The numbers paint a grim picture: Europe is in a full-blown coronavirus resurgence. While in September it seemed that emergency wards were for the most part unaffected, there are now growing reports of intensive care units nearing capacity.
In Belgium, officials warn that at this rate ICU beds could run out in two weeks. Former Prime Minister Sophie Wilmès has been laid low by the virus — one of many European politicians to have tested positive. Things aren’t looking better across the Channel, where there are reports of Manchester hospitals running out of critical care beds. France is grappling with similar problems, with occupancy rising to worrying levels in the Paris region of Île-de-France.
Data from the European Centre for Disease Prevention and Control shows that emergency unit occupancy is increasing at an exponential rate. The doctors and nurses staffing these ICUs have scarcely recovered from the spring, with many still trying to catch up on the backlog of suspended surgeries. POLITICO spoke to front-line medical staff around Europe to understand the unfolding crisis.
‘Prevention is the most important thing’
— Jozef Kesecioglu, president of the European Society of Intensive Care Medicine and professor of intensive care medicine at the University Medical Center Utrecht, the Netherlands
“We are faced again with a surge,” warned Kesecioglu. “Maybe not as huge as before, but it has the potential to become huge.”
The good news was that unlike in March, there’s no shortage of equipment and protective supplies. And comparatively “early” action compared with the first wave has helped to blunt the scale of the increase, he notes.
At the same time, the situation could “change at a moment’s notice,” just like it did in March, he said. “We should be ready for everything.”
For now, though, intensive care unit capacity in the Netherlands is still enough, he said. When one ward fills up, “there are always other hospitals, accepting the patient outside the region,” he explained, adding that patients can also be transferred across borders to other countries. “Germany has already indicated that they have beds,” he added.
“Prevention here is the most important thing,” he stressed. “When things start to happen, everybody rightfully looks at the hospitals.” But the most important prevention starts at home, which makes it all the more critical to educate parents and children about the risk, he said, adding that “the door of the hospital” should only be the last resort.
‘What protects Bergamo is that people are afraid’
— Guido Marinoni, doctor and president of the Bergamo Medical Order, Italy
“What worries me is not so much ICU occupancy,” said Marinoni, a physician in one of Europe’s worst-hit towns in the first wave. “What worries is the increase in cases that’s become exponential in Milan, Varese and Monza.”
As for herd immunity — even in Bergamo, with its sky-high infection rates — that scenario is still far away, he said. “What protects Bergamo right now is that people are afraid,” Marinoni explained. “Everyone has had a relative or a friend die of COVID-19.”
The new restrictive measures are welcome, and should be even stricter if it were up to him, Marinoni added.
In his view, ultimately controlling the spread of the virus will come down to the diligence of citizens, as well as the government’s skill and willingness in administering contact tracing and quarantine — and should it become necessary, lockdowns.
“We don’t find ourselves fighting with many more weapons that we had before,” the doctor admitted.
‘The health of non-COVID-19 patients is a concern for the whole European community’
— Carole Boulanger, consultant nurse in intensive care at the Royal Devon and Exeter Hospital, U.K.
This time of year is always busy for ICUs, with capacity stretched due to diseases like the flu and pneumonia, notes Boulanger. And while March and April offered the prospect of better weather, now it’s only getting colder.
What’s more, it was essential to avoid any interruptions in treating patients who weren’t infected with the coronavirus, she adds.
“The untold cost on the health of non-COVID-19 patients is a concern for the whole European community,” Boulanger said. The challenge, then, is to deliver the very best care for those with the coronavirus without compromising the treatment of everyone else.
In the meantime, she said, hospitals have been working hard, training regular staff to operate in the ICUs.
“We’ve had some time to put into training some people,” she said. “It’s very different from ward work. You can’t train in 90 hours.”
One challenge: Wearing protective equipment all the time.
“It’s hard to hear and you lose capacity to be able to lip read,” said the nurse, who has 20 years of experience. “We don’t realize how much we lipread on a daily basis, between ourselves and patients.”
As for the future, Boulanger hoped that management and government take away lessons from the pandemic.
“One of the things I really learned is the absolute importance of the staff,” she said. “You can have Mercedes building ventilators, but it’s about valuing the staff as much as the kit.”
‘Everything went back to how it was before’
— Baptiste Lafont Rapnouil, trainee intensive care doctor at the Henri Mondor University hospital and Institute Mutualiste Montsouris hospital, France
“In every hospital, when they ask what’s lacking, it’s nurses,” said Lafont Rapnouil, who’s beginning his third year of intensive care training.
“It’s not new,” he explained. “But it’s also related to the way the first wave was managed.”
While staff was given full organizational support in the spring, this hasn’t held up. Back in March and April, red tape was slashed and administrative obstacles were removed to allow personnel and bed space to be rolled out when needed. “Everyone got hyped up, and they thought it was going to change,” Lafont Rapnouil said. “But everything went back to how it was before.”
Now staff is leaving and morale can’t get lower, he admits. Instead, it’s been replaced with disillusion, while doctors are trying to catch up with all the backlog in surgeries and treatments. “Everyone is either busy or tired,” he said.
‘Physically and emotionally, we’re not over it yet’
— Harlinde Peperstraete, intensive care doctor at the Ghent University Hospital, Belgium
One difference from the first wave is the impression that the virus is much more pervasive, says Peperstraete.
“People get infected by their family members,” she said. “We now have nurses that are infected by their children or by their husbands, not by the patients. It gives you a scary feeling, not being safe at home.”
And medical staff is still reeling from the first wave, with many unable to take any vacation since the start of the pandemic.
“Physically and emotionally, we’re not over it yet,” the ICU doctor explained. These worries are compounded by the thought of a loved one getting sick, and not being able to take time off due to the number of patients.
“You have no choice. You have to come to work and you have to treat and care for your patients — and we will do it well, but you feel now that we’re still tired,” she said.
While in the first wave “there was a lot of team spirit,” doctors and nurses now look to the future with a more fatalistic attitude.
“Whatever comes, comes,” Peperstraete said. “We will have to keep up.”
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