Liene Cipule: Any subsequent patient may be left without a place in the hospital
In six Latvian hospitals, the admission of patients has already been disrupted, and in fact any subsequent patient may be left without a place in the hospital, such a grave picture is painted by the Director of the Emergency Medical Service Liene Cipule. She emphasizes that the health care crisis has already been predicted by the service.
In several hospitals, intensive care beds are currently 100 percent full, which means that new patients brought in by an emergency team cannot be admitted to the hospital. The Ministry of Health assumes that a health care emergency situation will have to be declared, which means that hospitals will only admit Covid-19 patients and patients in an acute, severe situation.
Every subsequent patient - in the risk zone
143 Covid-19 patients were hospitalized in one day, but the total number of Covid-19 patients admitted to hospitals reached 709 patients on Tuesday, according to the National Health Service. This is the largest number of Covid-19 patients hospitalized both per day and in general. It is the Emergency Medical Service that faces major challenges every day in organizing the transfer of patients to hospitals, as there is new information every day about whether and how much space is available in hospitals. Liene Cipule, the director of the service, said that the admission of patients in six hospitals is currently hindered: “This is a big burden for the service, because it is necessary to understand where to bring patients and, secondly, to transfer patients from one hospital to another. We have already predicted this situation. Any subsequent patient is at risk of not being found a place in the hospital.”
The average bed occupancy rate in hospitals is 73 percent, which means that, at least on average, the emergency rate has not been reached, but that is just the average. In multiple hospitals the occupancy is more than 80 percent, but in some hospitals the occupancy of inpatient beds is over 100 percent, for example, in Vidzeme hospital, North Kurzeme Regional Hospital, Rēzekne Hospital. The intensive care unit in Liepāja Regional Hospital is 100 percent full or practically blocked, but in Jelgava Hospital this was the situation the day before, but the hospital found an opportunity to open another 20 beds.
Riga East University Hospital and Pauls Stradiņš Clinical University Hospital have the greatest workload in the treatment of Covid-19 patients. In these hospitals, the load of intensive care beds has also exceeded 85 percent. According to Liene Cipule, the situation is also complicated by the fact that the number of outbreaks in social care centers and psychoneurological hospitals has increased, which also means the need to change patients' hospitalization plans. The provision of other emergency services is significantly affected in all hospitals with a load of more than 80 percent.
Waiting for 90 percent?
"The situation is not promising," says Sanita Janka, Head of the Quality of Medical Treatment Department of the Ministry of Health. "We are preparing for a worst case scenario, which would mean admitting only Covid-19 and acute patients to hospitals, and we will have to stop admitting all other patients." However, S. Janka added: "We hope that it will not come to such a situation."
What are the criteria for determining an emergency situation in health care? At present, planned health services are limited at the national level, but in theory they are not completely discontinued. Outpatient care also is working. Sanita Janka points out that the criteria are related to intensive care and Covid-19 bed occupancy in hospitals. Scheduled assistance could be completely stopped if the beds for Covid-19 patients are 90 percent occupied and it is no longer possible to transform or re-profile other wards, and it is also not possible to find doctors who will work in these wards. Although the specialists of the Ministry of Health talk about the emergency situation as theoretically possible and express it in the form of a possibility, it must be concluded that currently these criteria are in fact a reality and the emergency situation has been reached. For example, the occupancy of intensive care beds is currently 80 percent (the critical figure is 85 percent, but it should be taken into account that in some hospitals this figure already reaches 100 percent).
We could turn Ķīpsala into a hospital, but there are no doctors
The idea to open a specially adapted hospital in Ķīpsala Hall has been offered to the Ministry of Health by the owners of the hall, however, as Antra Valdmane, Director of the Health Department of the Ministry of Health, emphasizes, "we do not reject the idea, but it must be taken into account that there are no medical resources that could work in this hospital.”
Currently, two local hospitals have been approached - Balvi and Gulbene Hospital Association and Dobele City Hospital, where an additional 20 beds (each) could be opened for Covid-19 patients, however, these hospitals also have a human resources problem. According to Antra Valdmane, the main reason why a state of emergency could be declared in health care is the lack of medical workers. It is planned to talk about this topic and possible larger restrictions in health care at the meeting of the State Operational Medical Commission on December 10.
"We are looking at the possibility that we may have to declare a health care emergency situation precisely because we are short of medical staff," concluded Antra Valdmane. She rejected accusations from the Ministry of Health that she was only thinking but doing nothing. One of the questions is whether the Ministry of Health has talked to representatives of private medicine about the possibility of supporting the state health care field with various resources.
Where there are no doctors, we have to stop providing care
Rinalds Muciņš, Chairman of the Board of Stradiņš Hospital, confirmed that the main problem is the availability of staff. "We are not far from canceling planned aid. If doctors and other staff in one of the wards leave the ranks as Covid-19 patients or as contact persons, then in fact we have to stop work in this ward, so it can be said that planned help is being phased out,” admitted R. Muciņš. Simply put, where there are no more doctors, medical services are also being canceled. 105 employees have been diagnosed with Covid-19 or as contact persons at Stradiņš Hospital.
Kārlis Rācenis, a hospital doctor who heads one of the Covid-19 wards, also confirmed that the hospital has addressed practically all medical residents and medical students to work in the hospital and has no more candidates to ask. Everyone who can is already working. It is precisely the medical residents who work in the Covid-19 wards.