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The number of corona patients in intensive care units is increasing and early hospitals are postponing elective interventions. By early next week, more than a third of all cantons could have reached their capacity limits. However, individual hospitals find it difficult to forward their data correctly.
Medical staff from the intensive care unit of the Pourtalès Hospital in Neuchâtel during the first Corona wave in March.
How well a country copes with the Crown crisis is directly related to the number of beds available in the intensive care unit (IPS). The higher this capacity, the more resilient the health system and the greater the probability that the number of deaths will remain relatively low.
A week ago, the Swiss Society of Intensive Care Medicine (SGI) described the number of intensive care places as “sufficient”. This statement will soon be out of date. According to a forecast by the ETH platform icumonitoring.ch, ten cantons will have used 80 to 100 percent of their IPS capacities by the beginning of next week (Aargau, Friborg, Neuchâtel, Nidwalden, Schaffhausen, Schwyz, Solothurn, St. Gallen , Wallis and Zug).
More beds, fewer patients
The platform was criticized after the first wave because it had predicted an overload of IPS capabilities, but this never materialized. In the meantime, the model has been refined, as ETH professor Thomas Van Boeckel tells ETH news service. Hospitals have also improved their reporting on the number of intensive care beds. It seems that there are still hospitals that struggle to transmit the information correctly. But this is rare now.
According to figures from the Coordinated Medical Service of the Armed Forces (KSD), Swiss hospitals currently have almost 1080 intensive care places, including the specialized personnel required for this. A realistic scenario for maximum expansion is the number of 1400 IPS beds, also here with staff. The KSD now records the occupation of IPS beds in all cantons twice a day. However, the figures are only released twice a week, on Tuesdays and Fridays. A comparison of the latest figures with those of the previous week shows that the number of Covid-19 patients in intensive care units has increased considerably.
On October 23, the KSD counted 144 corona patients at IPS across Switzerland, as of Tuesday there were already 200. But what is surprising is that the number of occupied IPS beds was significantly lower this week than the previous week. Last Friday there were 732 patients at the IPS, on Tuesday there were 681. The experience of the first wave shows where this could come from: On the one hand, the number of work-related and traffic accidents is falling due to less mobility. On the other hand, patients hesitate to go to the hospital for fear of infection, although they need urgent treatment, with fatal consequences.
Not only has the utilization of intensive care capacities declined, individual hospitals have already provided additional beds, albeit in the single-digit range. According to the KSD survey at the end of last week, the canton of Aargau had a total of 50 IPS places, this week there were 52. The cantonal hospital of Baden activated the first escalation stage on Monday and increased the number of care places Intensive from ten to twelve, according to Barbara Hürlimann, director of the Department of Health, confirmed.
Other hospitals have also reacted to the second wave. The canton of Vaud has also increased its beds from 83 to 85 beds. The Cantonal Hospital of St. Gallen activated the first of two levels of climbing on Wednesday. The hospital has not yet created any additional IPS capacity, but will reduce certain elective interventions that result in intensive care starting next week, explains Philipp Lutz, spokesman for the Cantonal Hospital St. Gallen and a member of the hospital’s task force. These are, for example, plannable cardiac interventions.
Second level of climbing
This will allow the hospital to increase the number of existing intensive care places from 36 to 44 in the coming days. In the second stage of climbing, according to Lutz, an expansion to 56 locations is possible, more than are currently available in the entire canton. “In intensive care, the problem is not the infrastructure, but the staff,” says Lutz. Fans can be purchased or rented, but professionals who can operate such devices are not available overnight.
The SGI also shares this view. The company assumes that the bottleneck will not be in the beds or fans, but in the staff. “All the treatment of critical patients requires specific skills, which specialists in intensive medicine and specialists in intensive care acquire over many years of training and maintain through continuous and advanced training courses,” as reported by the SGI Under petition.
After the first wave experience, St. Gallen Cantonal Hospital assembled the “IPS tandems”, teams of two with an intensive care specialist and another specialist from another area. The goal is to compensate for bottlenecks with non-departmental staff without having to give up specialized knowledge. The hospital also trained additional staff for IPS in the first wave, says Lutz. “We trusted people who had already worked closely with IPS, for example in anesthesia.”
Lutz gives little thought to the idea of establishing ad hoc intensive care facilities in hospitals that previously had no such department. “Intensive care settings have to be where the processes are known.” Also, there are not enough staff to take care of those departments.
Exchange across national and cantonal borders
Interchange between hospitals worked well in the first wave, even across national borders. Several Swiss hospitals have accepted Covid 19 patients from Alsace when intensive care units were overloaded. The Cantonal Hospital of St. Gallen also took care of two at the time – the canton weathered the first wave comparatively well.
Things now look much less favorable for several Swiss cantons that did not show any capacity problems at the time. As long as capacities can be balanced across cantons and state borders, hospitals will be able to avoid overloading their intensive care units.
However, if the number of cases continues to increase at the same rate in all regions, there will still be bottlenecks in the medium term, because then there will be a shortage of staff, as the SGI reports on request: “If the pandemic spreads and every time more intensive care staff have to be quarantined, the existing staff shortage in the intensive care unit worsens. “In intensive care units, nurses and doctors would be absent at a time when cold weather it means that there is more absenteeism in normal times than in other seasons.
