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Prime Minister Viktor Orbán increasingly wonders whether healthcare can withstand the pressure of the coronavirus epidemic. Last Friday, he said that according to the calculations before him, the number of infected people will increase dramatically, by December 10, 4480 people will have to be treated in the intensive care unit, 30-32 thousand coronavirus patients can be hospitalized.
Tuesday is M1In an interview with
if this continues, there is a fifty percent chance that we will be able to see patients in hospitals.
That is why he said that the austerity announced Tuesday was necessary. But will the measures, and if so by how much, reduce the pressure on healthcare?
From the outside, it is almost impossible to get a complete and accurate picture of how much pressure is currently in the system and how much reserve capacity is still available, as the official information page does not provide data on how many hospitalized patients are in the care unit intensive, how many, the saturation rate of each hospital, how many are infected in the hospital (which accounted for a quarter of confirmed infections in the spring, including those who entered the institution as asymptomatic and only later produced a positive test ), how many hospital workers are currently infected.
We did not receive answers to these questions from Medical Director Cecília Müller. From conversations with hospital staff, it is known that although the number of people infected with the coronavirus has increased greatly in all counties and all hospitals have to receive patients with covidium as of Monday, the burden is not distributed evenly. uniform.
Until we know the numbers, we can’t tell if we are on the edge of performance or have been beyond that for a long time.
A virologist who requested anonymity told hvg.hu.
The same data is public in Austria, following the example of the Prime Minister, as in a The standard you can see it in the graphic on their website. Two markedly contradictory statements about the performance cap could be heard over the weekend: Zoltán Szabad, president of the Union of Hungarian Doctors, said that intensive care was already full in many hospitals and that the situation was as critical at home as in Bergamo in the spring. According to the general director of St. John’s Hospital, Péter Takács, this is out of the question. Interviews with hospital staff revealed that while the number of infected people has risen sharply in all counties and all hospitals should receive covidium patients as of Monday, based on our conversations with doctors and nurses, the burden does not appear to be evenly distributed among hospitals.
The virologist, who told us anonymously, assures that for months there has not been sufficient and reliable data on the burden on the health system, so it is not possible to model,
we do not know where the epidemic is heading.
We see hospital admissions and test positivity rates, but that’s not enough, he added. “It is already the end of the chain, it does not help which prevention strategy we should choose.” According to the rector of the University of Semmelweis, Béla Merkely, the proportion of positive people is very high because most people undergo symptom tests and contact investigations are no longer carried out.
However, this is important for the sake of clairvoyance: the virologist who spoke to hvg.hu said that in countries where significant resources have been invested in detailed investigation of infection chains, they can save a lot now because they don’t have to close an entire country, if not precisely, often even by district. they know where to apply restrictions. With such a number of infections, it no longer makes sense to regret why this was not the case with us. “It’s not worth looking west either. Until the wave actually came from there, it was logical, but now the infection is so widespread and so random that it is better to look at regions than to compare Hungarian conditions with a country.” This would only make sense if there were sufficient data and data quality. Many more tests would be needed to get an accurate image.
No one should expect immediate improvement
According to the immunologist András Falus, a regular member of the Hungarian Academy of Sciences, the effects of the announced measures can appear for the first time up to 2-3-4 weeks after the entry into force. And even then, we can’t expect a quick improvement. “It would be a very good sign if a trend started, the infection rate and the number of hospital admissions started to stagnate.” That is, there will not be a sudden gulf in the epidemic picture. However, according to the expert, this adjustment would have been necessary two or three weeks ago.
According to former medical director Ferenc Falus, with the measures announced Monday and then announced Tuesday night.
maybe we can avoid a truly tragic national catastrophe,
but the current near-disaster situation could have been avoided with a much more cautious summer opening. Even now, he could have imagined more rigor, he believes that non-vital stores like clothing store, tech store, shouldn’t even open. However, the village considers the care of non-covid patients to be unacceptably low, which, according to him, is unfair, because non-covid patients in need of primary care should have the same chance of recovery. ”
What can be seen from the trenches
The government is also trying to reduce pressure on healthcare by postponing non-emergency (elective) interventions, freeing up beds, but more importantly, professionals that can be used to treat coronavirus patients, and relaxing the rules. to admit patients with coronavirus. Minister Miklós Kásler also instructed that 7 percent of hospital beds be converted to intensive care units, which, according to health expert Zsombor Kunetz, means that the number of intensive care units could increase to around 4,000. However, to do that, the number of nurses would have to increase by 7-7.5 thousand.
To illustrate what this means in practice: According to a source at one of the front-line hospitals, the covid intensive care unit currently has 52 intensive care units, but only 40 employees. He did not elaborate on what this means (a high nurse-physician presence is normally required in the intensive care unit), or whether the 52 beds would be needed at this time. That being said, the workload is just as bearable, but 4-5 patients per nurse. They want to expand the number of beds soon. Due to increased patient turnover this may also be justified, it is a question of where there will be a person who will care for intensively cared patients, if they will not be able to redirect specialists from other places.
As in many other places, according to our source, this hospital employs unskilled transfer nurses. “There is also a physiotherapist, a midwife and a nurse in the department, mainly they can perform auxiliary nursing tasks,” we discovered. In addition to skilled nursing leadership, the most important thing for previously non-intensive staff is to “speak up if there is a problem or you need help,” but they can also help with medication dosing. However, in intubated and ventilated patients, aspiration, patient inversion, and especially ventilator operation, already require greater professional knowledge and practice.
In a rural hospital we learned that patients with positive coviditis are already arriving from “open” wards without covid. “3-4 patients leave every day and 6-7 come home,” said a source from our hospital. It is increasingly common for entire rooms to be closed due to positive patients. According to our source who works there, due to the lack of people, if one of the hospital staff gets sick, the others will not have a day off. “Our day off when we come home from the night shift comes back the next day,” he said. In addition to the shortage of people, there is no oversupply of equipment: “Oxygen cylinders need a reducer, basic care equipment such as lavor, toilet chair, urinals, infusion stand,” compiles the list our anonymous source.
According to another source from another rural hospital, which previously served as an epidemic center, the bed rooms have required the relocation of entire rooms many times since the spring, sometimes to a very small location. In one case, 15 minutes were given to move an entire room, all of which were understaffed due to infection or quarantine. So even wrapping and dragging was tormenting.
“People feel that there is a situation”
“The situation is very difficult, but there are still reservations in the system,” András Csilek, infectologist and president of the Regional Organization of the Hungarian Medical Chamber of Borsod-Abaúj-Zemplén County told hvg.hu. The specialist says it frees up significant resources that elective care has been discontinued, but at least one such important measure is that coronavirus patients should now be admitted to all hospitals.
“Obviously, this is a relief for the institutions that have been functioning as epidemic hospitals until now, but for others, it is a problem, a serious and difficult task to tackle. Creating, separating the covid classes, moving other classes, expansion can always be to the detriment of others, but we must be able to live with that now ”, underlines the ambiguity of the situation.
“Until now, many wards have been full because a patient with a suspected infection had to be placed in a separate ward. The rapid test speeds up the process, ”said the rapid antigen testing specialist. According to him, this speeds up the assessment of whether someone should be isolated as a Covid suspect but has not been shown to be infected, or can be paired with other infected people as positive. And these are very important data for bed math.
He welcomed the current tightening. According to him, in addition to reducing the number of human contacts and thus the possibility of new infections, they also draw people’s attention to the “situation” and strengthen the general state of preparedness in society.
“If the epidemic curve begins to flatten in 4-6 weeks and we reach the ‘plateau’ it would be good news, that is what we have to endure,” added the specialist. But when I ask him if the relays can come, he replies with a long “haha”. According to him, real change can come from an effective vaccine or herd immunity. However, the latter is still a long way off, so it would undoubtedly be more fortunate to be able to vaccinate as many of the population as possible as soon as possible. However, according to the prime minister, this vaccine is in predictable proximity, however, the masses can only get it around April.
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