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Omicron shows the lack of flexibility of public hospitals in Europe

The director of the intensive care unit at a hospital in Strasbourg is turning away patients. A surgeon at a London hospital describes a severe delay in a man’s cancer diagnosis. Spain is witnessing a determination to prevent a system crash that was tested because omicrons put medical workers off work.

Dr Julie Helms, who runs the ICU at University Hospital Strasbourg in eastern France, said: “There are so many patients that we cannot admit, and it is the non-COVID patients who are the victims of it all. these things.

The problem, experts say, is that few health systems have been built with enough flexibility to handle a crisis like the coronavirus before it emerges, while repeated waves of infections make people sick. The rest are too preoccupied with making changes during the extended emergency period.

The current per capita hospitalization rates in France, Italy and Spain are on par with last spring, when the three countries introduced lockdowns or other restrictive measures. Hospitalization rates for people with COVID-19 in the UK for the week ending 9 January were slightly higher than in early February 2021, before most people were vaccinated.

This time, there is no door lock. The Institute for Health Metrics and Evaluation, a population health research organization based at the University of Washington, predicts that more than half of people in the WHO’s 53-country region in Europe will be infected with omicrons within a year. within two months.

That includes doctors, nurses and technicians at public hospitals.

About 15% of the Strasbourg hospital system’s 13,000 staff have quit this week. In some hospitals, the employee turnover rate is 20%. Schedule is done and reset to plug gaps; Patients with unimportant needs must wait.

Mr. Helms said that the 26 ICU beds of France’s public hospitals were almost all filled with unvaccinated patients, who refused care, refused medication or who requested ineffective drugs.

She turned down 12 requests for admission on Tuesday and 10 requests on Wednesday night.

“When you have three patients for a single bed, we try to choose the one most likely to benefit from it,” says Helms.

In the UK, like France, omicrons are causing cracks in the health system although this variant appears to cause milder illness than its predecessors. The UK government this month appointed military personnel, including medics, to London hospitals, adding to the ranks of service members who have helped administer vaccines and operate ambulances. love.

At the Royal Free Hospital in London, Dr Leye Ajayi described a patient facing a delay in her initial cancer diagnosis.

Ajayi told Sky News: “Unfortunately, when we finally got to the patient, his cancer had already spread. a year ago, might have suggested curative surgery. We are now dealing with palliative care.”

Nearly 13,000 patients in the UK are forced to wait on stretchers for more than 12 hours before their beds open, according to figures released last week from the National Health Service.

There are around 5.9 million people in the UK waiting for cancer screenings, scheduled surgery and other planned care. Some experts estimate that number could double in the next three years.

“We need to focus on why performance continues to decline and struggle for years and build solutions to drive improvement,” said Dr Tim Cooksley, president of the Society for Acute Medicine. in both the short and long term,” said Dr. Tim Cooksley, president of the Society for Acute Medicine.

Having the capacity to respond to a surge is crucial, and it is this spike capacity that many in Europe have been surprised to learn their countries lack. The people who can turn the tide are the same people who deal with crises on a daily basis.

In the midst of the first wave, in April 2020, WHO’s European office released guidance on how health systems should build their systems for new outbreaks, including define a temporary health workforce.

“Despite the fact that countries think they are prepared for a possible pandemic, it is not. So they’re building the ship as it sails,” said Dr David Heymann, who previously led the World Health Organization’s infectious diseases division.

But France had been cutting hospital beds – and doctors and nurses – for years before the pandemic. Building it back in a few months is too much when the current wave is already infecting hundreds of hospital workers every day. Even allowing healthcare workers with symptoms of COVID-19 to report work is not enough.

England’s NHS Confederation, a member organization of donors and providers, said the public health service had fallen into the pandemic with a shortage of 100,000 healthcare workers only getting worse.

The first wave of the pandemic pushed Spain’s health system to its limits. Hospitals have improvised ways to treat more patients by setting up ICUs in operating rooms, gyms, and libraries. The public witnessed, in horror, retirees dying in nursing homes without ever being taken to the already overcrowded state hospitals.

After that, the Spanish government vowed not to let such a collapse happen again. Working with regional health departments, it designs what officials call an “elastic plan” to deal with sudden changes in service demand, especially in ICUs.

The idea is that hospitals have the equipment and, in theory, the staff, to increase capacity according to demand. But critics of the government’s health policy say they have warned for years about inadequate hospital staffing, a major cause of difficulty providing care in the current wave of health problems. now.

“The key is flexibility, having flexible buildings that can scale, having staff that are flexible in accepting task switching, having more flexibility in sharing the load of the structure. region,” said Dr. Martin McKee, professor of public health. at the London School of Hygiene and Tropical Medicine.

In the end, however, McLee says: “A bed is a piece of furniture. McKee said.

Helms, Strasbourg’s intensive care physician, knows that all too well. Her apartment has room for 30 beds. But it only has enough staff to care for the patients in its 26 existing hospital beds, a situation unlikely to change quickly following the omicron burn in the area.

In the same hospital’s infectious disease unit, bookers are aggressively borrowing staff from elsewhere in the facility, even if it means that non-COVID-19 patients receive little care. than.

“We are still in the midst of a complex epidemic that is changing every day. It’s hard to imagine what we need to build for the future with respect to other epidemics, but we will have to think systematically about how we organize care,” said Dr Nicolas Lefebvre, application moderator Infectious disease in Strasbourg said. hospital.

He said Europe is prepared to deal with isolated outbreaks like in the past, but the pandemic has revealed a weakening foundation across the entire health system, even those considered to be isolated. is the best in the world.

Frédéric Valletoux, head of the French Hospital Federation, said policymakers at the national level are now acutely aware of the problem. For 2022, the federation requested additional resources from nursing staff or more.

“The difficulty in our system is shaking things up, especially when we are in the midst of the crisis,” Valletoux said.

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Follow AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic

https://abcnews.go.com/Health/wireStory/omicron-exposes-inflexibility-europes-public-hospitals-82293056 Omicron shows the lack of flexibility of public hospitals in Europe

Emma Bowman

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