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Deferred surgeries, including one-day surgeries, will be suspended in the country as of Tuesday, and almost all hospitals will have to receive coronavirus patients, the human resources minister said on Saturday. According to the instruction signed by Miklós Kásler, the exception to this provision is emergency benefits, without which the patient would be in imminent danger to life or suffer serious or permanent damage to health.
Cancer patients must continue to receive the care they need, organized cancer screenings must continue, important cardiology services must not be missed, infertility treatments must be provided, and organ transplants can be performed with strict adherence to precautions epidemiological.
Memorable: As of March 16 of this year, an order has already been issued that planned medical care can only be provided for urgent needs. Then, with the favorable development of the epidemic situation, austerity gradually eased from May 4, and from June 18 it was possible to provide for everyone. In the meantime, however, a 20 percent capacity had to be maintained for those infected with COVID-19.
The queues are certainly getting longer
There is no publicly available summary of how many surgeries have been left for Covid-19 so far this year. Therefore, it can only be deduced how many patients then, and now, have had to acknowledge that they will not yet be operated. What you can know for sure: of inherently queued interventions
Cataract, spine, knee and hip operations have all but stopped.
although in summer the hospitals mainly tried to spice them up. Data from the National Health Insurance Fund (NEAK) show that almost 8,300 cataract surgeries were performed in September alone, and 33,288 in the last six months, making the most of this intervention for years, on average and approximately 80,000. Currently 8,500 people would need this intervention, but now they have to wait more than the average of 54 days for these surgeries due to delays.
The 50 most common treatments include arthroscopy, a mirror of the knee joint, of which nearly 15,000 have been performed over two years, in “peacetime”, and now the NEAK database shows only 831 and only 28 people on hold in the last six months. This is probably because knee pain can be relieved in many other ways, and patients don’t want to risk a viral infection either.
Spine surgeries have fewer alternatives, so now more than a thousand are forced to wait more than an average of 38 days. More people would need a hip replacement: the Waiting List database shows 4.5 thousand waiters, almost as many as the number of people who have had this procedure in the last six months (5,517).
NEAK, by the way, distinguishes two types of waiting lists: there are 13 mandatory center interventions, from tonsil surgery to spinal hernia surgery and knee replacement. But so is diagnostic cardiac catheterization, of which more than 26,000 have been performed in the last six months alone, but 1,218 patients would still need it. In addition to the compulsory one, there is also the so-called capacity shortage waiting list, which must indicate the interventions for which the waiting time in the given institution exceeds 60 days.
There are a total of 30 such surgeries, including open heart surgeries.
RIGHT NOW THERE ARE MORE THAN 600 PEOPLE WHO NEED THIS, AND IT EVEN TAKES AT LEAST TWO MONTHS BEFORE BEING AT THE OPERATING TABLE IF THERE IS NO PATH.
In May, an article was published in the British Journal of Surgery, according to which 28.4 million planned surgeries worldwide could be lost in 2020 if the peak of the coronavirus epidemic in each country lasts 12 weeks. The number of delayed surgeries increases by 2.4 million with each additional week. The researchers took information from 359 hospitals in 71 countries and extended it to 190 countries around the world using statistical methods. It was reported that
On average, 72.3 percent of planned surgeries fall short during the peak period of the epidemic,
mainly orthopedic interventions slip. Of the 28.4 million surgeries missed, they put the figure at 6.3 million, but they also estimated that oncology interventions would be delayed, at 2.3 million.
According to the president of the Hungarian Hospital Association, this is an extraordinary situation that poses serious challenges for both patients and healthcare professionals. Andrea Ficzere told the Index:
It is very unfortunate for those who have already had a surgical date, especially if it has been modified one or several times. However, they need to see that this measure also serves their safety, as more and more people infected with coronavir require hospital care, which currently takes precedence over those awaiting planned intervention.
The general director of the Uzsoki Street Hospital emphasized that once the epidemic subsided, as it did after the spring, the hospitals would once again do everything possible to make up for the missed surgeries. Today, resources, including the capacity of health workers, must be focused on curbing the epidemic and caring for those already in need of hospital care.
At the same time, Andrea Ficzere tried to assure everyone that those in need of intensive care, especially cancer and cardiovascular disease patients, would be treated without delay and would do their best to avoid infections during their hospital stay.
All hospitals became epidemic hospitals
The measure was already inaugurated by the Prime Minister himself, the last time Kossuth Radio Good Morning, Hungary! In his program, he spoke of the need for 2,240 beds in intensive care units by November 21 and 4,480 beds by December 10. As you said, here is the Hungarian performance cap, because it means that 30-32 thousand people will be hospitalized with a coronavirus.
The situation deteriorates day by day: according to the latest report on Monday
6,061 coronavirus patients are being hospitalized, 415 of whom are on ventilators.
This really places such a significant burden on the healthcare system that it could not bear the burden if everything ran as usual in the meantime. As the national chief physician Cecília Müller said:
They are prepared for the worst-case scenario, and sufficient space and medical staff must be provided in hospitals for patients with severe coronavirus.
Therefore, Miklós Kásler decided not only to postpone non-emergency surgeries, but also to decide that hospitals must now reserve 40 percent of all their beds for the care of Covid patients and another 7 percent for those with coronavirus patients needing ventilation.
According to NEAK data, there were just over 41,000 hospital beds in the country as of September this year to treat patients in need of active care, 64 percent of whom were patients. An additional 25,250 beds were available to treat patients in need of care, chronic care and rehabilitation, with an occupancy rate of 68 percent.
The instructions also specify which providers should care for children with Covid, premature babies who need intensive care, and suspected or infected patients who need close contact who need artificial treatment. The Minister has designated which institutions will retain their original function:
the National Institute of Oncology, Cardiology and Neuroscience, these are not open to patients with coronavirus. Furthermore, covids should not be admitted to wards and institutions for children, cardiology, oncology, obstetrics, psychiatry, care for diabetic and immunosuppressed patients, nursing and geriatric wards and institutions for the disabled.
Doctors had asked for it weeks ago.
Miklós Kásler a few weeks ago, when recommended by the Hungarian Medical Chamber, even refused to postpone non-urgent surgeries. The MOK wrote a letter to the minister in late September to stop the planned surgeries. This is because colleagues have been constantly receiving signals about capacity shortages and enforcement solutions.
The MOK called for the cessation of deferred surgeries for the same reason that it was finally taken over by the Minister: because elective care links intensive and anesthesiology (human and mechanical) capabilities, which
- jeopardizes effective defense
- poses a risk of infection for patients
- if there are new hospital foci, there is a good chance of spreading the infection
- and contributes to the further spread of the epidemic.
All of this could force new healthcare workers into quarantine, further reducing the required capacity; attention was drawn at the time. Restrictive measures were requested at least in epidemiological hospitals that treat a large number of patients with Covid.
EMMI then argued that a well-proven epidemic management strategy would be applied in the spring: they would gradually open care facilities and focus primarily on patients and professionals in institutions with extensive experience and expertise.
In keeping with the dynamics of the epidemic, we are regrouping doctors and nurses from hospitals that are not currently involved in infection control.
So they wrote.
(Cover Image: Christopher Furlong / Getty Images Hungary)
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