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In a week, Portugal may need 700 intensive care beds to treat COVID-19 patients, according to estimates from the tool created by the Portuguese Association of Hospital Administrators (APAH) to assess the need for beds and human resources. The worst-case scenario prediction, of two estimates, for November 27 brings the needs of the maximum intensive care beds that the Health Minister said exist for covid – 704 –, while highlighting that there is an expansion capacity that exceeds 900.
According to the report of the General Directorate of Health (DGS) this Friday, the country had 481 patients with covid in intensive care units (ICU), the highest number registered so far. For the second time, in a few days, in 24 hours more than two dozen patients were admitted to these different units. These patients are joined by hospitalized patients, for a total of 3,079 hospitalized covid patients.
If the worst case scenario is estimated for the 27th – the forecast is based on the data from the DGS report this Thursday, applying a reduction or a 2% increase in the transmission rate (R) – if confirmed, the 700 beds UCI represent a growth of 45.5% compared to the latest DGS data. The best scenario, however, points to the use of 481 ICU beds. That is, an occupation similar to the one announced this Friday.
Regarding the need for total beds (including ICU and infirmary), in the worst case, 4583 beds may be necessary, an increase of 1.8% in relation to the previous scenario. In the best case, 3,192 beds may be needed, 3.1% more than in the previous estimate. The increase in needs is maintained, but there is a slowdown. “There is less pandemic dynamics, but it continues to grow. It is in line with what was said yesterday at the Infarmed meeting ”, says the president of the APAH, Alexandre Lourenço, referring to the approach of the R to 1.
With regard to the regions, the forecasts continue to show an increase in the need for beds in all of them, with the exception of Lisbon in Vale do Tejo, if compared to the previous forecast. In terms of human resources, the needs are also growing, but less markedly than in the previous estimate. Thus, next Friday, 1202 doctors, 8421 nurses and 3310 auxiliary health technicians may be needed, in the worst case, in the infirmary and the ICU.
The effort must be shared
The president of the Portuguese Society of Internal Medicine, who technically advised this tool with clinical data and percentages of patients in need of hospitalization – around 15% need hospitalization and of these, 25% in nursing, around 60% need hospitalization. oxygen therapy and 16% ICU – , highlights “the similarity with reality” that the tool has been able to estimate. Regarding the new scenarios, João Araújo Correia says that in the best scenario “we can still function”. In the worst case, “it would be downright complicated.”
The specialist speaks of a difference in patients from the first wave to this one. Now they are younger: recent DGS data indicated that about 35% of hospitalized patients were between 40 and 65 years old –, which “fortunately did reduce mortality, but the average hospital stay lasts until recovery.” Which means less patient turnover. In the case of intensive care, the stay can exceed 20 days.
“The maximum horizon for ICU beds can exceed 900, but that’s it. We must always respond to trauma in complicated surgeries. We cannot get to this point, ”says João Araújo Correia. “We have here a work base that is worth pursuing, which has been equated with reality and which makes us think that not all regions have the same needs. There must be a centralized management of these needs, making the effort to be shared, “he defends.
Especially since one of his concerns is uncovered patients. “We cannot allow hospitals to suspend all scheduled activities and others to do their normal activities. This is not acceptable and creates inequality. It demands that there be a leadership that must be from the Ministry of Health “, he affirms, considering that” it has to move faster with agreements with the private sector so that there is no greater damage “.
Also in relation to human resources, João Araújo Correia considers that it is necessary to call in doctors from other specialties to support the response to the covid. “Intensivists, internists, and infectious diseases are the specialties that capture the vast majority of patients. The response in the rooms must be mixed. A nucleus that has to be internists, but in the same unit there may be surgeons, orthopedists, other specialties. The same in ICU, using anesthetists. The situation is very serious, but there is a solution ”, he says.
