There are now 7,431 confirmed coronavirus cases in the Netherlands. That means the number of patients who have COVD-19 in the Intensive Care Unit (ICU) is increasing faster than the number of available beds and associated equipment.
The moment is, therefore, approaching for making tough choices is, therefore, fast approaching – who will get an ICU bed and who will not? The Dutch Association for Intensive Care (NVIC) has defined three phases of care provision in a pandemic scenario: regular care (phase 1), upscaling care (phase 2), and crisis care (phase 3).
The Netherlands is currently in phase 2. There are around 600 patients in ICUs. On 1 April, the number is expected have risen to 1,600, of which 1,100 will be corona patients. “Those beds are not in place yet,” says NVIC chairman, Diederik Gommers. Hospitals are working hard to expand their IC capacity.
According to Gommers, when there are no ICU beds available, were the Minister of Health to decide to go to phase 3. In phase 3, ICUs will not treat new patients with a low survival rate and short life expectancy. Here are the criteria medical personnel will have to follow to determine this.
- Cardiac arrest, where nobody was present, causing excessive damage
- Severe trauma, with over 90% mortality risk
- Severe burns, with over 90% mortality risk
- Serious and irreversible brain disorders
- Metastatic cancer, including leukaemia, with a short life expectancy
- Organ failure (e.g., heart or lung failure) with a short life expectancy
- Immuno-diseases with a short life expectancy (e.g. an HIV infection where treatment is no longer possible)
- People who require complete assistance for their daily care
- The terminally ill
Extension to phase 3
In the case of even greater shortages of ICU beds, extended criteria would apply. Patients who are still capable of certain level of self-care would not be admitted to the ICU. Instead, those patients would receive help among their outdoor activities and several indoor activities (e.g. housekeeping, climbing stairs, and personal care activities, such as showering and dressing).
According to Derde, these criteria would affect a large group of people. It will, therefore, be a last resort option. Both GGD Brabant Zuid-Oost and the Regional Consultation Acute Care (ROAZ) confirmed that Eindhoven’s hospitals still have enough intensive care beds to accommodate the flow of coronavirus patients.
According to ROAZ spokesman, Chiel Jonkers, the Brabant region has transferred more than 100 patients to hospitals in other parts of the country since last Friday. “We notice that the contagion wave is now reaching the rest of the country. So I understand that hospitals there are becoming more reluctant to take over patients from Brabant. They increasingly need their ICU beds for patients from their own area.”
Editor: Melinda Walraven