The number of new infections with the coronavirus is increasing rapidly. More and more people have to be treated in intensive care units. Beds are also becoming scarce in Munich. The fourth wave of corona infections has hit the city with full force. On Thursday, the Robert Koch Institute (RKI) reported an incidence of 694.8 for Munich.
A day earlier, in view of the gloomy prognoses, the government of Upper Bavaria had instructed the specialist clinics in the administrative district to cancel or postpone operations that were not urgently required by medication until mid-January. The hospital of the merciful brothers in Neuhausen is also affected. Only interventions that cannot be postponed, such as the operation of a rapidly growing tumor, are carried out there.
Of the 26 intensive care beds, ten are occupied with Covid patients, twelve other infected people are in the normal ward. In theory, more than half of the intensive care beds are still free, but this snapshot is deceptive. “It fills up,” says Christine Beenken, spokeswoman for the hospital, “the beds are always full in the evening.” The situation is very tense, which is why the press spokeswoman and none of the senior doctors reported.
“With them the land is under,” says Beenken. Since the emergency medical department of the clinic has many years of experience in the treatment of acute lung failure, its artificial lung machines – so-called Ecmo systems – have been in demand since the pandemic. “Sometimes we have to say no and reject patients,” says Beenken.
22 free intensive care beds in Munich, none more in the district
Things look similarly tight at the other Munich clinics. According to the intensive care register of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), of 455 intensive care beds in the state capital, just 22 were free on Thursday afternoon. This corresponds to a utilization of more than 95 percent. Accordingly, 117 Covid 19 cases are being treated in the intensive care unit, 62 of them are ventilated through a tracheal incision or are intubated. None of the intensive care beds in the district were free.
In the past few days, the Munich Clinic had launched an appeal to all medical and natural sciences students on social networks. “Students against the 4th wave – help in normal and intensive care units or in the laboratory!”, Writes the city society there. It is a matter of “maintaining supplies for the citizens of Munich” in the coming weeks, over the holidays and in the period up to the end of March.
According to the Munich Clinic, there are currently 100 Covid-19 patients in their four large hospitals – Bogenhausen, Harlaching, Neuperlach, Schwabing. Of these, 67 are treated in normal and 33 in intensive care units. Nine other patients are still considered suspect patients. According to Axel Fischer, Managing Director of the Munich Clinic, intensive care beds are “no longer free per se”. And he speaks of a “very tense situation” in the hospitals. Mainly because one sees that “the situation will be even more difficult”.
Since last week, the Munich Clinic has already cut back half of the elective, i.e. plannable, operations. These include, for example, foot operations or interventions for joint replacement. Semi-selective cases are, for example, certain tumor operations that can wait a little longer. Absolutely urgent interventions, including cancer operations that have to be carried out because the prognosis would otherwise be worse, are still being carried out, emphasizes Fischer. Of course, emergencies such as heart attacks and strokes are also treated and accident patients cared for. “We’re moving from urgency to urgency,” says the managing director. The patient’s frustration and suffering will increase the more operations have to be postponed.
“There is still air in the system. But only if all clinics participate in the corona supply.”
The fact that since Wednesday there has been an announcement by the government of Upper Bavaria that corona clinics have to suspend all non-medically necessary operations by January 10 is “certainly correct” emphasizes Fischer. Because sometimes this is needed so that everyone can participate. But only the main Covid suppliers would then be responsible. And these are a few large houses, says Fischer. However, the clinics in Munich should all stick together. “There is still air in the system. But only if all clinics participate in the corona supply.”
The less space there is in the intensive care unit, the more often doctors are faced with a problem: Which patient gets a bed: a heart attack or an accident victim? A latent triage, i.e. the prioritization of medical emergencies due to insufficient capacities, has already begun, it writes Medical journal about the situation in the south and east of Germany. In the Munich Clinic, says managing director Fischer, people are preparing for triage so that they can “act legally and ethically” if need be. But at the moment, says Fischer, “we are not yet using triage.”
The Brothers of Mercy Clinic has a paper on triage that was drawn up as part of the pandemic plan last year. It is based on the recommendations of the German Ethics Council, which published updated guidelines a year ago. These were last updated in July. It states that the patients should be prioritized according to the chances of success of the treatment. Age or origin should therefore play a subordinate role.
In the Munich university clinics, the employees are also at their limit. “Because we need more intensive care beds for patients with Covid infections every day, we have to close more and more operating theaters and can only guarantee the treatment of other seriously ill patients with difficulty,” says Philipp Kreßirer, spokesman for the LMU Klinikum.
The doctors responsible are busy several hours a day organizing new intensive care beds. However, no patients have yet to be transferred to other federal states or even abroad. “The care of the unvaccinated Covid patients in our intensive care units takes place at the expense and expense of many vaccinated patients with other serious diseases,” says Kreßirer.