743 Covid patients are currently in hospital care, 74 of them in intensive care. The programmer Robert Salzer is looking for the total number of hospitalizations with the support of the Statistical Office of the Canton of Zurich. Over the weekend, the Federal Office of Public Health reported 8,737 laboratory-confirmed new infections and 171 hospital admissions. The anxious question is currently: can the growth of the virus be contained in such a way that the hospitals do not reach their capacity limits?
In spring, at the height of the pandemic to date, Covid patients occupied a maximum of almost 2,400 beds at the same time. The health system withstood the pressure. At the press conference last Friday, Martin Ackermann, head of the federal scientific Covid task force, was unable to estimate when exactly the attack will now come. If the curve for new infections is pointing upwards, as before, the task force is reckoning with a doubling of hospital admissions every seven to ten days. The Federal Council and the cantons hope to break the trend with the restrictions – including the extended mask requirement and the ban on gathering in public spaces for 15 or more people.
The intensive care units have 1,000 beds across the country, and if necessary they can put an additional 500 into operation. About a week ago, the capacity was less than 50 percent full, with Covid patients making up a small proportion. According to information from the federal government, the cantons currently have a good 6,000 free hospital beds.
Occasionally, hospitals report bottlenecks. Last week or so, the Schwyz Hospital warned that it would soon no longer be able to cope with the onslaught of Covid patients. It is urgently looking for nursing staff. Meanwhile, the health department of the Canton of Zurich has announced that the hospitals are not currently being hit, but that the situation is being monitored carefully. Whether the hospital is able to cope with a possible onslaught of a second wave depends above all on whether enough specialists are available.
Hospital association absolutely want to prevent a treatment ban
The cantons and hospitals are currently making preparations to look after Covid patients across cantonal borders if necessary. That means: If one canton reaches its limit, another one, who still has resources, steps in. In the spring, the Federal Council imposed a treatment ban for all operations that are not urgently necessary. At the end of August, H +, the Association of Swiss Hospitals, announced that the damage from this treatment ban would amount to up to 2.6 billion francs for the whole year.
The hospitals are now doing everything possible to avoid a renewed treatment ban by coordinating with other hospitals and flexibly adapting their capacities, says H + Director Anne Bütikofer. The association demands a national information system with up-to-date data on bed capacities, staff and material in order to be able to better assess the situation in the hospitals and to improve coordination. “This is the only way to ensure that patients can be well cared for even with increasing numbers of cases and hospitalizations,” says Bütikofer.
Different starting position than with the first wave in spring
There is also positive news to report from the front of the intensive care units. Because the starting position is different than in spring, when Switzerland was overrun by the first corona wave. The staff is more experienced and calmer, says Peter Steiger, Deputy Director of Intensive Care Medicine at the University Hospital Zurich (USZ).
In addition, the Covid 19 patients would now come to the hospital earlier, which is important: The therapies must start as early as possible to prevent severe courses. If there is a lack of oxygen, all patients are now given Remdesivir, which was only available to some of the patients in the spring on a study basis. The drug is now approved in Switzerland and, according to Steiger, is also available in sufficient quantities.
The cortisol preparation dexamethasone is administered against the severe inflammation. “In addition, patients received blood plasma as part of a study, which contains antibodies from those who have recovered, which seems promising. The results still have to be awaited, ”says Steiger. The length of stay in the intensive care unit has been shortened. Other findings are that the patients were no longer intubated as early. Steiger says:
This also means that fewer places are occupied in the intensive care unit. On Monday, 16 beds in the ward and four in the intensive care unit of the University Hospital Zurich were occupied with corona patients. For comparison: At the height of the first wave, 20 patients were in the intensive care unit of the USZ and 32 in the ward.
The youngest patient in intensive care is 32 years old
So is the mortality of corona patients in the hospitals falling? According to Steiger, this trend is not evident across Switzerland. At the University Hospital Zurich, however, which took on many seriously ill patients from other hospitals in the first wave, mortality is currently only half as high.
“The increasing numbers still worry me,” says Steiger, “they could be very demanding on the system.” In addition, the staff could hardly have recovered from the stressful time in spring.
Corona patients are very difficult to treat. And Steiger points out that even if many remained without symptoms, SARS Cov-2 is a serious illness and that when there is a flu epidemic, so many people never come to the intensive care unit. The youngest patient in the last few weeks was 32 years old.