset as a concept of equity, since we thought that all patients, COVID or not, have the same right to be treated in a hospital like ours.
There were several initiatives: one was to share patients with private hospitals. This was also very important and we cooperated with the Dexeus, Teknon and Sagrat Cor hospitals. However, there came a time when these hospitals were full too. The hotel option was providential, because it allowed us to have a very large structure, which fortunately we did not end up filling, and with higher levels of comfort and clinical safety than we might have had if we had gone to the temporary field hospitals.
In the Medicalized Hotel set up, the infrastructure and systems people helped a lot and we were able to turn a hotel into a totally medicalized hospital in a very short time.
All of us who participated in that decision and those that were working there, everyone felt very comfortable and recognized that it was the right thing to do.
What were the differences between the waves? Was the management the same?
The complexity varied a great deal from one wave to another. In the first wave it was because of the magnitude, because it was unexpected, due to our lack of knowledge, the uncertainty about how it would evolve. That was very hard to manage. However, in the other waves, the management was much more technical. We probably continue to have a great lack of knowledge about what COVID is, there are different aspects we do not fully understand yet, but the difficulty from the hospital management's point of view in terms of making decisions is that it is increasingly complex, because you have to reconcile many more parameters than just the disease alone, the COVID.
At the moment, for example, the management of waiting lists is a serious problem. The issue of caring for the relatives of the patients we have in the hospital, of whether or not to allow visits. Everything has changed in complexity. We have gone from being on the verge of collapse to ensuring a far more technical management, despite the fact that we still have a lot to learn about a situation that has gradually stabilized but which, unfortunately, will be with us for some time.
Now, with hindsight, is there anything that you would have done differently in the first wave?
There are things we have learnt. I remember the first days when we wanted to ensure all the rooms were single occupancy, so that each patient would be in a separate room. We didn’t want to put two patients together because we still did not know whether they were infected with the same variant of the virus. We don’t do that now. The isolation policies were very strict at the start, and perhaps they didn’t need to be so strict. But it’s easy to say that now, because we have learnt lots of things. But at that time… This is one of the things that we wouldn’t do now.
Are we better prepared to deal with this type of emergency situation?
I think so. There are things we have learnt. We are able to make decisions more quickly now. This has been key and I think it will stay with us forever. When the pandemic goes, it will remain with us for our everyday work. The other thing we have learnt is to trust each other. At that time, during the first wave, when we were on the verge of collapse, the public health system depended on different elements, on different hospitals and primary care centres, so that each one could deal with the situation the best they could. And this happened in the hospital too. We trusted each other and transferred a series of responsibilities without any fear. I think that at this point in time the hospital is less pyramidal, it is more transversal and this is also one of the lessons that we need to keep in mind.
We have had six waves so far, what is the mood among the professionals?
The professionals are tired, because it’s inevitable. During the first wave, the feeling of solidarity, empathy when saying things, humility, and trust were of key importance. And people went for it and gave everything and more, without worrying about anything at all. This was the speed race that we often speak about. When it becomes a middle-distance race or a marathon, you have to develop other characteristics. This is what has been happening. And people have got tired, become a little more intolerant than they were at the start, because they see that this is going to go on for a long time and that the environment and the system don't help, because we don't have the resources to keep up all this activity in a stable way. And finally, just when it seemed like everything was coming to and end, this sixth wave arrived with a more contagious variant, which luckily causes less severe disease due to its own characteristics or because of the vaccines. This has meant that lots of professionals have caught the disease and, as a hospital, we have had to cope with the same activity as usual but with fewer staff. This again has contributed to the fatigue.
You have always said that this was a pandemic of values. What would you highlight about the atmosphere in the hospital?
I have said many times that this was a pandemic of values and I am really convinced of this. I hope that we will learn from this. The values that we mentioned regarding trust were of key importance, generosity in particular. From the management too, gratitude. I don’t think that from the management we have ever thanked everyone so much. Maybe we used to “take it for granted”, as the British say. We thought that our gratitude went without saying. But no, I think it has to be made explicit.
Trust, gratitude, generosity, solidarity, humility for the errors we have made and we have been able to recognize. These have been the key aspects. This pandemic of values has not only been in the hospital, but rather in general throughout the entire healthcare system and society itself. I think that everyone in our hospital, in our environment, has suffered from COVID in one way or another. So, if as a society we hadn't learnt to cope based on these values and to control the emotions that can play tricks on us, we would not have been able to deal with this.
