No abstract

ZusammenfassungDie Covid-19-Pandemie stellt seit Anfang 2020 insbesondere die Gesundheitssysteme weltweit vor ungeahnte Herausforderungen und führte u. a. dazu, dass ursprüngliche Intensivkapazitäten in einigen Ländern nicht zur Behandlung aller Patienten ausreichten. In diesem Beitrag werden die Entwicklungen der Covid-19-Hospitalisierungen und der Ausbau der Intensivkapazitäten in Europa im Verlauf der ersten Pandemiewelle vor dem Hintergrund der jeweiligen Ausgangsbedingungen veranschaulicht und darüber hinaus Unterschiede in der Patientensteuerung aufgezeigt. Dazu wurde auf zwei Datenbanken zurückgegriffen, die mit dem Ausbruch der Covid-19-Pandemie vom Fachgebiet Management im Gesundheitswesen der Technischen Universität Berlin und dem European Observatory on Health Systems and Policies im März 2020 ins Leben gerufen wurden. Der Beitrag zeigt auf, dass viele europäische Länder auf das Verschieben planbarer Eingriffe und die Aufstockung von Intensivbetten gesetzt haben, um dem rasanten Anstieg an Covid-19-Patienten zu begegnen. Weiterhin wird gezeigt, dass dies in den meisten Ländern ausreichend war und initiale Kapazitätsgrenzen in der Akutversorgung nicht überschritten wurden. In einigen stärker betroffenen Ländern wie Schweden und den Niederlanden hätten jedoch die verfügbaren Intensivbetten ohne Aufstockung nicht ausgereicht.

Background: The exponential increase of SARS-CoV-2 infections during the first wave of the pandemic created an extraordinary overload and demand on hospitals, especially on intensive care units (ICUs), across Europe. European countries have taken different measures to surge ICU capacity, but little is known on the extent. A country level analysis was conducted to compare hospitalisation rates of COVID-19 patients in acute and intensive care and the levels of surge capacity for intensive care beds across 16 European countries and Lombardy region during the first wave of the pandemic (28 February to 31 July).Methods: We used data on infection rates and numbers of current and/or cumulative COVID-19 patients in acute and intensive care in 16 countries and Lombardy region to analyse the burden on hospitals during the first wave of the COVID-19 pandemic. Data on COVID-19 hospitalisations was continuously extracted since 20 March, 2020 from publicly available sources. To evaluate whether hospital capacities were exceeded, we retrieved information on hospital and ICU surge capacity. Treatment days and mean length of hospital stay were calculated to assess hospital utilisation by COVID-19 patients during the first wave. Results: Pre-pandemic hospital and ICU capacity varied widely across countries. In no studied country did the utilisation of acute care bed capacity by COVID-19 patients exceed 38.3%. However, the Netherlands, Sweden, and Lombardy would not have been able to treat all COVID-19 patients during the first wave without ICU surge capacity. Indicators of hospital utilisation were not consistently related to the numbers of SARS-CoV-2 infections. The mean number of hospital days associated with one SARS-CoV-2 case ranged from 1.3 (Norway) to 11.8 (France). Conclusion: In many countries, the increase of ICU capacity was important to accommodate the high demand for intensive care during the first COVID-19 wave. Our study indicates that SARS-CoV-2 incidence is not the only aspect when it comes to the burden of hospital care for COVID-19 but rather the utilisation of hospital resources as shown by cumulative hospital days and mean length of stay during the first wave. Indicators presented in this study could inform forecasting models, especially in regard to necessary surge capacity.

Background The COVID-19 pandemic has developed into an unprecedented global challenge. Differences between countries in testing strategies, hospitalisation protocols as well as ensuring and managing ICU capacities can illustrate initial responses to a major health system shock, and steer future preparedness activities. Methods Publicly available daily data for 18 European countries was retrieved manually from official sources and documented in an Excel table (March-July 2020). The ratio of tests to cases, the share of hospitalisations out of all cases, and the share of ICU admissions out of all hospitalisations were computed using 7-day rolling averages per 100 000 population. Information on country policies was collected from the COVID-19 Health System Response Monitor of the European Observatory on Health Systems and Policies. Information on health care capacities, expenditure and utilization was extracted from the Eurostat health database. Results There was substantial variation across countries for all studied variables. In all countries, the ratio of tests to cases increased over time, albeit to varying degrees, while the shares of hospitalisations and ICU admissions stabilized, reflecting the evolution of testing strategies and the adaptation of COVID-19 health care delivery pathways, respectively. Health care patterns for COVID-19 at the outset of the pandemic did not necessarily follow the usual health service delivery pattern of each health system. Conclusions This study enables a general understanding of how the early evolution of the pandemic influenced and was influenced by country responses and clearly demonstrates the immense potential for cross-country learning.

Im oben genannten Artikel wurde in den Zusammenfassungen die Angabe zur Fahrtzeit auf Deutsch und Englisch korrigiert. Richtig muss es heißen: Die Modellierungen von Umverteilungen aller Patient*innen nur zu zertifizierten Zentren ergab eine durchschnittliche Fahrtzeit von 29 Minuten.Modeling of redistributions of all patients to certified centres resulted on an average travel time of 29 minutes. e43Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.