Europe is better prepared for a second pandemic winter as case numbers again spiral into record territory, with countries investing heavily to expand the number of beds in their hospitals’ intensive care units.
But front-line staff are at the very limit, warn health experts and professional groups, as ICU doctors and nurses who have been working flat out for a year and a half increasingly cut back their work hours due to exhaustion — with some even quitting the health profession entirely.
“Morale is very low among nurses. We’re tired and we’re disillusioned,” said Alda Dalla Valle, a veteran nurse who works in the emergency unit in the Epicura Hospital in the Belgian town of Hornu. Almost 40 percent of her team is missing, Dalla Valle, who is also vice president of Belgium’s nursing federation, told POLITICO, as some clear leave that has piled up and others are sidelined by burnout.
The good news is that, compared to a year ago, the EU finds itself better prepared, with vaccines, new medicines, and more bed and ventilator capacity than ever. And the coronavirus is no longer the mystery illness that swept Europe’s health systems like a tidal wave last year. Doctors and nurses working in intensive care units across the bloc have built up experience in treating COVID-19 patients.
But Europe isn’t out of the woods just yet. The latest wave of contagion has been more dramatic in Eastern Europe, and now even the more vaccinated West is reaching new peaks. Germany is seeing a record number of cases and the government is preparing new public health measures. Austria has imposed Europe’s first lockdown on the unvaccinated, while the Netherlands has also introduced new restrictions.
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The spread of the flu — which barely made an appearance last year — could further clog up hospitals. Years of low case numbers are usually followed by spikes as people’s immune systems become progressively more susceptible to the illness. Health systems also warn of record numbers of young children being hospitalized with respiratory syncytial viruses (RSV) for the same reason.
While beds and medicines can be bought in bulk, training staff can take years, which makes the supply of willing and able doctors and nurses the limiting factor for care.
Won’t get fooled again
The Continent, once again at the epicenter of the pandemic, hasn’t sat on its hands over the past 12 months. Both the European Commission and member countries have been investing in treatments that have been shown to cut coronavirus mortality. And the arrival of antiviral drugs like those developed by Roche and Pfizer will tilt the table even more in favor of physicians battling the virus.
Europe is also better prepared for this winter in terms of infrastructure. In response to the first wave, when health systems were flooded with patients and came close to collapse, governments have invested in new intensive care beds and respirators. Sweden, for example, has more than doubled its number of ICU beds to 10.4 per 100,000 people from before the pandemic, according to the European Observatory on Health Systems and Policies.
At the request of the Commission, the European Society of Intensive Care Medicine (ESICM) helped devise a training program to make hospitals more resilient for the winter. It rolled out basic skills to other hospital staff so that they could help in the ICU when there is a surge in patient numbers.
“It’s very, very basic. You’re not independent, but you can help in moments of demand for acute care,” explained Maurizio Cecconi, ESICM president and head of the intensive care department at Humanitas Research Hospital in Milan.
He said the program had been a success — with some 17,000 doctors and nurses given training, above a target of 10,000.
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Juliane Winkelmann and Gemma Williams, research fellows at the European Observatory, said countries are learning to scale hospital capacity up and down in response to the coronavirus. But the extra load on health systems comes at a price. “The most common and effective strategy to increase acute and ICU bed capacities was the postponement of elective treatments and surgeries,” the researchers explain.
Making sure there’s enough trained staff, and not just beds and respirators, is the real bottleneck for care, the European Observatory experts said.
End of their rope
European countries also face the challenge of retaining exhausted hospital staff.
According to the Standing Committee of European Doctors (CPME), “extreme working conditions” are starting to drive doctors out of the profession. The situation is even worse for nurses, with the European Federation of Nurses estimating that just under a third of nurses working before the pandemic have since left their jobs.
Unhappiness among medical workers over low wages and budget cuts preceded the pandemic, dating back to the policies of austerity imposed after the 2008 financial crisis.
In Ireland, around 3,000 doctors left the country between 2016 and 2020 to take up positions abroad, said Ray Walley, a general practitioner in Dublin and vice president of the CPME. And the situation for doctors who stayed has continued to worsen — with a survey carried out by the Irish Medical Organisation at the start of the year showing that seven out of 10 were at high risk of burnout.
“The conditions prior to the pandemic were bad, and the pandemic has exacerbated those things,” said Walley.
In Estonia, one third of nurses are considering quitting, said Gerli Liivet, vice president of the national nurses’ union.
At the start of the pandemic the government raised pay by half for nurses working in emergency care during pandemic waves. But that may no longer be enough, said Liivet. “The salary is not motivating nurses anymore because the workload is so high,” she explained.
Even health systems held up as examples of success are under strain. In June, Danish nurses went on strike for nearly 10 weeks to demand better pay before being ordered back to work by government decree. This follows similar strikes in France, Belgium and elsewhere.
According to the Danish Nurses’ Organization (DSR), a trade union, wages for nurses are 15 to 20 percent lower than groups with a comparable level of education in other, more male-dominated fields. Nurses rejected as insufficient a negotiated settlement under which their pay would have risen by 5 percent over three years.
Prime Minister Mette Frederiksen announced the return of restrictions as cases reach a peak not seen since last December. She asked hospital staff to redouble their efforts, provoking pushback from disgruntled nurses in social media.
The government has launched a commission to examine the pay issue with an eye to salary negotiations in 2024, but in the meantime the DSR points to some 5,000 open positions, as well as a rise in the numbers of staff applying for jobs elsewhere — up to 10 percent in October from 5 percent in February — as evidence of the morale crisis in the profession.
In the longer term governments will have to build more spare capacity. “We’ve learned that in order to build resilience into the system, you need to create some reserves,” said ESICM’s Cecconi. According to the intensive care specialist, during a normal winter — outside of a pandemic — it’s rare to have more than 10 to 15 percent of beds available. Often all beds are filled.
Upping staff numbers will have to go hand in hand with increasing capacity. Cecconi said that adding 10 intensive care beds required an increase of between 20 to 60 nurses and 10 doctors — and that’s not counting physiotherapists, pharmacists and other auxiliary staff. Training an intensive care nurse can take five years, and a doctor up to a decade.
“I’m not sure that people realize that the ventilator is probably the easiest thing to find,” said Cecconi.
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