Pandemic: were the intensive care units really overloaded?

Covid cases have accounted for "at most a quarter of all intensive care patients" in German hospitals during the pandemic. This is the result of a Group of doctors and other medical experts around the Cologne scientist Matthias Schrappe in an ad hoc paper on the corona policy.

There is a fierce argument about it on social networks. Nurses and doctors experience their everyday work differently, more dramatically ("on the edge"). The discussion under the hashtag #DiviGate Was "a slap in the face" for those who worked in intensive care units, tweets one user.

The associations criticized in the paper by Schrappe and his colleagues – first and foremost the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi) – were outraged and rejected the accusations of scaremongering and manipulation "in the strongest possible terms". "Many of Schrappe's accusations are based on misjudgments and a lack of knowledge of the actual situation in hospitals," according to a joint statement released Monday by Divi, the Marburger Bund and the German Hospital Association.

Corona forecasts as political expectation management

But: have the federal government and advocacy groups dramatized the situation, stuck to the truth? "The forecasts were not supposed to come true, after all," says Frank Ulrich Montgomery. "The warnings have led to politicians and the public behaving cautiously," the World Doctors chief told our editorial team.

The Robert Koch Institute (RKI) is familiar with this kind of expectation management. Its president Lothar Wieler The warnings are "also an appeal to the population", he said. That was "also the goal of forecasts."

The Intensive care registry of the German Interdisciplinary Association for Intensive Care Medicine (DIVI), however, does not register moods, but facts; on a daily basis, how many beds are occupied in intensive care units. On 18. May it was 20.448.

Physician President Montgomery: "You can't count beds alone"

Over the course of the past twelve months, the figure has fluctuated between 19.000 and 21.000. The "Welt" quotes the epidemiologist Klaus Stohr with the sentence "one always had enough beds." For virologist Alexander Kekule, Germany "at no time had a problem in intensive care units."

"One must not count beds alone, but must also look at the staff behind them," Montgomery cautions. He points out. "that covid patients were concentrated in clinics particularly suited for this purpose". In these intensive care units, the proportion of Covid patients higher than average figures reflect. "The warnings were totally justified. We had an overload. It was not alarmism in my eyes," says Montgomery.

Covid patients must stay longer in intensive care units

The claim that covid patients are getting younger is more difficult to substantiate. In the Ad Hoc study states that the statement by those responsible for the intensive care registry "that 30- to 40-year-olds are now already in intensive care units can therefore be specified in that they account for 2.8 percent of all Covid 19 patients in intensive care units". In absolute terms: about 130 patients. 7.8 percent of ICU patients are 40-49 years old, 22 percent are 50-59 years old, and the majority of patients are older than 60 years, he said.

It is undisputed that the covid patients are in the intensive care units for a disproportionately longer time – on average until 18 days – than is typically the case for other ill patients (three to four days). Before the start of the third wave, intensive care units had to fear that the proportion of younger patients (the older ones were partially vaccinated) would increase and that, as a result, they would stay there longer.

A frequent argument was that clinics Scheduled interventions had to be postponed to avoid competition for intensive care space between "conventional" patients and Corona-infected patients.

The authors of the ad hoc paper, on the other hand, "maintain that the number of elective procedures (surgeries that cannot be postponed, note. of the editors) is disproportionately high in Germany in international comparison." In no country would "so many infected persons receive intensive medical treatment compared to the reporting rate, and in no country are so many hospitalized infected persons treated in intensive care units."

ICUs: Careless transfer of covid patients

The accusation: in Germany, Covid 19 patients are transferred to intensive care units too lightly compared to other European countries. Divi's statement on the matter said the reference was "entirely unsubstantiated". It is "precisely the strength of German hospital structures to adequately care for critically ill patients in intensive care capacities".

The "taz" journalist Malte Kreutzfeldt has also checked the calculation of the paper. There the percentage Covid patients In treatment in an intensive care unit reported at 44 percent of all hospitalized covid cases.

According to Kreutzfeld, however, this is based on incorrect figures: those used in the paper describe the Number of new admissions per week In hospitals – not the total number of patients lying there. This is not recorded exactly, but can be calculated from the average length of stay, according to the RKI 10 days.

If one converts the hospital cases given in the paper with this value, one comes to substantially more hospitalized covid cases – which lowers the rate of intensive care patients among these cases to 31 percent. This is much closer to the rate reported by other European countries, albeit slightly above it.

The Federal Ministry of Health is even based on an average length of stay of 11.2 days, which lowers the rate even further.

Thus, the Divi writes in the statement, Schrappe's accusation is "a real slap in the face of the doctors and nurses in the hospitals".

Pandemic: Even heart attack patients avoid clinics

Cardiologist Ulf Landmesser made a completely different observation in the Berliner Morgenpost at the end of April: "We are seeing 30 percent fewer heart attacks. He saw a "big problem" not on the part of the clinics, but on the part of patients, "because many people are afraid to go to the hospital."

The authors of the ad hoc study write that "after a phase of excessive demands due to a lack of organization and equipment during the first "wave", there was a heavy strain on the medical staff in the second phase and – partly due to the vaccination of the staff – a relative stabilization in the third "wave"". At the beginning of the third wave According to the report, expectations were gloomier than the situation.

Corona in intensive care units: Was there always enough capacity available?

According to the ad hoc paper, in the year 2020 "to treat Covid-19 patients, an average of two percent of inpatient capacity and four percent of intensive care capacity-with significant differences in time and space-is used".

In the summer of 2020, the number of Covid 19 patients in intensive care units leveled off at between 200 and 250, rising to more than 5,700 at the turn of the year. Currently it lies at over 4000. Nationwide had free beds and an emergency reserve available at all times.