If there is not a kink in the curve soon, hospitals will run into the limits of their intensive care capacity next week. The chance that this scenario can be avoided is getting smaller by the day. ‘Next Friday, intensive care will be full.’
Day after day, the situation in Belgian hospitals is becoming more precarious. Today, as many covid patients are in the hospital as at the peak of the first wave. The difference is that we haven’t reached the peak yet. The curve will certainly continue to rise for a while. Jan Stroobants (58), president of the Belgian Association for Emergency Physicians, sees the near future as gloomy. “Anyway, the tanker hits the rocks,” he says. Epidemiologist Pierre Van Damme (UA) also warns against this. According to him, our healthcare system will “crack” in a good week.
The capacity in intensive care units (ic) in particular is a cause for concern. Our country can free up 2,000 ic beds for covid patients in dire need. At the moment, almost half of those beds have been taken over, but that could change quickly. At the current rate, the total number of IC admissions doubles in about eight days. According to Sciensano virologist Steven Van Gucht, the intensive care units will be full by November 6, next Friday.
That does not necessarily have to be the case, it says. “We assume that the pace will slow down. But even then, I think there is a good chance that we will flirt with the threshold of 2,000 people in intensive care, ”says Van Gucht. Biostatistician Niel Hens (UHasselt, UAntwerpen) also has little hope. “We see in the curves that we most likely cannot avoid that scenario. Day after day, that becomes less likely. The question then becomes how much damage we incur. ”
For the time being, little has been noticed of a delay in hospital admissions, says Van Gucht. aIt is also the case with the number of people who become infected with Sars-Cov-2. There are tentative signs that the virus is losing strength. In Brussels, for example, the number of new infections is still increasing day by day, but the doubling time of that daily figure has increased to about three weeks. That is the first sign that there may be a kink in the curve.
However, the daily contamination figures should be taken with a good grain of salt. The reason for this is that the test strategy was redesigned on 21 October. Since then, only patients with symptoms of Covid-19 have been tested. Anyone who does not show symptoms will not be tested. This means that the figures before and after October 21 cannot be compared.
Sciensano is working on a solution. “We know of all infections whether those people had symptoms or not,” says Van Gucht. “So we can draw a new curve for the past weeks with only symptomatic people. This gives you a more or less consistent picture, even though the situation is not ideal. ”
“The best indicator we now have to map out the epidemic is the hospitalizations and the number of hospital beds occupied,” says Hens. The problem with this is that those figures only provide a national picture, and do not allow monitoring the epidemic per province. This is because patients from Brussels, for example, are also transferred to hospitals in East Flanders.
The great unknown is what the effect of the measures taken in the past month will be, and when that effect will show itself. Broadly speaking, it takes about 10 to 12 days for that to happen. The first links date back to 6 October, when, among other things, the close contacts were reduced to a maximum of three. Hens: “This was communicated very strongly by Minister Vandenbroucke (sp.a), but we have not seen any effect in the figures.”
In the meantime, stricter measures have been announced step by step. During the past week, events and leisure activities were severely restricted. But these interventions come too late to prevent us from hitting the limits of our IC capacity, experts say. “There is little doubt about that. We should never have ended up in this situation. ”
The consequences for healthcare can be dramatic. Beds are not the biggest problem: extra capacity can be provided in dire need, for example by bringing convalescing patients to rehabilitation centers. The real bottleneck is with the staff: there is no can of new doctors that you can quickly open. In addition, specialized doctors are needed for intensive care. The first wave has shown that the care for the extra beds created is not as good as for the regular ic beds.
The consequences are also significant for other patients. In theory, anyone who needs care can receive care. “But the reality is different from the theory”, says oncologist Baki Topal (UZ Leuven). Many consultations will take place over the telephone, for example. The consequences can be dramatic. But we cannot do otherwise: these are the means by which we have to do it. That is very painful. ”