The unrelenting increase in COVID-19 infections in Spain following the holiday season is again straining hospitals, threatening the mental health of doctors and nurses who have been at the forefront of the pandemic for nearly a year.
In Barcelona's Hospital del Mar, the critical care capacity has more than doubled and is nearly full, with 80 per cent of ICU beds occupied by coronavirus patients.
There are young people of 20-something-years-old and older people of 80-years-old, all the age groups, said Dr Joan Ramon Masclans, who heads the ICU.
This is very difficult, and it is one patient after another.
Even though authorities allowed gatherings of up to 10 people for Christmas and New Year celebrations, Masclans chose not to join his family and spent the holidays at home with his partner.
We did it to preserve our health and the health of others. And when you see that this isn't being done (by others) it causes significant anger, added to the fatigue, he said.
A study released this month by Hospital del Mar looking at the impact of the spring's COVID-19 surge on more than 9,000 health workers across Spain found that at least 28 per cent suffered major depression.
That is six times higher than the rate in the general population before the pandemic, said Dr Jordi Alonso, one of the chief researchers.
In addition, the study found that nearly half of participants had a high risk of anxiety, post-traumatic stress disorder, panic attacks or substance- and alcohol-abuse problems.
Spanish health care workers are far from the only ones to have suffered psychologically from the pandemic. In China, the levels of mental disorders among doctors and nurses were even higher, with 50 per cent reporting depression, 45 per cent reporting anxiety and 34 per cent reporting insomnia, according to the World Health Organisation.
In the UK, a survey released last week by the Royal College of Physicians found that 64 per cent of doctors reported feeling tired or exhausted.
One in four sought out mental health support.
It is pretty awful at the moment in the world of medicine," Dr Andrew Goddard, president of the Royal College of Physicians, said in a statement accompanying the study.
Hospital admissions are at the highest-ever level, staff are exhausted, and although there is light at the end of the tunnel, that light seems a long way away.
Dr Aleix Carmona, a third-year anesthesiology resident in Spain's northeastern region of Catalonia, didn't have much ICU experience before the pandemic hit.
But as surgeries were cancelled, Carmona was summoned to the ICU at the Moiss Broggi hospital outside Barcelona to fight a virus the world knew very little about.
In the beginning, we had a lot of adrenaline.
We were very frightened but we had a lot of energy, Carmona recalled. He plowed through the first weeks of the pandemic without having much time to process the unprecedented battle that was unfolding.
It wasn't until after the second month that he began feeling the toll of seeing first-hand how people were slowly dying as they ran out of breath.
He pondered what to tell patients before intubating them.
His initial reaction had always been to reassure them, tell them it would be alright. But in some cases he knew that wasn't true.
I started having difficulty sleeping and a feeling of anxiety before each shift, Carmona said, adding that he would return home after 12 hours feeling like he had been beaten up. (Only the headline and picture of this report may have been reworked by the Business Standard staff; the rest of the content is auto-generated from a syndicated feed.)