The medical error that caused a massive quarantine of toilets in a Mexican public hospital

When the 66-year-old patient arrived at the reception of the Hospital Zona 27 in Mexico City in mid-March with shortness of breath, sweating, headache and semi-conscious, the first thing they did to him in a special room at this center of the Institute Mexican Social Security was a questionnaire. He, according to two doctors involved, was very weak. After answering some basic questions to rule out covid-19 – which at the time was based on only one: Did you travel abroad? – he was classified as a patient with community-acquired pneumonia, which is usually bacterial. And he went to the emergency room as one more patient. Without isolation, protocols or protection for those who cared for him or for the patients with whom he lived in the same room for a day and a half. The man died days later in another public center from coronavirus. And 35 members of the medical staff were quarantined, almost the entire emergency department that night, seven of the students.

The hospital at that time was not in a critical phase of pandemic care. It was not even enabled yet to serve patients with the covid-19, as of last week the facilities for it were modified. Despite everything, the authorities blamed the patient for having lied in the questionnaire, a practice that health personnel deal with on a regular basis and for which they must be prepared. But the medical error of that night in mid-March reveals the challenges of the Mexican public system to face a crisis of these characteristics, especially when the country enters a more pressing situation expected in a few weeks.

The Mexican government defends again and again that since January it has been monitoring the evolution of the pandemic, but the urgency in recent weeks to acquire medical supplies and the outbreaks of infections in different hospitals suggest that the deficiencies are greater. This newspaper has tried to collect the version of the authorities of the center through Social Security, but they have not given any official explanation about what happened in this case.

Those who carried out the questionnaire to the patient were medical students in the last year of Medicine who, although they are supervised by a base doctor, was in charge until last April 7 of the first battle line. More cases like this alerted the university authorities to the risk that their students were taking and the country’s main public universities suspended their compulsory service. “We did not have a mask, the few we could get were given to us by colleagues who had bought them outside. We were a risk for the patients and for our families, ”says one of the intern doctors – in practice – who prefers not to give his name for fear of retaliation.

“The patient started to get complicated, his oxygen was low. So they put him in the crash area and there I met him. I did several tests, took blood samples, did an EKG, and spent hours talking to him. He sneezed, coughed near me, I had no protection, ”says the intern. After waiting a few hours, an emergency bed was set up for him and he was transferred to a space where there is no separation between stretchers, the two inmates say, and whereon his left side was a man with heart disease and on his right a woman with about 70 years intubated by bacterial pneumonia. Neither of them knows if these patients underwent a covid-19 test.

In the emergency area, César Eduardo Barrios, 23, took more blood samples and performed an arterial blood gas, also without protection. “Chest plates were requested, there it was shown that he had lung damage, but both he and his wife explained that he had COPD, chronic lung disease. There was some doubt among us, but since he had this underlying disease and had not traveled abroad, it is difficult to distinguish ”, explains Barrios, also an internal medical student. “I was like three hours with him attending him. The emergency department is an open area. So, even if I wasn’t directly with him, I attended to those who were next to me and I was there all morning, ”added Barrios.

A day and a half after being treated in this hospital, according to the testimony of the two internal doctors, the wife confessed to another of them that they had traveled abroad. It was then that the center triggered all the alarms. “At that moment, everyone loses their minds. Then they scolded us because they had escaped us, ”says the other inmate.

The center ordered that day that 35 members of the health staff be isolated at home for 14 days. The patient underwent a coronavirus test and was transferred to the National Institute of Respiratory Diseases. The inmates were told that he had tested positive a few days later. Also, that the patient had died.

One of the trainees began to show symptoms three days before his two-week quarantine ended. “I had a fever, cough, muscle pain… And I had to go back to work. I was very afraid to comment on something in the hospital, because we all know that when you meet more than 15 days of disability, the center can disenroll you as an intern, but I was convinced that I had it, ”he tells this newspaper. “In the end, I asked to be tested, at all times I felt that the hospital authorities wanted to hide this case, they were very reticent to do it to me. They did it to me, I was the only one of my colleagues, and apparently my sample was lost in the laboratory, I never obtained the results, ”he adds. “I wanted to do another test privately, to support myself before the center, but I did not have the money to do it, I am supporting myself with scholarships from the university,” says the intern.

This Saturday, a doctor from this hospital died of a coronavirus, Dr. Eduardo Martínez Etchart, and although the relationship between his infection and this case is unknown, the environment in the center has been tense for a few weeks. A stretcher-bearer from the same hospital has shown symptoms and has been classified as a suspect. He is in isolation at home. The sanitary personnel of this hospital has demonstrated on two occasions at the gates of the compound due to the lack of material to deal with the pandemic. In recent weeks there have also been protests in at least eight states in the country due to the lack of supplies.

Protests over a lack of material have occurred in the country before phase 3 of the pandemic has even been reached. And the difficulty in supplying the centers has become the main problem for Mexico ahead of time. Last week a first shipment arrived from China with 725,000 gloves and 820,000 N95 masks, those recommended for medical personnel. The total purchase of Chinese supplies exceeds 56 million dollars and includes 11.5 million masks and 5,272 mechanical ventilators that would add to the 8,000 that already exist in the country. In total, 20 flights are planned from Asia to replenish the Mexican health system, as reported by the Government.

The case of hospital 27 is not the only one in Mexico. At clinic 72 in Tlalnepantla (State of Mexico, the metropolitan area of ​​the capital), at least 19 health workers tested positive for covid-19 a week ago and in a city in the north of the country, Monclova (Coahuila), the In the case of a patient who was diagnosed up to a week later, it could have caused another 26 infections in the same hospital and the death of a doctor from coronavirus. “We live it with a lot of fear. In the race they tell you that you have to be ready, but we are not. Crisis management is a catastrophe that is exposing the health system that we have, ”says the intern.

Source: The Union Journal

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