Ernst Kuipers: ‘It’s not possible to go back to pre-covid. Spread and more ic beds are here to stay ‘
Covid-19 will continue, this year, in 2022 and beyond. At least, that’s what 90 percent of scientists think by scientific journal earlier this year Nature have been asked about their expectations for the future. The chairman of the National Network Acute Care (LNAZ) Ernst Kuipers also thinks this. Lasting covid doesn’t mean lockdown after lockdown and constantly bulging hospitals. The vaccines will make the disease less severe for large groups, but like influenza, it will flare up every now and then. Covid is becoming endemic and that has consequences for healthcare, says Kuipers.
In 2018, the hospitals were full of flu patients. If we have another outbreak like this and covid is added as a new seasonal infectious disease, how are hospitals going to deal with that?
“Hospitals are very busy with the here and now because of the possible increase in patients in the coming month. At the same time, we are discussing the longer term. It is not possible to go back to pre-covid. We permanently need more capacity in ICs and clinical departments, especially seasonally. In winter we always have 200 to 300 influenza patients on ICs. Because a cohort covid is added to this, we cannot scale down. ”
How many beds are permanently needed?
“In the past, the capacity for ICs was approximately 900 beds. We expanded that to 1700. We needed those 1700 beds during the peak of the first wave. In the second wave, the peak was 1,450 beds, including non-covid care and the empty beds ready for use at any time. That 1700 will remain, although these beds are not operational 365 days a year. But when the time comes, we’ll have the equipment and staff ready. We will then temporarily remove them from other departments. ”
To ease the pressure on hospitals, covid patients are scattered across the country. Will it stay that way? Also for flu patients?
“Yes, it will also remain that way. But only if the pressure on healthcare becomes too great somewhere. Whether that is due to influenza, covid or another disease. The National Center for Patient Distribution was established for this purpose last year. That will continue to exist. ”
Patients spread meets with resistance. Wouldn’t it be better to take in patients in your own region?
“Yes, everyone wants that, but that is not always possible. Last year we had outbreaks in Limburg and Noord-Brabant, then came the Randstad, then Twente and Salland and now Noord-Holland. It is impossible to expand the capacity everywhere in such a way that hospitals can always receive their own patients on site.
It is very annoying for the patient and the family, I understand that. But if you want to guarantee regular care, it is sometimes necessary for a patient to be moved from Zeeland to Zutphen. ”
Then it must be clear where there is space. This is often lacking because healthcare institutions such as hospitals do not always provide the correct figures themselves.
“After the permanent extra capacity and the spread, that is the third point to deal with future covid care. Information exchange must be improved. In the past, care providers were not aware of how busy their own institution was. Especially when the demand for beds comes in waves, that is not enough. You must have a good overview of where it is busy in the Netherlands and where beds are available. You need a good ICT system for that. In the first wave we worked with a kind of trial version. That has now been further developed. Soon you will be able to see in real time where beds are available. That is really going to help.
“What will also help is that plans have been made in the regions about how care organizations can help each other. Suppose a nursing home is reaching its limits. What is the best solution then? Perhaps a patient can be taken to a hospital, or can stay at home with some other form of support, or be moved to another region. So we do not only look at hospitals, but at the entire sector, from district nursing to nursing home, mental health care, care for the disabled, GGD and general practitioner posts. ”