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The worst of COVID is yet to come and it will catch us very tired, says a doctor in CDMX

From time to time music plays in the emergency room of the Hospital Ajusco Medio, in the south of Mexico City. Dr. Marta Patricia Mancilla, head of the service, is convinced that this helps to lift the spirits of the staff, helps them forget bad times and avoid thinking about what is coming.

Eight months after becoming one of the public hospitals dedicated to treating patients with COVID-19 in the Mexican capital, “the worst is yet to come,” said Mancilla. “And, unfortunately, we are going to get very tired.”

Mexico City – which accounts for almost 20 percent of COVID-19 cases in the entire country, with more than 219,000 infected and at least 13,800 deaths – is going through an outbreak that has set off alarms. The head of government, Claudia Sheinbaum, has not ruled out new restrictions but, so far, she has only multiplied the number of tests and the screening of positives and is expected to announce more beds for hospitals.

The problem of the city of 10 million inhabitants and many others distributed in its suburbs is that the streets are increasingly crowded. And hospitals too.

On a blackboard in his office, Dr. Alejandro Ávalos, director of the Ajusco Medio, updates the occupancy level in real time: total 122 percent, ICU (Intensive Care Units) 116 percent, emergency 100 percent, it was read on Wednesday .

“As of May we have not dropped 100 percent,” said the surgeon with 35 years of experience who has opted to provide early, specialized care with a young and motivated team.

In the spring they were overwhelmed when people began to accumulate in the corridors and could not allow the relatives of a deceased to enter to identify him for fear of contagion.

Then “our way of thinking changed,” Ávalos explained. “We have learned to cry with people, to suffer with people, to understand people more.”

The main bet of the Ajusco Medio is the early care through tents outside the building where the first evaluations and studies are made to start treatment as soon as possible and that patients can follow it at home and be admitted only if their situation becomes complicated.

In May they cared for about 90 people a day. By Wednesday until early afternoon, 143 had already passed.

The results in this hospital managed by the city’s Health Secretariat and totally free are promising. According to its director, mortality fell from 68 in April to 8 percent in November.

But not all health centers have the same luck.

In La Raza in the north of the capital, also public but operated by the federal government, a group of doctors and nurses signed a complaint last week in which they threatened to stop treating patients with COVID-19 if the authorities The health authorities did not decree the “red traffic light”, the maximum alert level that paralyzes all non-essential activities.

According to health personnel, the authorities should be more energetic when it comes to imposing social distancing measures, but President Andrés Manuel López Obrador continues to disdain the mandatory use of face masks and this week suggested that confinements or quarantines are typical of dictatorships.

But this Friday, in his usual morning press conference, he echoed the claim of health personnel and after announcing an expansion of 500 intensive therapy for the city, he asked Mexicans to stop crowding the streets and stay at home.

“In this month of December there are road problems, the number of vehicles on the streets grows. Now we cannot act like this, ”he said.

“More and more of us are fed up,” complained a resident pulmonology doctor who signed the document and asked not to be identified for fear of reprisals. “In Mexico, the disease as such is not killing, but the bad information, the bad management of the pandemic and the ignorance of the people. Seeing that shopping malls are full is more exhausting than working 24 hours in a row ”.

The average hospital occupancy in the capital is 70 percent, but the situation between the different public hospitals is highly variable and depends on which institution manages them and the resources that reach them.

Adjco Medio is one of the privileged ones. Lines on the ground delimit “contaminated” or “clean” spaces and in which direction to walk. A newborn baby arrives in a room immediately separated from his mother, sick with COVID-19, so that he does not get infected. Upstairs one of the 36 ventilated patients has just been successfully disconnected from a ventilator.

The ER has doubled its capacity and is also used as an intermediate therapy. The sleep unit cameras are now used to monitor disoriented elderly people after being in the ICU or patients with high levels of anxiety.

And a technician repairs the tomograph because according to Dr. Arturo González, deputy director, he has done so many tests in these months – about 4,500 – to detect lung damage from the coronavirus immediately that he did not give more.

In La Raza the situation is different. “If in May we were bad, now worse,” said the resident of Pulmonology. “There are fewer doctors (due to sick leave, vacations or leave), fewer drugs (especially sedatives) and it is shameful to tell patients to do their own PCR or that they have to go to another hospital and on their own because there is no Beds”.

María Eugenia Ortiz, 51, and her husband were infected at the same time. Ortiz had hemorrhages and recalls with horror the days when she could not breathe lying on a bed next to her husband without knowing that he was just like her. “Everything turned black and I felt like I was floating, my chest felt hollow and cold,” she recalled in anguish.

After seeing 14 friends and family die, he believes that he was saved by the grace of God and because he was already taking the medications that were given to him in the tents of the Ajusco Medio. “Before the doctors did not treat you, you were more afraid, we did not know what to do,” he said. Now, he said, the situation has improved, although people remain incredulous.

According to doctors, increasing the beds in hospitals could help but will not do much if the parties, outings and, therefore, infections multiply.

Although the vaccine is getting closer and closer, the time of pneumonia and the eventual consequences of the Christmas and New Year celebrations have yet to be overcome.

“The staff is emotionally very exhausted and also (there is) that feeling of why we have to continue exposing ourselves if people do not abide by” social distancing, Dr. Mancilla wondered. “This is overwhelming us all, it is difficult to continue like this” .

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