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It’s a mixed picture. We have currently passed the zenith of new admissions for the time being. We do not yet know exactly what will happen next. But in the normal ward, the situation relaxed a little, we have admitted fewer patients in the past few days and at the same time we were able to discharge some patients. Unfortunately, it looks completely different in the intensive care unit: The number of Covid patients is increasing, and the premises just had to be enlarged. In the past, the situation relaxed first in the normal ward and then two weeks later in the intensive care unit. Now we can observe the peculiarity that many patients have to go to the intensive care unit very quickly after being admitted to the hospital. The clinical courses are currently more difficult. The correlation between patients in normal and intensive care units got mixed up in the third wave.
Why is that?
Overall, the parameters have changed in the pandemic. In the first two waves, the proportion of infected people who had to be treated in hospital was fairly constant – that is, the hospitalization rate. This is an important value for hospital planning and policy. This number seems to have decreased because many old people are now vaccinated. Fewer infected people need hospital treatment. At the same time, the intensive care rate seems to be significantly higher – i.e. the proportion of patients in the hospital who have to go to the intensive care unit. The course of the disease has changed due to the mutation B.1.1.7. There are many young people under 50 who have very severe courses to be treated. That can really only be due to the mutation. All other factors in the second wave were similar to now. The incidence among younger people wasn’t much lower either. But in the third wave we see young patients with severe courses much more often.
To what extent have the courses changed?
Before that, the patients usually came to the normal ward with mild or severe symptoms one week after the onset of symptoms; at the beginning of the second week of illness, the disease often deteriorated. Now it is more often the case with us that the patients arrive in the emergency room with very little oxygen in their blood or they already have vascular occlusions. Some have to go straight to the intensive care unit – we’ve rarely seen that before, now it happens regularly. If the proportion of those infected with intensive care needs to continue to increase, even a slight decrease in the number of newly infected patients will not help to relieve the intensive care units. But that still cannot be assessed correctly.
So there is still no reason to be pleased that the incidence value has leveled off at a high level?
In Darmstadt it has been around 100 for a few weeks, when a plateau seems to have been reached. But the incidence value has to be recalibrated in its meaning for us. It is still a decisive factor, but we no longer know exactly which value has which significance for developments in the hospital. Subjectively, it seems to us that the younger patients have to be treated longer on average, that also plays a role. You have a much higher chance of surviving the intensive therapy – but with a longer hospital stay.
When do you move patients from the normal to the intensive care unit?
Covid stations have now become real monitoring stations. The vital parameters of the patients are monitored to the second, so patients who have a higher oxygen requirement can be safely kept with us for a long time. For example, a patient has to go to the intensive care unit if he needs more oxygen than can be administered in a normal ward. Mechanical pressure ventilation takes place, for example, in the intensive care unit. In addition, a patient is moved when we realize that a very ominous dynamic has begun. If the oxygen values deteriorate within a short period of time and the x-ray image of the lungs deteriorates at the same time, we sometimes relocate patients who do not even notice their shortness of breath themselves. You still get shocked when you transfer a patient who is smiling and talking to us to the intensive care unit and have to be intubated hours later.
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