In France, Britain and Spain, nations with comparatively
strong national health programs, that window may already be closed.
The director of an intensive care unit at a hospital in
Strasbourg is turning patients away. A surgeon at a London hospital describes a
critical delay in a man’s cancer diagnosis. Spain is seeing its determination
to prevent a system collapse tested as omicron keeps medical personnel off
work.
“There are a lot of patients we can’t admit, and it’s the
non-COVID patients who are the collateral victims of all this,” said Dr. Julie
Helms, who runs the ICU at Strasbourg University Hospital in far eastern
France.
Two years into the pandemic, with the exceptionally
contagious omicron impacting public services of various kinds, the variant’s effect
on medical facilities has many reevaluating the resilience of public health
systems that are considered essential to providing equal care.
The problem, experts say, is that few health systems 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 right now are as high in
France, Italy and Spain as they were last spring, when the three countries had
lockdowns or other restrictive measures in place. England’s hospitalization
rate of people with COVID-19 for the week ending Jan. 9 was slightly higher
than it was in early February 2021, before most residents were vaccinated.
This time, there are no lockdowns. The Institute for Health
Metrics and Evaluation, a population health research organization based at the
University of Washington, predicts that more than half of the people in WHO
Europe’s 53-country region will be infected with omicron within two months.
That includes doctors, nurses and technicians at public
hospitals.
About 15% of the Strasbourg hospital system’s staff of
13,000 was out this week. In some hospitals, the employee absentee rate is 20%.
Schedules are made and reset to plug gaps; patients whose needs aren’t critical
must wait.
The French public hospital’s 26 ICU beds are almost all
occupied by unvaccinated patients, people ”who refuse care, who refuse the
medicine or who demand medicines that have no effectiveness,” Helms said.
She denied 12 requests for admission early in the week, and
10 on Wednesday night.
“When you have three patients for a single bed, we try to
take the one who has the best odds of benefiting from it,” Helms said.
In Britain, like France, omicron is causing cracks in the
health system even though the variant appears to cause milder illness than its
predecessors. The British government this month assigned military personnel,
including medics, to fill in at London hospitals, adding to the ranks of
service members already helping administer vaccines and operate ambulances.
At the Royal Free Hospital in London, Dr. Leye Ajayi
described a patient who faced delays in his initial cancer diagnosis.
“Unfortunately, when we eventually got round to seeing the
patient, his cancer had already spread,” Ajayi told Sky News. “So we’re now
dealing with a young patient in his mid-50s who, perhaps if we’d seen him a
year ago, could have offered curative surgery. We’re now dealing with
palliative care.”
Nearly 13,000 patients in England were forced to wait on
stretchers more than 12 hours before a hospital bed opened, according to
figures released last week from the National Health Service.
Britain has a backlog of around 5.9 million people awaiting
cancer screenings, scheduled surgeries and other planned care. Some experts
estimate that figure could double in the next three years.
“We need to focus on why performance has continued to fall
and struggle for years and build the solutions to drive improvement in both the
short and long term,” said Dr. Tim Cooksley, president of the Society for Acute
Medicine.
Having the capacity to accommodate a surge is crucial, and
it’s just this surge capacity that many in Europe were surprised to learn their
countries lacked. The people in a position to turn that around were the same
ones dealing with the crisis daily.
In the midst of the first wave, in April 2020, WHO’s Europe
office put out a how-to guide for health systems to build slack into their
systems for new outbreaks, including identifying a temporary health workforce.
“Despite the fact that countries thought they were prepared
for a pandemic that might come along, they were not. So it’s building the ship
as it sails,” said Dr. David Heymann, who previously led the World Health
Organization’s infectious diseases department.
But France had been cutting back hospital beds — and doctors
and nurses — for years before the pandemic. Building it back up in a matter of
months proved too much when the current wave infected hospital staff by the
hundreds each day. Even allowing symptomatic COVID-19-positive health workers
to report for work hasn’t been enough.
Britain’s NHS Confederation, a membership organization for
sponsors and providers, says the public health service went into the pandemic
with a shortage of 100,000 health workers that has only worsened.
The first wave of the pandemic pushed Spain’s health system
to its limit. Hospitals improvised ways to treat more patients by setting up
ICUs in operating rooms, gymnasiums and libraries. The public witnessed,
appalled, retirees dying in nursing homes without ever being taken to state
hospitals that 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 designed
what officials call “elasticity plans” to deal with sudden variations in
service demands, especially in ICUs.
The idea is that hospitals have the equipment and, in
theory, the personnel, to increase capacity depending on the need. But critics
of government health policy say they’ve warned for years of inadequate hospital
staffing, a key driver of the difficulty delivering care in the current wave.
“The key thing is flexibility, having flexible buildings
that can expand, having staff that are flexible in terms of accepting task
shifting, having flexibility in terms of sharing loads more of a regional
structure,” said Dr. Martin McKee, a public health professor at the London
School of Hygiene and Tropical Medicine.
Ultimately, though, McLee said: “A bed is an item of
furniture. What counts is the staff around it,” McKee said.
Helms, the Strasbourg intensive care doctor, knows that all
too well. Her unit has space for 30 beds. But it has only enough staff to care
for the patients in the 26 beds currently occupied, a situation unlikely to
change quickly after omicron burns through the region.
In the same hospital’s infectious diseases unit, frantic
schedulers are borrowing staff from elsewhere in the facility, even if it means
non-COVID-19 patients get less care.
“We’re still in the middle of a complex epidemic that is
changing every day. It’s hard to imagine what we need to build for the future
for other epidemics, but we’re going to have to reflect on the system of how we
organize care,” said Dr. Nicolas Lefebvre, who runs the infectious diseases
unit at the Strasbourg hospital.
He said Europe is prepared to handle isolated outbreaks as
it has in the past, but the pandemic has exposed weakened foundations across
entire health systems, even those considered among the world’s best.
Frédéric Valletoux, the head of the French Hospital Federation,
said policymakers at the national level are acutely aware of the problem now.
For 2022, the federation has requested more resources from nursing staff on up.
“The difficulty in our system is to shake things up,
especially when we’re in the heart of the crisis,” Valletoux said. -AP