Index – Domestic: there can be three reasons for the huge and rapid rate of hospital evacuation

Miklós Kásler’s letter arrived. There was the order, and the hospital directors do not dare to go against the ministry and the hospital commanders.

– this is how a hospital worker evaluated the letter sent to the hospital directors.

According to the first press reports, according to an instruction from Emmi, at least 60 percent of the beds had to be vacated before April 15, and then it appeared on koronavirus.gov.hu ​​that unlocking the capacity of publicly-funded beds in hospitals by April 19 50 percent, which rises to 60 percent in the “next step”.

“Everyone made the decision unexpectedly and in an instant,” said health economist Balázs Rékassy. According to economists who told the Index, it does not seem reasonable to vacate so many beds, because even if the epidemic breaks out, it is unlikely that so many people will need hospital care.

There is no need for so many beds in Italy either

The centrally established objective is also outstanding at European level. In comparison, it was considered the European center of the epidemic, with 60 million in Italy.

• 106,607 active cases were reported on Thursday. The most seriously infected region, Lombardy (population of 10 million, similar to Hungary) has 33,090 active cases.
• 26,893 people are treated in hospitals (11,356 in Lombardy) and
• 2,936 people receive intensive care (1,032 people in Lombardy).

But let’s also look at a closer example, Austria (8.8 million inhabitants), which Orbán sees as a laboratory. There, according to data from Friday.

• 4,441 active cases to know
• 682 people are hospitalized and
• 227 people receive intensive treatment.

After all this in Hungary’s nearly ten million

The government fears the outbreak

“When this epidemic broke out, the number of infected people could increase by 5-10 thousand in a matter of days,” Gergely Gulyás responded Thursday to government information based on the decision made. He added that the government could not afford not to have enough beds if such a situation arose.

It was not the politicians but the professionals who determined that number.

– declared the Minister in charge of the Prime Minister’s Office.

Goulash also said in government information that doctors, virologists and mathematicians have calculated how many beds might be needed if the worst-case scenario occurs.

What is behind the decision?

Nobody outside the circle close to the government sees what could be the worst scenario, not even the experts on the subject know where this 60 percent came from.

“You can only judge if we see what model and what projections were used,” said László Balkányi, who previously worked at the European Center for Disease Prevention and Control for more than 12 years. Transparency and cooperation would be important to overcome the epidemic. “

A nurse with protective equipment in an isolation room designed to receive coronavirus-infected patients at the Korányi National Institute of Pulmonology in Budapest on April 3, 2020.

Photo: Zoltán Balogh / MTI

According to Balkányi, the decision should not be aimed primarily at having enough free beds in hospitals, but rather

This is because reducing the number of contacts of hospital staff also reduces the chance of infection. By the way, Gergely Gulyás spoke about 150-200 infected healthcare workers on Thursday, but many of the hospital workers are also in quarantine.

Balázs Rékassy thinks similarly, who, in addition to protecting health workers, described three other possible scenarios behind the rapid pace of bed release:

1. Data available to the government predict an explosion of such magnitude that it may require many more beds than it does today, and that is why hospitals must be evacuated so quickly. “If that’s the case, we want to see the numbers and calculations that it came out of,” said the expert. This is because, based on publicly available data, the care system could handle the virus.
2. Or it could be, according to Rékassy, ​​that the government has simply realized itself, and that is a wrong move. “Then, in turn, you need to acknowledge the mistake, draw the consequences, and correct it. That means that gradually, in various phases, the beds must be released, not all in a few days.”
3. The opinion is also widespread in professional circles, continues the economist, that the number of hospital beds in Hungary has so far been too high. “We have been talking for a long time about reducing the number of hospitals and hospital beds.” However, this cannot be done from one minute to the next just because basic care is not ready for it. Nursing and medical care would need significant improvements to keep chronic patients at home.

There is no history of home care.

So we don’t see what will happen to the chronic patients who are now being discharged from hospitals. For them to have any chance of recovery, or at least to maintain their condition, there is an urgent need to improve primary care, says health economist Eszter Sinkó.

In the current state of readiness, it is an insurmountable problem for families and the out-of-hospital care system that suddenly 15,000 people have to be cared for suddenly, added an employee at Semmelweis University.

People must be hired urgently for specialized home care, and the number of visits must also be increased.

As he says, with the government’s decision, general practitioners will also have additional responsibilities as more patients need to be visited at home. Therefore, in his opinion, both the nursing and general medicine systems should be strengthened immediately and have a sufficient amount of protective equipment, including protective clothing.

Many desperate readers have visited the Index in recent days and have told us that the evacuation took place. “I can’t even imagine what I’m going to do now,” said a man whose 85-year-old father was expelled from one of the hospitals in northern Hungary. Once she received a phone call to take her sick family members home. The old man recently suffered a stroke and was paralyzed on his side, still lying helpless, infused. Your child would have to settle for home care 200 miles away.

“There is also an ethical problem,” says Eszter Sinkó.

Why does a patient without coronavirus suffer from a patient with coronavirus? On what basis, for example, does an amputee in need of medical rehabilitation not receive the necessary care?

They are already preparing to lift the restrictions.

According to the economist, many are confused about the measure, suggesting excessive caution on the part of the government.

With the restrictions so far, the government has bought time to prepare hospitals for the outbreak, although Sinkó says that even this is not a sufficient explanation of why that capacity should be reserved for an increasing number of patients with coronavirus.

International data show no additional need

he claims. Perhaps the total capacity requirement was calculated based on the target of 8,000 fans.

Anyway, there are many beds in Hungary in international comparison, so, according to Sinkó, it is an unprecedented number to take sixty percent. It is true that the use of hospital beds has not been complete so far, Rékassy estimates that the number of empty beds is 15-20 thousand, while according to Gulyás, 31-32 percent of beds are not used.

Evacuation can also be helped by postponing unplanned, non-urgent surgeries for weeks. An anonymous employee at a county hospital, for example, said they had only had three major anesthetic surgeries in April, compared to the previous 10-12. diary.

The fans come slowly

In addition to the release of hospital beds, the purchase of ventilators is also a major problem. Having enough hospital beds is useless if severely infected people do not receive adequate care.

Viktor Orbán said last Friday that between 7,500-8,000 fans could be needed when the epidemic peaked, while Gulyás spoke Thursday that the government had ordered more than 15,000. Only they are hard to come by because “the laws of the wolves govern the market,” all countries compete for fans.

Zsolt Halmos, commander-in-chief of the national hospital, told Thursday’s meeting of the National Defense and Law Enforcement Committee. Currently, 60 people need it, but if the epidemic curve starts to increase more dramatically, it may need more.

“Decision makers are not in an easy position,” says Rékassy.

(Cover image: Beds prepared for the reception of coronavirus patients with ventilators at Saint John’s Hospital in Budapest in late March 2020 – photo: István Huszti / Index)