Footage of overwhelmed doctors treating patients in makeshift conditions in Italy's Lombardy region in March 2020 was the first sign of the deadly threat posed by coronavirus in Europe.
The sight of clinicians struggling to find beds in Spain’s capital, Madrid, also foreshadowed the public health emergency ahead.
Two years on, the situation has been transformed in both regions with vastly reduced hospital admission thanks to vaccine rollouts and the disease’s evolution into the milder Omicron variant. However, public health systems face different pressures. Health workers are contending with a big backlog of care postponed during earlier waves, a challenge compounded by staff absences caused by the highly infectious variant.
As doctors and nurses are forced to self-isolate, absence levels of up to 20 per cent are being reported in hospitals across Europe, said Maurizio Cecconi, an intensive care doctor in Lombardy who is president of the European Society of Intensive Care Medicine.
“That’s a huge number which basically is creating pressure on this system, even if the number of patients is more manageable,” he said.
Dr Cecconi said hospitals faced a "massive" backlog of treatment that has built up over the past two years. During the peak of the Omicron wave, routine surgery in Italy had fallen by up to 80 per cent in some hospitals, he said.
“This is one of the reasons the narrative about Covid deaths or Covid hospitalisation is missing a large part of the healthcare crisis,” he added. The situation, he said, underlined the crucial role of vaccination in keeping people out of hospital. “Every bed occupied by a patient due to Covid pneumonia takes away resources for other elective procedures.”
Staff shortages
In Madrid, Francisco, a general practitioner who did not wish to give his full name, said in early January four out of the five doctors in his practice were in quarantine. Meanwhile in Lombardy, Stefano Fagiuoli, medical director at Papa Giovanni XXIII hospital in Bergamo, said staff were forgoing days off and holidays to cover for Covid-positive colleagues required to isolate at home.
Antonio Zapatero, Madrid's deputy health chief, acknowledged constraints on hiring more staff to fill gaps. "It's impossible to find a doctor or a nurse [available for hire] today in Madrid or Spain, " he said.
However, he insisted that even during the worst of the Omicron wave only 1.7 per cent of the Madrid region’s health personnel – including clerical staff – were absent due to infections.
Infection rates in the region have more than halved in less than three weeks and are now far below Spain’s national average. Mr Zapatero credited Spain’s high level of vaccination – it is among Europe’s most immunised countries – and omicron’s relative mildness, for the fact that “some 80-90 per cent of cases are mild or asymptomatic; this did not happen with Delta”.
This meant hospitals were under less pressure than in previous waves but demand “falls more on primary care,” he said. Much of the strain resulted from the need to issue sick notes for self-isolating patients.
Hospitalisations
Clinicians across Europe are relieved that hospitals are no longer at the centre of the storm as they were in previous waves. Only in Finland, Norway and Denmark have the number of patients hospitalised exceeded the previous peak, despite the larger number of infections caused by Omicron. In only one country, Slovenia, has the number of patients in intensive care units risen above that seen in previous waves.
In Lombardy, admissions to intensive care departments stand at less than a fifth of the levels in March 2020.
Dr Cecconi said the current wave – a mixture of Omicron and the tail-end of its more severe predecessor Delta – appeared to have peaked in his region, with just 217 patients in the intensive care unit as of Friday, down from a high of 276 on January 20th. That peak figure was “probably about 18 per cent of [the high point] we saw in the very first wave in March 2020 which was very heavy for us here”. Broadly similar ratios applied across Europe, he said.
The situation is testimony to the power of vaccines: in some places, around 80 per cent of those in ICUs were not immunised, said Raffaele Bruno, director of the department of infectious diseases at the San Matteo hospital in Pavia, who treated Italy's first Covid-19 patient almost two years ago.
“Compared to previous waves, the situation is much better, with fewer hospitalisations,” he said. Dr Bruno added that he was grateful for “remarkable therapeutic tools” that have made the disease easier to tackle.
In the Madrid region, bed and intensive care occupancy rates rose from the low points of last autumn but throughout the most recent wave remained below the peaks of the first three.
“The relationship between the number of patients we have and cases in the ICUs has decoupled,” said José Ramón Arribas, head of infectious diseases at Madrid’s La Paz hospital. “You have clearly seen less pressure on the ICUs.”
The contrast with previous waves – which featured a much greater proportion of pulmonary infections – is dramatic. "In the first wave my hospital was the worst affected in Madrid," said Alicia Gil, a nurse at the Infanta Leonor hospital in the city.
“We normally have 370 beds but at the start of the pandemic we had almost 700 Covid patients. You can imagine the waiting rooms.” Now, however, the number of Covid patients in the hospital is around 130.
Doctors hope Omicron will signal the end of the pandemic’s current phase, with less need for restrictions among a more immunised population.
But in Lombardy, frontline staff cannot afford to let up as Omicron continues to take its toll on staffing rosters, as much as on patients. “We feel like hamsters in the wheel,” said Dr Fagiuoli. “We keep running, because the wheel cannot be stopped.” – Copyright The Financial Times Limited 2022
