Postponed surgeries, continued treatment at home, longer queues and tighter approval of ambulance calls have been a reality for several weeks. However, the moment when hospitals are forced to refuse patients is not far away, as reported by LTV programme De Facto.
Last year the National Plan for Medical Emergencies was expanded with recommendations for the order under which patients would be provided with beds in intensive care. Latvia was lucky in the last Covid-19 wave and recommendations were not used. This time the situation is different. This is both because the infection rates are on a rise and because the Delta variant of Covid-19 is more contagious and causes more severe consequences upon infection.
And like with other crisis management aspects there is a justified question – what is being done to make sure doctors are not forced to pick «who lives and who dies».
Given the choice which of three patients will get the bed in intensive care, preference will be given to patients suffering from organ failure, pneumonia and with high possibility of recovery. The next in line would be patients suffering from chronic illnesses that are simple enough to control, explains the programme.
Patients under high risk of death may be let in intensive care only if there are no other people with higher chances of survival.
A couple of weeks are left until doctors are forced to choose. Hospitals hope to avoid such a situation, but they still brace for the worst.
Riga Eastern Clinical University Hospital (RAKUS) board member Haralds Plaudis told LTV:
«We are aware there will be some people why will not fully understand the reasons behind this decision. We expect an emotional response, and doctors will have to endure it, but this is normal for the profession.»
Applies to all patients
Intensive care priority plan will come into play once the number of filled beds in hospitals in Latvia exceeds 90%. On 19 October the Ministry of Health announced that intensive care wards for Covid-19 patients are 86% full. Numbers keep changing, which is why it is difficult to predict the development of the situation. However, when the time comes, doctors will not make decisions alone.
«Undoubtedly there will be a council involved,» said Plaudis, adding that prioritization of patients for a place in intensive care will not apply to some specific group of patients or diagnosis – it will apply to all patients.
To postpone this possibility for as long as possible, RAKUS has increased resources of its intensive care ward and added 12 new intensive care beds.
P.Stradins Clinical University Hospital has also made preparations.
«We are making preparations. We hope the situation does not become tragic. Nevertheless, we are preparing,» said the hospital’s chief physician Eva Strīķe.
Forms are filled, but there are no reinforcements
The decision to reassign anaesthesiologists and resuscitators towards intensive care wards is one of the reasons why the hospital is no longer able to perform scheduled surgeries. The calls for help sent to medical workers employed in the private sector have not brought much help, unfortunately, De Facto reports.
Although the Health Inspectorate notes that this month 160 medical workers have submitted forms this month, the inspection has yet to receive word from hospitals if those people have started working there.
Hospitals report no reinforcements from the private sector.
«Additionally, our talks with Riga municipal healthcare institutions have gone on for too long. But I think this situation, which is a crisis, will bring us together,» said Strīķe.
Plaudis adds: «In regards to any private sector medical workers coming to work to RAKUS, I can say with certainty – no, no one has. If and when this might happen, I cannot say.»
Patient sorting is already a reality
Emergency Medical Service (NMPD), which is already forced to pick which calls to respond to and which patients to take to hospitals, admits that patient sorting is already a reality.
Read also: Minister: intensive care patients may have to be moved abroad in extreme cases
The service is aware of the level of load on hospitals and the limited capacity of intensive care wards. NMPD director Liene Cipule admits people who are in need of intensive care, which is the final sorting stage, are given priority.
«I am confident that if we look at data from hospitals that provide it, 100% of their beds have been filled. The patient sorting process has been a reality to some extent. We have to make the choice sooner or later,» said Cipule.
She notes: «There have been situations when hospitals ask for support from the state to procure artificial lung ventilation machines. Intensive care wards are overloaded by the hospital receives four patients in need of assistance.»
The head of NMPD notes that the situation should not have come close to a collapse.
«In regards to a collapse that lasts months, and if you have to make tough decisions in your everyday life as a medical workers, it is incredibly emotionally stressful. It is highly likely that many doctors will not be able to continue performing their duties. This is why prevention of a collapse is one of the main tasks for any government in the event of a catastrophe, pandemic included,» said Cipule.
We should have acted yesterday
Preparations for the possible sharp decline of the situation should have been made in summer, when there was a slow vaccination rate and political refusal of tighter restrictions. Doctors had no idea why nothing was done.
The Ministry of Health started organizing additional resources in October. The ministry did not, however, check if Madona Hospital is ready to admit Covid-19 patients. The order to admit those patients was given nonetheless.
Minister of Health Daniels Pavļuts had this to say: «It was difficult to imagine Latvia being in first place in the world and we experience another outbreak this autumn, which will exceed the severity observed last winter. […] And so our planning included activities we had previously expected. And then there are the dramatic crisis scenarios that exceed our worst expectations.»
This pushes us close to being forced to choose which patients get to live, which is also a difficult ethical matter in the medical sector.
Patient prioritization when resources are limited is acceptable, experts say. However, everything needs to be carefully regulated. This is why it is good that this topic is at least discussed.
Bioethics expert Signe Mežinska explains: «To some extent this is a sort of political responsibility issue. The criteria are politically approved. Doctors follow them. This takes some responsibility away from doctors, which, I believe, is important in this situation. This does not make it any easier, however.»
According to data from the National Health Service, there are 1 352 Covid-19 patients currently undergoing treatment in hospitals in Latvia.
Programme: shortage of beds in intensive care close to reality in Latvia
