Omicron denounces the inflexibility of European public hospitals
A World Health Organization official warned last week of a “shutdown window of opportunity” for European countries to prevent their healthcare systems from being overwhelmed as the omicron variant produces a near-vertical growth of coronavirus infections.
In France, Britain and Spain, countries with relatively strong national health programs, this window may already be closed.
The director of an intensive care unit in a Strasbourg hospital refuses patients. A surgeon at a London hospital describes a critical delay in the diagnosis of cancer in a man. Spain sees its determination to prevent a system collapse tested as omicron keeps medical staff from working.
“There are a lot of patients we can’t admit, and it’s the non-COVID patients who are the collateral victims of all of this,” said Dr. Julie Helms, who heads the intensive care unit at the University Hospital of Strasbourg, in the far east of France.
Two years into the pandemic, with the exceptionally contagious omicron impacting public services of all kinds, the effect of the variant on medical facilities has many reassessments of the resilience of public health systems that are considered essential to provide equal care.
The problem, experts say, is that few health systems have built up enough flexibility to handle a crisis like the coronavirus before it emerged, while repeated infection spikes have kept the rest too preoccupied to implement changes. during the long emergency.
Hospital admissions per capita are currently as high in France, Italy and Spain as they were last spring, when all three countries had lockdowns or other restrictive measures in place. The hospitalization rate for people with COVID-19 in England for the week ending January 9 was slightly higher than it was in early February 2021, before most residents were vaccinated.
This time, there is no confinement. The Institute for Health Metrics and Evaluation, a population health research organization based at the University of Washington, projects that more than half of the people in the WHO Europe 53 region will be infected with omicron within two months.
This includes doctors, nurses and technicians in public hospitals.
Around 15% of the 13,000 staff in the Strasbourg hospital system were discharged this week. In some hospitals, the employee absenteeism rate is 20%. Schedules are established and reset to fill gaps; non-critical patients must wait.
The 26 intensive care beds at the French public hospital are almost all occupied by unvaccinated patients, people “who refuse care, who refuse the medicine or who ask for medicines that have no effectiveness”, Helms said. .
She refused 12 admission requests at the start of the week and 10 on Wednesday evening.
“When you have three patients for a single bed, we try to take the one with the best chance of benefiting,” Helms said.
In Britain, as in France, the omicron is causing cracks in the healthcare system, even though the variant appears to cause less severe disease than its predecessors. The British government this month assigned military personnel, including doctors, to replace hospitals in London, adding to the ranks of military personnel who already help administer vaccines and run ambulances.
At the Royal Free Hospital in London, Dr Leye Ajayi described a patient who faced delays in his initial diagnosis of cancer.
“Unfortunately, when we finally decided to see the patient, his cancer had already spread,” Ajayi told Sky News. “So we are dealing with a young patient in his 50s who, perhaps if we had seen him a year ago, could have offered curative surgery. We are now talking about palliative care.
Almost 13,000 patients in England have been forced to wait on stretchers for more than 12 hours before a hospital bed is opened, according to figures released last week by the National Health Service.
Britain has a backlog of around 5.9 million people awaiting cancer screening, scheduled surgery and other scheduled care. Some experts estimate that this figure could double in the next three years.
“We need to focus on why performance has continued to drop and struggle for years and find solutions to drive short- and long-term improvement,” said Dr. Tim Cooksley, President of the Society for Acute Medicine.
Having the capacity to accommodate a surge is crucial, and it is precisely this surge capacity that many in Europe were surprised to learn their countries lacked. The people in a position to turn the tide were the same ones who faced the crisis on a daily basis.
In the midst of the first wave, in April 2020, the WHO European office published practical guidance for health systems to create slack in their systems for new outbreaks, including identifying a staff temporary health.
“Despite the fact that countries believed they were prepared for a pandemic that might arise, they were not. So it’s about building the ship as it sails,” said Dr David Heymann, who previously headed the World Health Organization’s infectious diseases department.
But France had cut hospital beds – as well as doctors and nurses – for years before the pandemic. Rebuilding it in a few months proved too difficult when the current wave infected hospital staff by the hundreds every day. Even allowing symptomatic COVID-19 positive health workers to report to work was not enough.
The UK NHS Confederation, a membership organization for sponsors and providers, says the public health service entered the pandemic with a shortage of 100,000 health workers that has only gotten worse.
The first wave of the pandemic pushed the Spanish healthcare system to its limits. Hospitals improvised ways to treat more patients by installing intensive care units in operating rooms, gymnasiums and libraries. The public witnessed, appalled, pensioners dying in care homes without ever being taken to public hospitals which were already well over capacity.
After that, the Spanish government vowed not to let such a collapse happen again. Working with regional health departments, it has designed what officials call “elasticity plans” to deal with sudden changes in service demands, especially in ICUs.
The idea is that hospitals have the equipment and, in theory, the staff, to increase capacity as needed. But critics of the government’s health policy say they have for years warned of a shortage of hospital staff, a key factor in the difficulty of providing care in the current surge.
“The key element is flexibility, having flexible buildings that can expand, having flexible staff in terms of accepting the transfer of tasks, having flexibility in terms of sharing the loads of a regional structure”, said Dr. Martin McKee, professor of public health. at the London School of Hygiene and Tropical Medicine.
Ultimately, however, McLee said, “A bed is a piece of furniture. What matters is the staff around it,” McKee said.
Helms, the resuscitator from Strasbourg, knows this only too well. His unit can accommodate 30 beds. But it only has enough staff to care for patients in the 26 currently occupied beds, a situation that is unlikely to change soon after the omicron fire in the area.
In the same hospital’s infectious disease unit, frantic planners are borrowing staff from elsewhere in the facility, even if it means non-COVID-19 patients receive less care.
“We are still in the midst of a complex epidemic that is changing every day. It is difficult to imagine what needs to be built for the future for other epidemics, but we will have to think about the system of organizing care, ”said Dr Nicolas Lefebvre, who heads the disease unit. infections at Strasbourg hospital. hospital.
He said Europe is ready to handle isolated outbreaks as in the past, but the pandemic has exposed weakened foundations across health systems, even those considered among the best in the world.
Frederic Valletoux, president of the French Hospital Federation, said policymakers at the national level are now fully aware of the problem. For 2022, the federation has asked for more resources from the nursing staff in place.
“The difficulty of our system is to make things happen, especially when you are in the heart of the crisis,” Valletoux said.
Danica Kirka in London; Maria Cheng in Toronto; and Aritz Parra in Madrid contributed to this report.
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