Status: 11/26/2021 10:54 a.m.
Due to the corona pandemic, clinics are increasingly reaching their limit – preparations for triage are in progress. DIVI President Janssens has now presented new guidelines for this. Vaccinated or unvaccinated – it shouldn’t matter.
The fourth corona wave is bringing hospitals nationwide to the limit of their capacities. It is also becoming more and more likely that doctors will have to decide in the foreseeable future, due to the overload, which patients can receive vital care first.
The so-called triage is “a tragic, but quite possible scenario”, warned Uwe Janssens, President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI). In such a case, a doctor would have to make the “inevitable” decision as to which patient has a “realistic chance of success” to survive and then to recover well from an illness.
DIVI updates recommendation
But Janssens does not speak of triage, but of prioritization. Triage comes from disaster medicine, when the treatment chances for a large number of injured people have to be assessed as quickly as possible. For the prioritization procedure, the DIVI has already after the outbreak of the pandemic, which has shown the “collapse of Western health systems”, Recommendations worked out and these are now supplemented. Put simply, the patient comes first with a high probability of survival and long-term recovery.
According to the now updated recommendation, it should not matter whether a patient suffering from Covid-19 is vaccinated or not, said Georg Marckmann, director of the Institute for Ethics, History and Theory of Medicine. Access to intensive care treatment is not dependent on whether an illness may have been partially self-caused. Especially since it cannot be clearly determined to what extent a failure to vaccinate is the cause of a corona disease. In addition, there is a risk of “social imbalance” if vaccination should become a criterion, warned Marckmann. The health system records the weakest vaccination rates in the socially disadvantaged classes.
Hundreds of new corona patients in intensive care units every day?
So far, the recommendations should not have been applied, so Janssens. But with the fourth wave, the “exponential growth in the number of infections, the vaccination rate that was too low from his point of view and the simultaneous decline in vaccination protection, especially in vulnerable groups, the situation changed. Janssens expects that hundreds of new corona intensive care patients will soon have to be cared for every day.” The high of 5723 Covid-19 patients in January of this year in the intensive care units will shortly be reached and will certainly be exceeded significantly – with resources becoming scarcer, said Janssens.
However, the increasing burden of the higher number of corona intensive care patients will in no way lead to them being treated to other patients who are also preferred to an intensive care unit. “Equal treatment” is an important point when it comes to prioritization, emphasized Jan Schildmann, internist and head of the Institute for the History and Ethics of Medicine. Restricting regular operations in the clinics would serve to be able to meet “the urgent need for intensive care measures” for all patients. If there is a lack of capacities in the treatment, the decisions must be ethically justified.
“Prepare for Triage”
Frank Ulrich Montgomery, Chairman of the World Medical Association, uses the word triage more clearly. He told the newspapers of the Funke media group: “We are all preparing for a triage.” Doctors tried everything to avoid making such a decision. But “in view of the increasing number of infections”, the clinics would have to arm themselves for such a case.
For weeks, the Robert Koch Institute has been reporting new highs in the corona numbers every day – including on Friday with more than 76,000 new infections within one day and a seven-day incidence of 438.2.
Many clinics operate on a restricted basis
Due to the increasing number of corona patients in intensive care units nationwide, 75 percent of all locations of clinics with intensive care units are already working in restricted operation, warned the chairman of the German Hospital Association (DKG), Gerald Gaß, in a guest post for the “Rheinische Post”. “In concrete terms, this means that, as in January 2021, we will again not be able to treat almost every third patient in the regular system,” said Gaß.
This also means that planned operations have to be postponed. The federal and state health ministers had already spoken out in favor of this measure two days ago. In his contribution, Gaß summarized this step in numbers:
We will perform around 20 percent fewer operations on colon cancer and around seven percent fewer operations on women with breast cancer.
For cancer patients it is “hard to bear” psychologically and physically to be put back on the waiting list for an intervention as a result of the effects of the pandemic. Janssens nevertheless welcomed the decision of the health ministers. DIVI has been calling for this step for weeks. Postponing operations, without the affected patients threatening any immediate dangerous health consequences, could “cushion” the growing overload in the clinics.
The first federal states are relocating patients
Thuringia, Bavaria and Saxony already have to move patients from their own hospitals to clinics in other federal states. More than 50 patients are affected. Nine federal states have agreed to accept patients. The Bundeswehr wants to support the transfer of those affected with flights. The Air Force has two aircraft ready for the relief mission. According to information from the dpa news agency, an Airbus A310 MedEvac is to land at the Bavarian airport in Memmingen at 2 p.m. and fly seriously ill people to Münster-Osnabrück in North Rhine-Westphalia.
As part of the so-called cloverleaf system, Covid 19 patients should be able to be distributed nationwide if hospitals are threatened with collapse in individual regions.
The head of the World Medical Association, Montgomery, had also urged the Bundeswehr to help. He advocated transferring patients not only within Germany but also to clinics in other EU countries. This “systematic transfer of Covid patients abroad” must be initiated immediately in order to relieve German hospitals.