The crucial question in the fight against the coronavirus is: are there enough beds in the intensive care units of Dutch hospitals?
There are now 354 people in intensive care (IC) in the Netherlands. Normally, 1150 IC beds are available. Half of this should remain available for non-corona patients. 800 hospital admissions are expected next week. “Then we are expected to reach a peak of 1400 patients in the IC,” said chairman of the Dutch Association for Intensive Care Diederik Gommers. “That’s actually what we can handle. After that, it has to go down.”
Beds are still available in many hospitals. This is also because planned operations are canceled: those who do not need acute care have to wait a while. There are also hospitals where rooms that are left are taken into use, says Gommers.
Beds and staff
“We have set up 55 IC rooms in the Erasmus MC in Rotterdam, but due to a shortage of staff, only 40 rooms are in use. We can scale up, so you can get extra staff from other departments.” Those people are less busy now because of the coronavirus. “Every hospital is now working with technicians to ensure that the ICs can scale up. We are looking into where suitable personnel can be obtained.”
The operating room personnel are deployed first. They are already used to breathing, because this is also necessary during an operation. “Now they need to be retrained to help with a corona patient,” says Gommers. “That is a collaboration between the intensivist with the expertise and the staff who can help.”
“This could take months”
Farid Abdo, intensivist at the Radboudumc in Nijmegen, explains that all help, from anesthesia but also from staff from other departments, may be needed. “This may take months and the influx may be so great that IC staff alone will prove insufficient.” People need to be trained for this now, because the IC is different from other departments.
Abdo: “At the IC you have the option of ventilation, other organ replacement treatments and the use of IVs with special medicines that keep people asleep, for which continuous monitoring is necessary.”
This is necessary for some of the corona patients, because they are stuffy by the virus and are at risk of oxygen deficiency. “This is only the case in the most serious cases.”
Not to the ICU
More than 80 percent of corona patients do not end up in the hospital at all, the intensivist emphasizes. And 20 to 30 percent of the small part that does come to the hospital for treatment ends up in the ICU.
It’s likely that an infected patient will then have to ventilate for weeks, Abdo says. “And the same applies: the older you are, the greater the attack on your body. Not everyone can and wants to.”
“Sometimes, in consultation with their GP, people choose to die at home. When they do go to the hospital and ICU admission is required, prior to admission, the survival chances and expected quality of life are examined together with the patient and family. after an IC recording. “
This explains why three-quarters of the deceased corona patients in the Netherlands have not been in ICU. “This has nothing to do with the IC capacity. In addition, we currently have sufficient IC capacity so that it is not yet taken into account in recordings with a corona infection.”
Faster and more aggressive than flu
It is not yet completely clear why one is affected by the virus and the other is not. “We also see that with normal flu. It affects the young and the elderly. But the coronavirus spreads faster and is much more aggressive. There are clear risk factors and the response of the immune system plays a role in this, but what makes the exact difference now we don’t have an answer yet, “says Abdo.
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