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About 3,000 Covid-19 patients are currently being treated in an intensive care unit, more than at the height of the first wave in spring. Around 7,000 of the more than 30,000 intensive care beds in Germany remain free. The current restrictions serve to curb the increase in new infections and therefore also serious courses. At the same time, the capacities of the health system must be prevented from being overloaded. With exponential growth in new infections, that would soon be the case.
But there is a subtle reason for hope, because German intensive care units are filling up with Covid 19 patients less quickly than previously feared. Since the week of October 26, the increase in new admissions of infected patients has tended to decrease compared to the previous week, as shown by the intensive care registry of the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI). The same goes for the growth of the total number of patients in intensive care units as of November 2. The weekly increase in the number of intensive care beds occupied by Covid 19 patients was around 65 percent on October 26. On November 10 it was still 30 percent, and the trend is falling.
This means that intensive care units will continue to fill up, but more slowly than was feared two weeks ago. Yet despite this good news, skepticism remains appropriate. “It remains to be seen to what extent the trend of increasing infections with a delay of 10 to 14 days is reflected in intensive care units,” says DIVI President Uwe Janssens. “We are currently observing that the mean age of onset has increased markedly since the beginning of September. Therefore, it is necessary to fear that the proportion of cases of hospitalized patients and, therefore, also of intensive treatment will increase.” Even if the trend is currently showing a slight decline, the situation could change again at any time. “We must not forget in any way that treating a Covid 19 patient in the intensive care unit can be lengthy, in some studies up to 24 days on average,” says Janssens.
A trend reversal cannot be observed in normal wards, the number of patients continues to increase
In some regions, hospitals have already switched to emergency operations and postponed admissions and surgery. “We urgently need to determine which hospitals, at what level of care, should assume which tasks in the pandemic,” the intensive care physician demands. Buffering in intensive care units actually requires spare capacity, which must be available immediately, and not within seven days. General emergencies and the actual number of seriously ill Covid 19 patients cannot be precisely planned in advance.
Clemens Wendtner, chief physician for infectious diseases at the Schwabing Clinic in Munich, also believes that it is premature to draw conclusions about the decrease in the number of intensive care units for Covid 19 patients. “The rate of increase of patients in intensive care is decreasing a bit, but we are still seeing an increase in patients in intensive care units in absolute terms, ”says the doctor. “At the level of normal wards, there is still no change in trend, that is, the number of patients is continuously increasing.”
Care has improved so much that patients need less intensive care.
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However, more patients come to the clinic with early diagnosed symptoms, so that, with the right treatment, an intensive stay can be prevented. Time in intensive care units also appears to be shorter due to better medical care, which is aided by refined ventilation techniques and dexamethasone administration, Wendtner suspects.
Wendtner believes that the slightly declining growth in intensive care is already due to contact restrictions in November: “With Covid-19, we have to expect three to four weeks to pass from the onset of the disease to intensive medical care.” Furthermore, neighboring European countries should be a warning: even in the beginning, there was only a slow occupation of intensive capacities in late summer, before the system is now overloaded. Currently, patients must be transferred within these countries or to other European countries. “It is still too early to give the go-ahead, either in Bavaria or in Germany,” says Wendtner.
“I have the impression that, unlike the first wave, we have many more cases in the normal ward,” says Matthias Kochanek, head of intensive care medicine at the University Hospital Cologne. “My impression is also that the time from infection to the intensive care unit is a bit shorter than in the spring. The active ingredient dexamethasone also shortens the time in the intensive care unit a bit.”
There have been fluctuations in the occupancy of intensive care units in recent weeks. In this regard, experts agree that it is advisable to wait one to two weeks before drawing reliable conclusions. It would also be desirable to have more precise data on the age distribution of the patients to better assess the situation.
