Quickly occupied beds and staff working on the edge of the forces, often in quarantine. This is the situation at the Liberec Regional Hospital.
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The events forced director Richard Lukáš to film video display for the public, in which he calls for people to abide by all regulations and, in particular, to wear veils responsibly. The need to set aside intensive care for patients with covid-19 has affected the surgical plans so much that it also affects cancer patients.
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“Patients can no longer be treated in intensive care rooms,” the director said in an interview with the News List.
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In the video, you pointed out the huge workload of your hospital and the need to reorganize intensive care. Can you estimate how long the hospital will be able to receive more cases when it is still stable?
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We are now expanding intensive care with dormitories. It will take place in operating theaters, which are within easy reach of the intensive care unit, where patients normally lay after operations. We are now occupying this space and we have already partly occupied it with beds that are equipped with monitoring tools, ventilation devices and so on.
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So we can still take new cases. But I wanted to talk to that camera so that people would realize that our capacities are not infinite. But I can’t say when we will treat patients “I don’t know how and God knows where”. People are behaving irresponsibly, and when it comes to the reproduction number, if it doesn’t reach at least 1.1, it’s unpredictable and the development can be really crazy.
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I’m amazed by people who say veils are not needed. Veils are the minimum a person can do – protect themselves and others. The spread of the virus needs to be stopped. Influenza epidemics occur for a limited period of time, such as two, three, or four weeks in early spring. But these people are not able to comprehend this at all. It is about the life of the whole society.
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Probably the most worrying are your words about the need to postpone even oncological procedures. What are the cases? Can’t this cause more problems in the future?
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We postpone surgical treatment because it is not possible to treat these patients in intensive care rooms. We do not have enough intensive care to be able to operate them well and safely now. Now we took the time out until November 7, when we will try to arrange things in our surrounding hospitals so that we can catch up.
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We do not want to wean the patients somehow. In particular, non-surgical care – that is, radiation and chemotherapy – continues normally. Surgery is, of course, an essential part of that treatment – we have multidisciplinary teams that determine which method of treatment is appropriate for a given disease in a given person. But now Holt has to do without a multidisciplinary team without the possibility of operations. I am convinced that it is the same in many other hospitals.
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Are they benign cancers? On what basis can I decide what is postponed?
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It’s about everyone, we don’t even mean bad now, we mean bad growth. We took two weeks to organize and catch up with the care. In the spring we were in the same situation and no one was so worried, because the sick were almost not. Now, strangely, people act as if they are not sick, but there are a really large number of them. At that time, there are 150 patients in our country who usually need at least oxygen or even intensive care. At the same time, we cannot dismiss some people because they would not take care of themselves at home, they are old people and so on. I haven’t experienced this… and I hope I don’t die in it.
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Is it not possible to delegate deferred patients to another hospital that has the capacity?
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We are a regional hospital with a thousand beds, and we are definitely the largest medical inpatient facility in the Liberec Region. We practice medicine comparable to university hospitals – we don’t have cardiac surgery, we don’t have transplant medicine, these relatively exclusive things are not here. But cardiology, oncology, traumatology, neurocentre yes, we simply provide the highest level of care and we have nowhere to send it!
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Maybe there are some theoretical reserves in the Central Military Hospital in Prague, I have no other message about it than by hearsay, but the other hospitals are exactly the same. Or most of them. We are trying to find all possible backup mechanisms, we also operate the Turnov Hospital, which we are currently trying to operate as a non-civic one, so we will certainly intensify the operation there, but again it is limited by the number of intensive care beds.
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Warning numbers
As of Tuesday, the Czechia has 6,191 patients hospitalized for covid-19, of which 893 are in serious condition requiring intensive care. In the last two weeks alone, the number of hospitalizations has increased by about 3,500. At the same time, a large impact of the disease on vulnerable groups of the population threatens to put increasing pressure on the health care system.
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It probably has to be difficult for doctors to decide who can and can’t be put off. What is the decision?
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There are certain guidelines for this. We have rules for which tumors can be postponed for a certain period of time, none will be postponed definitively, all will be provided with non-surgical tumor treatment. The ones we have to operate on and now have nowhere to treat, we are trying to build capacity in our two neighboring hospitals. We are already transferring cancer surgery or operations to Frýdlant, where people do not subsequently need to stay in the intensive care unit. In Turnov we have better security, there we are definitely able to operate on patients who will need intensive care after the operation. We are already operating there, but it is still a hospital with its own limited number of beds, the number of doctors and so on. And I’m not even talking about the fact that a number of health professionals have already become infected, a lot of people work in work quarantine.
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In those oncological surgeries, I am talking about so-called slowly developing diseases, but some tumors are growing so fast that we cannot afford to postpone them even in this situation. Then there are a number of non-tumor items, someone ordered for three quarters of a year or three months ago for a hernia – and that it suits him in November, so it will have to suit him in a different November than this one.
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Note: We have updated the article with the latest data for Tuesday, October 27.
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