ICU traffic down compared to March
As positive tests for Covid-19 have spiked in recent weeks, with an uptick in hospital admissions trailing shortly later, the Sunday Mail sought to get a sense of the stress on the healthcare system. Though by no means an exhaustive investigation, it appears that for the time being the state of play, while serious, is under control.
Amalia Hatziyianni is the medical and scientific director of Famagusta general hospital, that back in March was designated as the referral facility for Covid-19. All available beds there are for Covid-19 patients.
The hospital can treat 75 patients, six of them in the high-dependency unit (HDU).
According to the doctor, both the infrastructures in place and the human resources available at the hospital do not currently allow them to increase their inpatient capacity.
Patients in the HDU are classified as being in a serious condition, requiring continuous treatment and monitoring. Most, if not all, are placed on non-invasive mechanical ventilation. If a person’s condition doesn’t improve there, and they require intubating, they’re transferred to an intensive care unit (ICU) elsewhere, usually at the Nicosia general hospital.
Famagusta general registered its maximum capacity on November 9, with 67 patients.
On November 12 – the date on which Hatziyianni spoke with the Sunday Mail – there were 53 Covid patients at Famagusta, six of them in the HDU and the remaining 47 (68 per cent of available beds) in the treatment wards.
The duration of a patient’s stay obviously depends on their clinical condition. But roughly, the average duration of admission is seven days – although some can stay far longer, particularly if they are transferred to the HDU.
Covid-19 patients usually present pneumonia symptoms.
The relationship between admissions and discharges isn’t cut and dry, as it depends on patients’ clinical condition and the rate of transmission of the virus in the community at any given time.
But as an example, on November 9 Famagusta saw 11 new admissions and six discharges; on November 10, three admissions and 11 discharges; and on November 11, five admissions and six discharges.
In six cases, and for various reasons – other than a patient’s state of health – the need arose to transfer patients to another hospital.
On the tricky issue of dying of Covid-19 or dying with it, and how this determination is made, Hatziyiannis concedes it’s a gray area. In practice, she notes, it’s often difficult to determine whether the cause of death is exclusively attributed to Covid or to other causes.
“In the great majority of deaths relating to Covid-19, the deceased had underlying medical conditions or suffered lethal complications due to infection with the virus. In this case, these people may have lived longer had they not contracted Covid, which therefore is deemed to be the real cause of death.”
Asked whether she has experienced something similar in her professional career, Hatziyianni said she has not:
“We can recall the H1N1 flu pandemic, when we had devised similar plans. But, whereas that was a serious disease which on the one hand posed a risk to susceptible groups, on the other hand it [the flu] had lower transmissibility and was non-deadly to healthy persons.”
According to the latest tally (as of Friday November 13), the total number of deaths due directly to Covid-19 was 37. The average age of the deceased stood at 75.
The latest epidemiological bulletin for Covid – data relevant up to November 8 – shows that daily admissions in the current timeframe peaked at 12. This compares to 13 in late March.
But cumulatively, hospital traffic now has overtaken that in the spring.
“In total, 6.9 per cent (n = 401) of people with Covid-19 received hospital care, as of November 11,” the report states.
What of the ICU situation? The same bulletin shows that ICU traffic is likewise down compared to March-April, now reaching a maximum of seven (intubated and non-intubated persons). By comparison, the number of people in ICU back in springtime had reached 15.
But Hatziyianni explains that’s because in spring there was a higher tendency to transfer patients into ICU if their condition worsened. As doctors accrued more experience along the way, they now provide ill Covid patients with non-invasive oxygen, and only if their condition becomes grave are they transferred to ICU.
“Right now we’re giving patients more time, more leeway, if you will, to get better without invasive ventilation before we cross the bridge to ICU,” the doctor said.
The Sunday Mail also spoke to Pambos Charilaou, spokesman for the state health services organisation (Okypy).
He said capacity at the Famagusta referral hospital for Covid-19 currently could be expanded to 88 beds.
Nevertheless, it’s understood that the number 88 applies only to an extreme, hypothetical scenario and only should the situation spiral out of control.
Officially, capacity at Famagusta is 75. In theory the facility could clear space for extra Covid beds, but the congestion of Covid patients would pose a risk to medical staff.
There’s also a dedicated ward at Nicosia general hospital whose space holds 16 beds, reconfigured if need be for a maximum of 26 beds.
With cases on the rise, Okypy has formulated a contingency plan. It’s already been approved by the health ministry. It provides that, should the Famagusta facility’s beds fill, the entire fifth floor of Limassol general hospital would be cleared to accommodate coronavirus patients. That would yield an additional 70 beds.
And then if Limassol general can’t cope, Nicosia general would clear a ward with a capacity of an additional 28 beds.
Nominally, health authorities could generate about 200 beds total for Covid patients alone.
Charilaou said total bed capacity across the island’s state hospitals works out to approximately 1,400.
The health minister has issued a decree by which hospital capacity at any given time must not exceed 80 per cent. The 20 per cent buffer is to ensure that state hospitals don’t get overwhelmed and can keep treating non-Covid patients as well.
Should state hospitals reach the 80 per cent mark, non-Covid patients would be referred to private healthcare facilities, who are obligated to admit these patients under the decree.
Charilaou said state hospitals have always had high traffic.
“Resource-wise, the situation now [with Covid] is manageable, and in fact in this aspect we’re doing better than we did during the first phase, having since learned a great deal and gained experience.”
Asked to compare the current situation in state hospitals, to prior years, the official said any such comparison would be misleading.
He explained that before the national health scheme (Gesy), everyone entitled to public healthcare would end up in a state hospital.
So in a typical year, occupancy might go as high as 90 or even 95 per cent.
But now, people can be referred to a private hospital for inpatient care if the hospital is contracted with Gesy. This has eased the pressure on state hospitals.
Hatziyianni recently requested data from the health ministry regarding occupancy in general. About 10 days ago the overall occupancy rates at the various state hospitals were as follows: Nicosia 80 to 85 per cent; Limassol 70 per cent; Paphos 65 per cent; Larnaca 60 per cent.