On Monday, a good 3,000 beds were still available in intensive care units in Germany. Over 2500 people had to receive intensive care because of Covid-19. On a weekly average, there are currently 200 corona patients every day, although the number has recently increased significantly and is possibly accelerating even further. So roughly two weeks remain until the intensive care units are overcrowded across the board. And every day it becomes less likely that this can be prevented.
The mathematician Andreas Schuppert from RWTH Aachen University, together with the intensive care physician and head of the Intensive Care Register Divi, Christian Karagiannidis, calculated what the capacity utilization of the intensive care units could look like in the coming weeks. In the best case scenario, your model calculation assumes 3500 Covid intensive care patients. To do this, however, the infection process would have to be suddenly slowed down. The R-value, which indicates how many people an infected person passes the virus on on average, should drop to a value of one or less. This measure for the infection dynamics has been higher since the beginning of October. The weekly incidence should not exceed 250 reported new infections per 100,000 population. Last weekend this value had already reached 200.
The model calculation by Schuppert and Karagiannidis shows that a total of almost 6,000 intensive care beds would only be necessary for Covid patients if the R value only drops to one or below at an incidence of 400. A strong flu wave that would require additional intensive treatment is not yet included in these calculations.
In addition, the load on the intensive care units varies greatly from region to region. In more than 80 counties, only ten percent of the intensive care beds are free. Apart from Bremen, Hamburg and Berlin, Bavaria currently has the highest occupancy. There, on average, only 10.4 percent of the intensive care beds are free, reports the intensive registry. Corona patients occupy a good 20 percent of the intensive care beds in Bavaria.
The fact that the situation is very different from one region to another is primarily due to the different vaccination rates. However, overall fewer intensive care beds are available in the fourth wave than a year ago. According to the intensive register, a good 5,000 available beds were lost within a year. The beds are still there, but there is a lack of staff to adequately care for patients in them.
That is why many clinics are already reaching their limits. Although there were no vaccinations at the time, twelve months ago the situation was far less tense. At the beginning of November 2020, more than 1,000 of the roughly 1,600 intensive care units in Germany were able to maintain their regular operations, so they didn’t have to postpone operations or redistribute new patients to other hospitals. More than 600 clinics are currently reporting restricted operation of their intensive care units, and more than 300 have “partially restricted” operations.
The number of patients alone is not decisive
It is not the number of patients alone that leads to ICU overcrowding. Their average age has also decreased because many of the younger ones are not vaccinated. Younger people die less often from the virus than the very old, but they wrestle with it longer in the intensive care unit. This means that they have to lie there much longer. For the staff and the bed capacity, the absolute number of patients during a wave of infection is not decisive, but only how many patients currently need to be cared for. The clinics cite overload as the reason for the lack of staff. Many caregivers are burned out and frustrated after 18 months of the pandemic and have quit. This was already apparent last winter. However, they failed to improve working conditions. So it happens that a situation that is actually more favorable due to the vaccinations could result in a situation that is soon as desperate as it was a year ago.
If nothing changes in the location of the hospitals, total overload can become the normal state from now on. The winter half of the year has always been particularly stressful for the nursing staff, even without Corona. Influenza viruses require many thousands of hospital treatments each year. Last year this was not done because of the protective measures.
Schuppert and Karagiannidis therefore also show scenarios for the next few years in their report. As long as there is no comprehensive community immunity, it is to be expected that violent corona outbreaks will occur again and again in winter, almost parallel to the influenza season. “If the increase in incidences turns out to be lower from year to year and with it the associated intensive exposure, the corona pandemic could end like an oscillation that decreases from season to season,” they write. However, the incidences are only likely to rise as high as can be achieved in intensive care medicine. “Closing the vaccination gap would, on the other hand, resolve all of the previous points ad hoc and enable a largely normal life.”