Treatments for cancer patients, major heart surgeries and organ transplants: The immense and persistent crowds have forced hospitals across the country to postpone treatments for increasingly ill people. Meanwhile, concerns are growing about how this backlog should ever be made up. Many tens of thousands of people are waiting for an operation. Some hospital administrators are already calling it the ‘fourth wave’.
The drivers want to warn: it will certainly take the rest of the year, maybe even years before everyone who is now on the waiting list will have their turn.
While the terraces are full and the Ajax championship is celebrated extensively, the world within hospitals is a completely different one. There are currently about 2,500 Covid patients in hospitals. More than 800 of them are in intensive care, they occupy two-thirds of all beds in use. In recent weeks there were fears aloud for ‘code black’, including by intensivist Diederik Gommers. In addition, eleven intensivists from Brabant hospitals warned at the end of April in a letter threatening to stop staff and “reach the limit of our IC capacity”.
A tour of ten hospitals shows that there is no question of code black, but the situation is dire. Directors say that they often had to cancel their leave before the May holidays, and that staff are in danger of succumbing. Hospitals in Emmen and Hoogeveen have even declared an emergency. Until mid-May, they can no longer accommodate their share of Covid patients and other hospitals will receive extra patients as a result. Too many employees are ill, they have physical but also mental complaints. Only three of the twelve operating theaters are still open and cancer patients also have to wait longer.
The crowds in the rest of the country are also leading to the postponement of treatments for seriously ill ‘regular’ patients. “We are scaling down and that just goes very far,” says Bart Berden, director of Elisabeth-TweeSteden Hospital in Tilburg. “Think of transplants, vascular operations, oncological operations. For example, we had to postpone the operation of someone with a colon tumor, who also really causes symptoms. ”
These are devilish dilemmas, says intensivist Peter van der Voort of the University Medical Center Groningen: “Esophageal cancer or pancreatic cancer?” Only a fraction of the surgeries they are used to doing go ahead. “The postponement happens for conditions that we have to operate within six weeks. We want to do that much faster, but now it is getting longer. That feels very uncomfortable for us, and for patients and family. ”
Also read: Full IC’s but no code black
Major heart and cancer operations are also being postponed in the Catharina Hospital in Eindhoven. There, too, it is no longer possible to help all the people from this group within six weeks. “When choosing who can go first, we look at who needs care most at the moment,” says director Nardo van der Meer, “but we also look at who can best get through the operation.”
Hospitals have made an inventory of the backlog in recent weeks and the picture is not attractive. At Isala in Zwolle alone, for example, there is a backlog of 6,000 operations. The Zuyderland in Limburg had five and a half thousand operations. “If we wouldn’t treat anyone else, we would need three months for that,” says driver David Jongen. “Of course that is not possible, it will be evening and weekend work. I assume that we will be working on clearing the backlog for another one and a half to two years. ”
Hospital manager Berden compares the postponement to taking out a huge mortgage, but it is not yet clear how it will be paid. “The big problem is that our maximum capacity is very close to the regular capacity. So we can hardly provide extra care. In addition, the number of Covid patients will probably decline only slowly. ”
Recovery time needed
“Catch-up care will be the fourth wave in this pandemic,” thinks Rob Dillman, director of Isala and the Dutch Association of Hospitals. He wants to temper expectations. “Staff cannot continue at the same pace. They have had an incredibly high workload for so many months. We advocate a recovery phase in which they can catch their breath. People should also be able to go on vacation for a while. ” Dillman thinks his hospital won’t be back to normal until the end of August.
Other drivers are also asking for recovery time in the summer. “There will come a time when the infections will decrease and some air will come back,” says Jongen. “Then there will be enormous social and political pressure to make up for delayed care. But I am afraid that staff will be out for a long time. ”
In his hospital, Zuyderland, the absenteeism rate is almost 10 percent. Staff often suffer from fatigue complaints. A plan to tackle the waiting list therefore failed. The idea was to start doing non-emergency operations on Saturday. Staff could volunteer and received a 75 percent bonus. “It worked one Saturday. The following week we did not get the people together. They are broken. You don’t seduce them with money. ”
In the UMC Groningen, absenteeism due to illness is 12 percent, twice as high as normal. The VieCuri Medical Center in Venlo decided to train managers in recognizing stress in employees. In addition, psychological help for employees is offered.
A catch-up plan
In a blog post, Armand Girbes, an intensivist at the Amsterdam UMC, complained this week that there were there is no broad plan for the period after vaccination. He argues for central control to be taken when care is taken up. But the theme is already being considered extensively. Hospitals have all submitted a plan to insurers this week about how – as far as they can currently estimate – they think they will get rid of the waiting lists.
Because the waiting list is not the same in every hospital, hospitals will soon want to help each other as much as possible with catch-up care. They think that the best way to do this is to cooperate regionally. “Corona patients became top-down distributed from a center in Rotterdam ”, says Dillman. “This time we want to tackle it more from the region.” In addition, there is the idea of working more intensively with independent treatment clinics.
The Isala hospital is investigating with neighboring hospitals the option of operating in other hospitals with its own staff. Dillman: “We don’t have much extra space. Normally we already use all operating theaters. Perhaps we will soon operate with a mix of staff from different hospitals in one team. ”
There are also optimistic stories here and there. Such as Hazra Moeniralam, internist-intensivist at the St. Antonius Hospital in Utrecht. The hospital has treated 1,770 Covid patients since its inception, 392 of whom are in intensive care. Moeniralam: “We had to work very hard. And still. The number of beds has been considerably expanded. Nevertheless, we have been completely full for weeks. Regional cooperation is good and we can continue to move forward so far. The staff has not recalled holidays. There are problems and a lot is being asked of the staff, but from that work in the first wave we have also learned a lot for the second and third wave.
Also read: The third wave is pressing everywhere
Such as the importance of training buddies and nurses, but also better diagnostics and treatment. “We have been able to shorten the length of stay of patients in the wards by five days by sending people home with oxygen,” says Moeniralam. “And recently, with extra oxygen through nasal cannula, patients are moving earlier from intensive care to the regular wards. That saves an average of six days, and as a result we have been able to receive more people in intensive care. Covid patients were initially in intensive care for an average of three weeks. Now they are less ill, thanks to better diagnostics and treatment, and they are only there for one week. ”
A version of this article also appeared in NRC on the morning of May 7, 2021