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Anyone that is transportable will be relocated. But there is also a lack of ambulances that can accommodate patients with ventilation aids. Image: keystone
Belgium is in danger of collapse: Europe’s number 1 virus hotspot report
In Liege, Belgium, hospitals have reached their capacity limit. Now people fear difficult decisions about life or death. Visit to the intensive care unit of the “MontLégia” hospital.
Liege, the former industrial city of eastern Belgium, is there as quietly as a Sunday morning. The shops are closed, there is hardly any traffic on the streets, only a few people are on the move. Simply: it is not Sunday morning, it is Tuesday. And the city is not quiet on Sundays either, but in a state of emergency imposed by the authorities.
The reason: nowhere in Europe are crown numbers as high as in Belgium and nowhere in Belgium is the situation as acute as in the province of Liège. For comparison: three times more people are infected with the coronavirus here than in Switzerland, where the number of infections has also risen sharply recently. In the last two weeks there were more than 3,300 infections per 100,000 inhabitants. This is a top European value.
Big rush: shortly before the tightening of the crown measures, many people took the opportunity to visit the so-called “non-essential shops”, on October 31, 2020. Image: keystone
A permanent juggling with the treatment sites.
As the number of cases increases, so do hospital admissions. Capacity limits have been reached: “We are completely full and we no longer know what to do with people,” complains Philippe Devos, deputy director of the intensive care unit at the “MontLégia” hospital in Liège. The 62 intensive care beds are all occupied, yet new critically ill patients are delivered every day.
The fact that so far no one has had to be turned away is solely due to the fact that transportable patients are transferred immediately. In neighboring regions of French-speaking Wallonia, to Dutch-speaking Flanders or by helicopter over the border with Germany.
A Covid-19 patient is being prepared for transport to Germany in a Belgian intensive care unit, on November 3, 2020. Image: keystone
It is a constant juggling with treatment sites: ten go in, ten go out. There is no more buffer. “We are working on the last point,” says Devos. To make matters worse, there is a shortage of ambulances that can transport intubated patients. And in addition to all this, there are cases in which relatives oppose relocation to another region with hands and feet.
The central question, however, is: When are the capacities in the other hospitals also exhausted? While the infection rate slowly stabilizes after lockdown measures, hospitalizations are still lagging behind. In just a few days what everyone here fears could threaten: A triage between patients and the decision between life and death. Which Covid Patient Has Priority? What happens to a 20-year-old victim in a car accident or a 40-year-old man who has a heart attack when all the beds are occupied?
On Monday, the hospital’s management established guidelines to aid decision-making. Devos cannot and does not like to estimate whether he will have to use them soon:
Belgium has a well-developed healthcare system and the MontLégia Clinic is one of the most modern hospitals in the country. Opened in March of this year, there are usually 48 intensive care beds. An additional 14 have now been created by temporarily converting the recovery room for postoperative operations into an intensive care unit. Here patients line up, some in the prone position, others in the supine position. 95 percent are between 55 and 75 years old. They are all intubated. It’s strangely quiet, only the beep of the fans can be heard.
Nursing staff at the end of their tether
About 30 percent of the patients would not make it out of the intensive care unit alive, Devos says. Despite their training, the high mortality rate is a great burden for caregivers. Practically every day they have to deal with deaths. Psychologists try to absorb the staff as much as possible. But they all run to the limit.
Many nurses have yet to recover from Wave 1 efforts: they are partially supported by the military.
(Image: Belgium, November 4, 2020) Image: keystone
Many nurses have already retired, either due to exhaustion from the first wave that claimed more than 10,000 deaths in Belgium. Or because they got Corona, like Devos did last March. At that time she had to stay home for 20 days, struggled with shortness of breath and extreme fatigue. Those who are better off and experience an asymptomatic course of the disease still come to work. More than five percent of the personnel present are currently infected. “Without her we wouldn’t do it,” says Devos.
With the prospect that it could last for months, he doesn’t know how to resist. Medical students and others with nursing education have already mobilized. However, personnel who meet the highly specialized requirements profile of intensive care medicine cannot be quickly found. Sooner or later foreign personnel will have to be requested, as in the spring in Italy.
The personnel emergency is also known to politicians. Belgian Health Minister Frank Vandenbroucke paid a visit a few days ago. Close to tears and hoarse, he had to admit how helpless he felt in the face of the precarious staff situation. This has been running for weeks, often full shifts, without the ability to even go to the bathroom.
The only thing left for him was the request that everyone adhere to the stricter crown rules without compromising. “We have our backs to the wall,” said the minister. In fact, the next few days will show if there will be similar dramas to those of Lombardy in spring. Belgian newspapers already write about “Bergamo an der Maas”.
Corona’s current situation on the ticker:
Intensive care doctor Devos can only speculate on why Liège has become an epicenter for Covid19. Perhaps it is due to the dismissal behavior of the 20,000 students in the city. Or the general fatigue of the crown after the first blockade, which was particularly severe in Belgium and lasted more than two months.
As a citizen, you can understand anger at the restriction of social life, says Devos. However, as a doctor, there are only two options for him: now either of them strictly adheres to blocking measures. Or you can opt for triage, the conscious choice to let patients die.
(bzbasel.ch)
