Many countries in Europe are running out of intensive care beds amid a surge of coronavirus cases – as well as the doctors and nurses required to staff them.
In Italy, queues of ambulances can be seen parked outside hospitals awaiting beds for patients, while in France the government coronavirus tracking app prominently displays the intensive care capacity taken up by Covid-19 patients: 92.5% and rising.
In the intensive care unit (ICU) in Barcelona, there is no end in sight for the doctors and nurses who have endured this situation already.
In country after country, the intensive care burden of Covid-19 patients is nearing and sometimes surpassing levels seen at last spring’s peak.
Health officials, many advocating a return to stricter lockdowns, warned that adding beds will do no good because there are not enough doctors and nurses trained to staff them.
In France, more than 7,000 health care workers have undergone training since last spring in intensive care techniques.
Nursing students, interns and paramedics have all been drafted, according to French health minister Olivier Veran.
“If the mobilisation is well and truly there, it is not infinite,” he said last week, when the ICU units were filled to 85% capacity.
“It is not enough.”
Within days, the capacity had jumped another seven percentage points and Mr Veran warned it would continue to rise.
And, unlike in the first wave last spring, the virus is now everywhere in France, making transfers from one region to another by high-speed train less practical.
One hospital in the southern city of Marseille recently wheeled in refrigerated rental trucks ahead of a feared rise in ICU deaths there.
In Italy, Filippo Anelli, the head of the national doctors’ association, said at the current infection rate, there soon will not be enough physicians to go around.
Recently in Naples, nurses started checking on people as they sat in cars outside emergency rooms, waiting for space to free up.
Italy has a total of 11,000 ICU beds, but only enough anaesthesiologists for 5,000 patients, Mr Anelli said. As of Monday, 2,849 ICU beds were filled nationwide – up 100 from just the day before.
For the average coronavirus patient with serious symptoms, it takes seven to 10 days to go from infection to hospital admission.
Those admitted often need to stay for weeks, even as more patients arrive. The maths is inexorable as long as infection rates rise.
Patients from France and the Netherlands are being evacuated to German intensive care units, but German doctors say they are watching the number of free beds dwindle quickly.
Dr Uwe Janssens, who heads Germany’s Interdisciplinary Association for Intensive Care and Emergency Medicine, said some urban areas are reaching precarious levels.
He said: “When a city of millions only has 80, 90 beds left then that can be a critical mass, because you don’t just have Covid-19, there are also traffic accidents, heart attacks, pulmonary embolisms and so forth.”
In the past two weeks alone the number of coronavirus patients treated in ICUs in Germany has almost tripled, from 943 to 2,546.
However, Dr Janssens acknowledged that the situation in Germany is better than that in France, Belgium, the Netherlands and the UK.
Germany has about 34.5 ICU beds per 100,000 inhabitants, not including the emergency reserves. Italy has 10, while France has 16, he said.
“But a bed, a ventilator and a monitor doesn’t mean the patient can be cared for,” he added. “When it comes to nurses and specialist staff, Germany is far behind.
“We have a lot of beds but we don’t have enough staff for them.”
Spain has the same limitations, but had endured coronavirus deaths already on a scale Germany has yet to experience.
Dr Robert Guerri, head of the infectious diseases department and coordinator of Covid-19 admissions at Hospital del Mar in Barcelona, said: “On the one hand, the health workers are tired; on the other hand, the number of people that are working on the front line is limited.”
His coronavirus unit filled up in October, then the critical care unit filled up. Even with the rate of infection easing slightly, he does not know when any of those beds will be free.
In neighbouring Portugal, Fernando Maltez has 40 years of experience preparing contingency plans for health threats as one of the country’s leading infectious disease experts. This one is different.
In the seven months from early March through the end of September, Portugal officially counted more than 75,500 cases of Covid-19. In the month of October alone, it counted almost 66,000.
In all, 391 coronavirus patients were in Portuguese ICUs as of Monday, when the country imposed a curfew. During the worst week last spring, the ICUs had 271 coronavirus patients.
“There’s no end in sight,” Mr Maltez said at the infectious disease ward he oversees at Lisbon’s Curry Cabral Hospital, where 20 ICU beds set aside for coronavirus patients are now all occupied.
“No health service in the world can withstand a deluge of cases that just keeps coming.”
Much of Eastern Europe, which was spared the harrowing wave last spring, is in the same position.
Hungary warned its ICU would run out of space by December under the worst-case scenario, and hospital cases in Poland have risen to three times the levels seen in the spring.
Late last month, American National Guard troops with medical training headed to the Czech Republic to work alongside doctors there, while the mayor of Prague took shifts at a hospital.
However, there are a few signs of hope.
Belgium, proportionally still the worst-hit nation in Europe when it comes to coronavirus cases, is seeing increasing indications of a turning point in the crisis after a partial lockdown.
Virologist Yves Van Laethem said hospital admissions seem to have peaked at 879 on November 3, and fell to about 400 on Sunday.
There were fears that the 2,000-bed ICU capacity would be reached last week, but Steven Van Gucht, a virologist with the Sciensano government health group, said the pace was slowing there as well.
“The high-speed train is slowing down”, at least for now, he said.
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