The Madrid Experience
During the peak of the outbreak, more than two-thirds of beds in most hospitals in Madrid were occupied by patients with COVID-19. Figure 2 depicts the official numbers of patients admitted to hospital, admitted to ICUs, who died and who recovered in Spain between mid-March and the middle of April.[12] Non-invasive ventilation was attempted frequently, even using improvised alternative strategies like the modified Easybreath diving mask to administer continuous positive airway pressure therapy. Invasive ventilation was often necessary and, in spite of tremendous efforts by the hospitals (for example Gregorio Marañón University Hospital opened ICUs in operating rooms and in the library), there were not enough ICU beds for all the critically ill patients who needed them. The limited availability of ventilation support was even more problematic due to the prolonged intubation – often more than 3 weeks – that many of these patients required. The news that prioritisation criteria were being applied in Spanish hospitals sparked widespread controversy and triggered a debate about the right of every individual, particularly the elderly, to access specialised healthcare.[13]