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Intensive care unit capacity requires new strategies in the pandemic

Updated: Apr 28, 2021

The situation in intensive care units is coming to a head. Even if only one third of the occupancy is caused by covid patients, it is already becoming critical, as other ICU patients also need free beds. The Corona-Commission sees an occupancy rate of 33 percent with Covid-19 patients in intensive care beds as a very high systemic risk. This is because specially trained staff is needed to operate in critical care units.

A maximum of 700 to 800 intensive care beds are available in crisis mode for Covid 19 patients throughout Austria. By mid-April, almost 600 beds were already occupied by people who needed intensive medical care.

It must be taken into consideration that even if there are still free capacities in the intensive care units, these cannot be fully occupied by Covid-19 patients. Resources must be available at all times for emergencies such as heart attacks, strokes or traffic accidents. In addition, already planned surgeries which require critical care units have to be postponed. In many cases routine operations have to be cancelled in order to keep capacities free and prevent the health system from collapsing.

In Vienna, Lower Austria and Burgenland, the critical threshold of 33 percent corona patients in intensive care units has already been significantly exceeded. This unpleasant fact was the main reason for the lockdown extension in the eastern provinces. The free capacities in the total number of intensive care beds vary between 16 and 34 percent, depending on the federal state. However, not every bed is suitable for people with covid 19 disease; in addition to qualified nursing staff, special medical equipment is needed, such as the ECMO machines used for extracorporeal membrane oxygenation. This device takes over the lung function of covid patients with a very severe course.

Rapid tests do not detect all infections

As important as regular testing for the coronavirus is - every detected virus carrier means a slowdown in the spread of the virus - it cannot be relied on alone. Especially in the first days of an infection, it is not always detected by a rapid antigen tests, as virologist Christian Drosten points out. In contrast to PCR tests, the rapid tests cannot always reliably detect an infection in the initial phase, when one does not yet experience any symptoms of an illness. Practical experience in the diagnostic laboratories has shown this.

Nevertheless, this is precisely why regular testing makes sense, because even if one test was negative, the next one could already detect an infection, says Christian Drosten. It is important to isolate the affected persons immediately without waiting for the result of a subsequent PCR test. If the Corona measures are relaxed and visits to restaurants, theatres and cinemas are possible again, distance and mandatory masks should still be used.

Vaccine roulette goes into the next round

In the dispute over the distribution of vaccine doses within the EU, EU Commission President Ursula von der Leyen recently announced good news. The manufacturers Biontech/Pfizer want to bring forward a delivery of 50 million vaccine doses to the EU, which was originally scheduled for the fourth quarter. According to the distribution key, which is calculated on the basis of population size, this means one million doses for Austria, which can be expected in the second quarter.

There are also new developments at Astra Zeneca. The vaccine had hit the headlines due to cases of thrombosis, and Denmark was the first country in the EU to completely stop vaccinations with Astra Zeneca in mid-April. Other countries had temporarily suspended the vaccine or made recommendations to use it only for older people. The European Medicines Agency (EMA) is currently carrying out a risk analysis on the Astra Zeneca vaccine to weigh up the risks and benefits. So far, the benefits of the vaccine have been rated higher than the risk of side effects.

A new study from Oxford University concludes that the risk of sinus vein thrombosis in the brain after Covid-19 infection is about 100 times higher than normal. Thus, problems with blood clotting are significantly more likely than with vaccination, regardless of the vaccine used. This also applies to younger people under 30 years of age.

The vaccination strategy suffered a setback due to the postponed delivery of the vaccine from Johnson & Johnson. The US manufacturer had suspended deliveries to the EU indefinitely due to cases of sinus vein thrombosis that had also occurred.

Herd immunity through vaccination and natural infection

The question of whether immunity is preferable after a vaccination or after a natural infection cannot be conclusively assessed at present. There is evidence that the immune response to natural infection tends to be broader, but may not last as long. In a study looking at reinfection, 0.7 per cent of the people examined became reinfected during the study period. Long-term safety, on the other hand, might be more pronounced with vaccines. Moreover, as data from Great Britain and Israel show, vaccination is highly effective in protecting against severe courses.

While scientists have so far assumed that herd immunity is achieved at 60 to 70 percent vaccination coverage, new findings suggest that a higher vaccination rate will be necessary due to new, more infectious virus variants such as B.1.1.7. It will therefore probably be some time before full herd immunity is achieved. In Austria, the number of vaccinated people is increasing daily, but two vaccination doses are necessary for effective protection against Covid with the vaccines used so far. And this number of fully immunised people was only 8 percent in mid-April.

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