Omicron denounces the inflexibility of European public hospitals

In France, Britain and Spain, countries with relatively strong national health programs, this window may already be closed.

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 on Tuesday 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 milder 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 saw the patient, his cancer had already spread,” Ajayi told Sky News. “So we are dealing with a young patient in his fifties 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 decline 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. It is crucial to have the capacity to host a thrust, and it is precisely this thrust capacity that many Europeans were surprised to learn their country 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 he’s 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, 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 nursing 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 intensive care units. The idea is that hospitals have the equipment and, in theory, the staff, to increase capacity as needed. But critics of government health policy say they have warned for years of inadequate hospital staff, a key factor in the difficulty of delivering care in the current surge.

“The main thing 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 said Dr Martin McKee, professor of public health at the London School of Hygiene and Tropical Medicine.

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Mary I. Bruner