Hospital El Salvador: a novel paradigm of intensive care in response to COVID-19 in central America

Source; The Lancelet

On March 18, 2020, the first case of COVID-19 was confirmed in El Salvador.1 Closely monitoring pandemic trends worldwide,2,  3,  4 local experts realised that if El Salvador's cases were to mirror global trends, 20% of people infected with severe acute respiratory syndrome coronavirus 2 would require hospitalisation, and between 5% and 8% would require an ICU bed.5 Yet there were only 94 ICU beds in the public health system, distributed between nine hospitals (1·45 ICU beds per 100 000 people). By March 18, the occupancy rate was already 80%, meaning that only 19 ICU beds were available for critically ill patients with COVID-19 across the country. The profound risk associated with this low bed capacity was highlighted by experiences in Italy, which has 8·42 ICU beds per 100 000 people,6 and yet still had a massive stress put on its health-care system when demand surpassed supply during an early surge of cases of COVID-19.

To avert the upcoming crisis, it was urgent to increase ICU bed capacity and the reach of critical care spe-cialists. After multiple consultations with public health officials and international agencies, the government decided to build an entirely new hospital exclusively for patients with COVID-19: Hospital El Salvador. Creating Hospital El Salvador represents a unique approach, as most countries in the region opted to set up temporary hospitals.

Hospital El Salvador was built using the existing infrastructure of the International Center for Fairs and Conventions of El Salvador. The hospital used two of the convention centre's pavilions for hospital beds, two for administration, and two for warehouses. The hospital has three emergency entrances for patients referred from different hospitals across the entire health care system. It also has two 15 000-gallon oxygen tanks to ensure oxygen supply to the remodelled pavilions. A negative pressure pavilion was set up to remove infectious particles from the ICU. Each ICU bed was fitted with a vital signs monitor, access to continuous oxygen flow, and a high-flow-capacity ventilator. The beds in both pavilions are monitored through cameras with a fibre optic connection, which feed images to the central monitoring hub at the hospital.



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