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HOSPITALS

Covid-19: How will a priority triage system in Swiss hospitals work?

As Switzerland’s medical facilities are near their saturation points, medical authorities are preparing a triage plan to decide who will get priority for beds in intensive care units.

Covid-19: How will a priority triage system in Swiss hospitals work?
Hospitals like CHUV in Lausanne might have to resort to triage of patients is Covid rates don't drop . Photo by AFP

According to Virginie Masserey, head of the infection control department at the Federal Office of Public Health (FOPH), “the limit to intensive care units could be reached in five days”.

In response, the Swiss Academy of Medical Sciences (ASSM) and the Swiss Society for Intensive Medicine (ASSM) are working out the emergency protocol for triage of patients in intensive care units (ICUs).

The two organisations say that triage system should be based on equity — that is, resources must be made available without discrimination of any kind, in order to avoid any arbitrary decisions.

“The guidelines provide assistance to ICUs, so that any triage decision can be made according to the same criteria across Switzerland,” regardless of whether patients have Covid-19 or another critical condition that requires immediate treatment, said Franziska Egli, communications officer at the ASSM.

READ MORE: Switzerland faces lack of hospital beds as coronavirus infections soar 

“The objective is to save as many lives as possible, but the short-term prognosis is the deciding factor for the decisions”, she added.

This means that patients whose prognosis for recovery or improvement is favourable with intensive care therapy, but unfavourable without this treatment, have top priority.

Age in itself is not a factor, but it is indirectly taken into account in the context of the ‘short-term prognosis’ criterion, since the elderly often suffer from pre-existing chronic conditions, defined as two or more diseases. 

Official directives list illnesses that are deemed to be incompatible with hospitalisation if there is shortage of beds. They include advanced cirrhosis, cancer with a limited life expectancy, and severe heart or neurological problems.

“So far, this directive has never been applied in Switzerland,” said Philippe Eckert, director of the Vaud University Hospital (CHUV).

If it becomes necessary to implement it, “the decision would be taken at the national level”, by the group of experts specialising in medical and ethical questions, Eckert added.


 

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BERLIN

Berlin’s major Charité Hospital warns of ‘critical situation’ if cases continue to rise

Doctors at Berlin's largest hospital have said that it will face serious strain on its capacity if a further rise in Covid-19 cases leads to similar rates of hospitalisation to those that were seen at the beginning of January.

Berlin's major Charité Hospital warns of 'critical situation' if cases continue to rise
An ambulance at Berlin's Charite hospital. dpa-Zentralbild | Paul Zinken

“If the number of seriously ill Covid patients exceeds the number in the second wave, we will be in a critical situation,” said Martin Kreis, director of patient care at Germany’s largest university hospital.

Kreis said that the Charité hit its upper capacity limit at the beginning of the year due to the high number of severe Covid cases in intensive care units.

In January, the hospital had to stop accepting patients from clinics in other German states.

At the same time, the Berlin hospital never had to transfer any Corona patients outside of the capital.

“We will continue to do everything we can to care for patients from the surrounding region as well,” Kreis pledged.

The number of new admissions to Charité’s intensive care units has risen significantly in the past two weeks. Kreis said that the age group between 30 and 60, which has had little chance of being vaccinated, is now particularly affected.

“The trend is clear, and it is forcing us to react,” he said, adding that a reserve intensive care unit has been fully reopened. In addition, scheduled surgeries that can be postponed have been cancelled.

Since a large proportion of Charité staff have now been vaccinated, concerns at clinics that staff would be absent due to infections and quarantine have been reduced.

Meanwhile, Kreis affirmed that staff at the hospital are still motivated to take on the challenge of dealing with a rise in patients. But he said that some staff were showing signs of exhaustion after months of high patient numbers and fatalities.

At the Charité, about one-third of ventilated Covid patients have died so far.

Intensive care specialists in the capital have warned that an overload of intensive care units is imminent.

Steffen Weber-Carstens, medical director of the German Association for Intensive Care Units (Divi), said that an additional 100 ventilated Covid patients had been treated in intensive care units in the capital in the past three weeks.

Currently, there are about 280 patients in the capital receiving ventilation, with 90 at the Charité alone, which treats the most severe cases.

READ MORE: German Health Minister pleads for lockdown ‘to break Covid wave’

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