Healthcare collapsing under Covid pressure?

As the Covid-19 pandemic continues, the healthcare sector is facing challenges in meeting the rising demand in patient. The healthcare industry is experiencing extreme pressure: patients that need treatment within a few weeks are already being denied.

For example, in Amsterdam hospitals are currently able to provide emergency care, but semi-acute care – such as cancer and heart surgery – that has to take place within six weeks is no longer available. The chairman of the Regional Consultation Acute Care Chain (ROAZ) Noord-Holland and Flevoland, Mark Kramer, gives more insight into the situation: “with the number of admissions, we are now almost at the maximum level of the second, third and fourth waves of last winter. If the number of infections continues to rise at this rate, then I do not know whether we will be able to continue to properly treat patients with emergencies and semi-emergencies in the future”.

The pressure on the hospitals in the region is distributed as fairly as possible, says Kramer, because other hospitals take over patients from those that are very busy. But all hospitals have to take on their share of Covid patients from parts of the country where the hospitals are overflowing, such as Limburg, Brabant and the Rotterdam region.

“We are now also converting one of the recovery rooms into an ICU. Just like in the first wave, that department will become an ICU, so that we can deal more efficiently with staff. The numbers are rising very quickly,” explains vascular surgeon and head of the medical crisis team, Roos van Nieuwenhuizen.

To help aid in the increased demand for care, more healthcare staff are being called in on their days off, despite the fact that they have not even recovered from the endless work in the earlier waves . “We mainly call on anaesthesia and OR staff. I was very resentful of mobilizing them again, because of course no one wants to work so much. Nevertheless, I think that everyone is flexible again. They feel like: ‘We will manage this again’.”

What is code black?
As the pandemic seems to ease at some moments but heighten at others, some healthcare workers are questioning when it will end as they try to provide aid to the vastly increasing number of patients. “What’s going to happen? And how long will this continue? This great uncertainty gnaws at the staff. Yet we must respond stoically to it. We have to be ready and all efforts must be focused on preventing a scenario of code black,” adds Van Nieuwenhuizen.

“Code black doesn’t mean ‘everyone save themselves’, but is rather a signal to society: do not count on healthcare always solving the problem,” explains Hans Meij, medical anthropologist, head of the Human Genetics department and division chair of the Outpatient Care department of Amsterdam UMC.

The Netherlands has one of the best performing healthcare systems on a global scale. As the Covid-19 pandemic began, however, the number of ward and ICU beds was not sufficient. This meant that some patients’ health conditions could not be treated or some treatments not being available at all anymore. Since the start of the pandemic, many hospital staff have left their jobs due to the extreme pressure – both timewise and emotionally – that they had to face. As a result, there are now even fewer beds available than at the start of the pandemic.

Finding a solution
In order to offer as many people as possible access to care, healthcare providers have to decide which patients need to be treated immediately. First, those in need of acute care (including Covid, accidents, heart attacks, strokes) are treated, followed by those who need urgent care (cancer, open-heart surgery). Finally, non-urgent but necessary care (such as hip replacements and cataracts) is carried out. However, due to the limited availability of beds, some people have been waiting for such non-urgent surgeries for more than a year. This may seriously damage their health in the long term and lead to higher medical costs in the future.

“The demand for health care to catch up is too great. It requires a structurally different view of healthcare from us Dutch people. People should take more personal responsibility for their health and not assume care will always be available,” says Meij. He adds that these are times when everyone must take that responsibility and adhere to the collective Covid restrictions. “This is such a time. We have to realize that code black is not a storm for the sector, but rather a red card for society,” Meij concludes.

Written by Nicole Kerr