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“The Hungarian health capacity must withstand twice the worst expected indicators of coronavirus infection determined by experts,” announced Viktor Orbán in the parliamentary session on Monday. The Prime Minister did not skimp on numbers either: based on expert opinion, he said that
in the worst case, 200,000 people can be expected to be infected in Hungary at the same time, and in this case 16,000 people will need a hospital bed at the same time and 800 people will need a ventilator at the same time.
Although, without a doubt, the system is already preparing for 400,000 infected people.
It is no coincidence that the head of government, in response to the drastic increase in coronavirus infections, highlights the capacity of beds and free ventilators: there really is no shortage of these in Hungary. In June, the Ministry of Foreign Affairs and Trade revealed that it had bought 16,000 fans for more than HUF 300 billion. If we have the worst case of Viktor Orbán, there are still 14,400 more than are needed at a time. (Although I still don’t know how many of the expensive machines are suitable for invasive ventilation, and how many are really flawless.)
In practice, the evacuation of hospital beds can also be solved: Miklós Kásler, the Minister of Human Resources, has once shown that, if necessary, chronic patients can also be sent home with reference to the coronavirus epidemic. According to the latest report from the National Health Insurance Fund (NEAK), Hungarian hospitals are not bad either, despite the fact that tens of thousands of patients returned to medical care in the summer and the occupancy of beds in active wards was of the 60 percent in July. This is partly due to the fact that many patients are still afraid to go to bed due to the epidemic, which has probably not changed since then.
However, the prime minister appears to be very reluctant to talk about the number of medical personnel that can be deployed.
The government, of course, has a solution for this too, with a “management plan” that states that if designated hospitals run out of capacity, one will be added to the chain of care to which workers will be redirected from another institution. (therefore, there will not be enough). However, this does not solve the obvious problem that the number of doctors and nurses working in Hungary is finite or even very incomplete, which was only exacerbated by the first wave of the coronavirus epidemic. From discussions with stakeholders, it appears that workers who disappeared from the system in spring have not returned since then, so even fewer people are on hold for the fall period, which according to Viktor Orbán is difficult.
According to September data from the Central Statistical Office, in the second quarter of 2020, there was a shortage of more than 9,000 workers in health and social care in Hungary, making health care the sector with the greatest shortage of manpower. This was also supported by our health sources, who spoke literally about the “brutal” labor shortage.
“Although we search, we have not found nurses in months, they have completely disappeared and we have no idea where. This year, the fluctuation was enormous anyway, not even those who stood up in the first wave came back, “said one of them, who, moreover, does not work in public but private health.
Viktor Orbán’s visit to the Korányi National Pulmonology Institute (OKPI) also revealed a lot about the state of medical care. In the video uploaded about this, a young doctor who has been working for more than 22 hours confronts the Prime Minister that a fan is not enough, they also need a technician, but here the Prime Minister interrupts him.
Close to tolerance
“Health care will surely be in the second wave of the coronavirus, the question is more about what quality is it”
Péter Álmos, vice president of the Hungarian Medical Chamber, told hvg.hu about the situation. According to the expert, it is far from ideal that psychiatrists, ophthalmologists or even dentists are already being referred to the Covid care departments, but during an epidemic, medical care is also forced to take over part of the economic crisis. The only question is how much.
In internal forums, more and more doctors are already indicating that they have reached the limit of tolerance, and in addition to the workload, one of the reasons for this is that they do not see exactly what is going on around them. Therefore, the vice president of the MOK believes that much more predictable communication from the government would be needed. He also listed as problems that many doctors have disappeared from the system, not just those over 65.
“Last year, 300 doctors under the age of forty ended their active membership in the chamber, usually went abroad or are no longer working as doctors. In proportions, it is as if an entire university degree had disappeared, “he said. It’s also a concern that care protocols haven’t become more transparent since the spring, and colleagues are still wondering on social media what to do.
Sleepy said doctors are also aware that “this epidemic wave must be carried on two feet by medical care,” but it would be easier if they knew something was happening in their interest, especially in the payroll area.
“If that were the case, we could say that we can stand next time because we can count on the government. At the moment, however, this is not the case at all, ”he added.
The MOK vice president acknowledged that the government was aware of the seriousness of the situation and that the medical check-up had been completed in the summer, but now there are decisions to be made that only politics can take, he added.
Preparation in the intensive care unit
The current wave of the coronavirus epidemic is affecting all corners of healthcare, but it is directly in intensive care units where the pressure is greatest. In her Facebook post last week, anesthesiologist Nóra Máté-Horváth, an intensive care specialist, warned that “doctors and nurses are fully armed but fear the epidemic,” one of the reasons is that, unlike the spring , there is no minimal restriction on medical care. surgery, all tests are done, even if it is not vital.
In addition, in his opinion, it is not true that no one is left without care, since it is not the number of free beds or the number of fans that guarantees that an intensive care unit will receive adequate care. A patient who needs breathing can only have a chance of survival if he is accompanied by the appropriate intensive care unit staff 24 hours a day: an anesthesiologist and intensive care physician, and an intensive care nurse specialist.
There are no exact figures on exactly how many nurses work in intensive care units in Hungary. Although the anesthesiology intensive care department of the Hungarian Chamber of Health Professionals (MESZK) has around 2000-2300 members, according to our sources, the situation is a bit better than this. Many intensive care units also have adult nurses who do not have specialized training, but with decades of experience behind them, they are fully professional.
“On the other hand, we are still very few, which certainly cannot be remedied in the short term,” an intensive care specialist told hvg.hu.
An expert who told our newspaper anonymously said that they could meet the strict quality assurance requirements at their institution for now (so there are enough nurses for patients), but this is likely to become more and more difficult in the next few months. Especially since the intensive care units were more loaded than usual in the summer: many went to the hospital late for fear of the coronavirus, in a much more critical condition.
Intensive nurses, according to our sources, are in a better position to be better prepared for protection and fewer of them are infected. On the other hand, “the spiritual burden on them is terrible” because no one knows how and when the epidemic will hit them.
“Even the first wave was a very rough ride, we never knew when we would arrive the next day or where a bug would slip into the system. Also, a coronavirus patient can enter the intensive care unit at any time, so we treat everyone as potentially infected, ”said an affected worker.
Loaded ambulances
Health economist Eszter Sinkó also believes that the 16,000 beds mentioned by the Prime Minister are in the system without problems, as are the necessary ventilators. (Although it is still a question of why it was necessary to buy 16,000 machines).
According to the expert, medical care is not fully prepared yet, as the sector is poor in terms of human resources and testing capacity has not been substantially expanded (although the pressure has now been relieved by classifying a patient as suspected of coronavirus without symptoms). thus remains in home quarantine). Nor does he consider it fortunate that the already loaded ambulances are taking samples.
“Fast-moving sampling units should be established, either reinforced with residents or trained health workers, to relieve paramedics,” he added. Obviously, the 17 additional outpatient sampling sites to be designated by the government later on will help.
Eszter Sinkó sees correct that the country has not been completely closed, but without a sufficient number of tests and isolations, the virus spreads practically without control. This, in addition, puts extreme pressure on health care while having to deal with additional commands and tasks. This, according to the expert, will also result in the resignation of some workers, as happened in the spring.
“It is important that the government does not make the fall mistake of tying extreme-size beds evenly to covidium patients across institutions, thereby limiting non-coronavirus patients’ access to benefits. Also, outpatient clinics should be designated in outpatient care, where covidium patients could receive services in separate wards, ”he listed.
However, the expert welcomed the fact that it was still possible to write a prescription over the phone and the government was also willing to provide some funding for telemedicine.
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