According to IC teams of ten Brabant hospitals and a hospital in Limburg, the physical and emotional burden of corona care is taking its toll and the quality of care is at risk. According to the intensivists, even further upscaling of IC-capacity has become a utopian dream. In a fire letter to Minister Hugo de Jonge (Health) and Ernst Kuipers of the National Network Acute Care, they write “be prepared”.
The signatories mean a scenario in which hospitals are no longer able to provide IC-care. They fear ‘code blac’, in which doctors select who is and does not qualify for a place in the intensive care unit.
Kuipers responds to the cry for help today. “I sympathize with them,” he says. “We see the tension, but we also help them. And it‘s not the first time I’ve heard it. More often, hospital administrators call me with the message: “We‘re on the border.” We are still able to distribute the IC-needs nationally, but that is at the expense of regular care.”
Extracts from the fire letter:
According to Kuipers, it is organized in such a way that no one region or one hospital can no longer handle it. “Then the protocol enters into force to distribute. We’re doing this together. But long-term further scale-up is now far from easy. The result is, among other things, that more OK staff will work on ICs. Helping all regions, we intensify the spread. But that will affect the entire distribution system.”
The question remains whether the worst peak is in sight, as Rivm-boss Jaap van Dissel expects. If these expectations are correct, the number of recordings will drop rapidly, said Van Dissel at the last coronabriefing in the House of Representatives. Around 1 May this should be clearly visible.
Kuipers still finds that uncertain. “For us – and I have been saying this since March – if you vaccinate everyone, with at least a first shot, there is really less chance of getting sick covid patients in three weeks. You can also see the results in the UK and Canada. Too bad we didn‘t do it this way, because it immediately relieves care.”
He has little understanding for the remarkable statements of RIVM top man Jaap van Delden. The vaccination coordinator said yesterday in a conversation with the AD: “If I were 66 and the GP would call me, I would also ask myself: today AstraZeneca, or in two or three weeks Pfizer?” Kuipers invites Van Delden to come and see a hospital.
Consequent of our behaviour
That vaccination is the key to the crisis, says also doctor and foreman of the Dutch Association for Intensive Care Diederik Gommers. “We are vaccinating like crazy right now. If something goes wrong with the vaccination in the coming weeks, we have a big problem.” He does not expect that the easing of the corona measures will cause a peak in the number of IC intakes because vaccination is now really on steam.
“ People are not taking so closely with a number of corona measures, such as the visitor scheme. We expect that this behavior doesn’t change much because of these easings,” say Gommers and Kuipers. The fact that the ICs are so full now is a consequence of our behaviour three weeks ago.
Kuipers doesn‘t fear ‘code black‘ now either. “We have up to 1700 IC beds in the Netherlands and we are not yet at that border. Now we are on 1450 beds and we are going to 1550. There is a discussion about going to 1700 IC beds, but that goes further at the expense of other care.”
The Amphia Hospital, one of the signatories, let us know that the rack is out. “We are very concerned.” Take a look at the ICU and the emergency IC of the hospital in this video:
“ If I compare it to last year, we were on 1500 included covid patients for two months,” says Kuipers. “This has been the case for more than six months now. The IC occupation is at the highest level and if you see that there are 10 percent more infections in the past week, the recordings will indeed increase in the next week”, expects Kuipers.
He therefore understands the call for help from the hospitals. “It seems as if we live in two worlds,” he says. “The world of relaxation and ‘we‘re over the worst, ‘versus the highest number of infections in the past week, the engagement withdrawn in hospitals and all hands on deck.”
The Ministry of Health says that the situation in the hospitals is paying full attention. “At the same time, there is also a loud cry for perspective from society. The Cabinet therefore always makes a broad social consideration in the decision-making process and that has been the reason for taking a cautious first step on 28 April. The Cabinet continues to monitor the figures and forecasts closely,” said the response.