Hospitals prepare for sharp increase in Covid-19 patients

The two hospitals in Zug are prepared for the emergency, and the two hospital directors expect the number of hospitalisations to continue to increase.

The number of Covid-19 infections is currently rising very sharply, and this presents a challenge for the hospitals in particular. In the canton of Zug, the director of the Zug Cantonal Hospital Matthias Winistörfer and the director of the Hirslanden Andreas Clinic Jonas Zollinger say that they are prepared for this increase. And the way in which patients are treated has changed significantly in the meantime.

The Zug Cantonal Hospital has been earmarked for the treatment of Covid-19 patients in the canton of Zug. What is the situation in Baar?
Matthias Winistörfer: We are operating normally at the moment. Although there are more Covid-19 patients undergoing inpatient treatment than at the peak of the first wave, the ratio of occupied intensive-care beds to the occupied normal beds is significantly different than in spring, however. There are far fewer patients in the IPS intensive care unit. As of Thursday, there are three, out of a total of 24 Covid-19 patients. During the first wave, we had ten Covid-19 patients in the IPS at peak times.

How do you explain this?
Winistörfer: We are currently carrying out much more testing than in the spring, because the test is now carried out regardless of the severity of the symptoms, and even people who only have light symptoms now know early on that they have Covid-19. We can thereby treat infected people whose symptoms are stronger or which have not improved after seven days with the appropriate medications in good time. According to our experience, patients who are treated early enough have milder and shorter case histories over the past few weeks – and are therefore less likely to go into intensive care, or are only there for a shorter period of time.

Does this help with human resources?
Winistörfer: Definitely - if things stay that way. Because the intensive care unit requires a lot of specially trained personnel. On the other hand, the care of Covid-19 patients on the normal bed ward is much less expensive. Specialists from other bed wards could also help In the event of a large number of patients.

Jonas Zollinger, in an emergency situation, the Andreas Clinic would make staff available to Baar and would take over a large part of the procedures from Baar that cannot be postponed. What is the current situation in Cham?
Jonas Zollinger: Like the Cantonal Hospital, we are currently operating normally. Both hospitals have good workloads at the moment due to seasonal factors.

What does that mean?
Zollinger: There are planned procedures – for example, an artificial knee joint – that patients prefer not to have carried out during the summer months, and postpone the procedure until the autumn. Another role is played by the annual franchises of the health insurance companies and the fact that many people want to get an operation or something similar behind them before the end of the year. But this is a Swiss-wide phenomenon.

Photo 1: The Corona test centre in the driveway to the Zug Cantonal Hospital in Baar.
Photo 2: Matthias Winistörfer, Director of the Zug Cantonal Hospital in Baar (left) in discussion with Jonas Zollinger, Director of the Hirslanden Andreas Clinic in the Zug Cantonal Council.

Their two hospitals have been working together since the beginning of the first wave. What have you learned from this?
Winistörfer: What we learned from the experiences in the first wave was incorporated into our processes almost as soon as the first wave subsided. Many procedures for the treatment of Covid-19 patients are now clearly defined, and many uncertainties have disappeared – the virus is now well known to us. In addition, the recommendations for treatment are not changing as quickly as they did in the spring.
Zollinger: There was a routine cooperation between the two hospitals, but also with the health department, the ambulance service and other partners. It is uncomplicated and pragmatic in all directions.

What is the limit at which your two hospitals would have to resort to a crisis scenario?
Zollinger: That's hard to say. It also depends on the situation in the surrounding cantons. How busy are the hospitals, where can load balancing take place? The situation here is also markedly different from that in the spring. The Rega, for example, is now coordinating the distribution of patients throughout Switzerland in the event of bottlenecks in the intensive care units.

How quickly can your two hospitals change over to crisis operation?
Winistörfer: If it’s urgent, it will be possible within one day. It would be good to have two to three days for such a changeover, however.
Zollinger: It would then also be a matter of deciding and communicating to the patients which urgent interventions will be performed, and which non-critical procedures need to be postponed.

How many patients could be cared for in the two hospitals in Zug?
Winistörfer: If necessary, we can expand the current capacity of beds on the wards, for example, by converting single rooms into double-rooms. We would thereby have a total of about 270 beds for inpatients over both clinics. But these would not only be needed for Covid-19 patients, however, but also for emergency patients and births.

To how many places can the intensive care unit be extended as a maximum in the two hospitals?
Winistörfer: In extremis, we could operate more than ten ventilator stations. But this would also result in far-reaching restrictions on the rest of the hospital operation.
Zollinger: The Andreas Clinic does not operate an intensive care unit, although we have trained persons for this purpose who could then be used in the Zug Cantonal Hospital, so that the higher number of IPS beds can be operated there.

How have you prepared for a possible staff shortage, as was the case in French-speaking Switzerland?
Zollinger: If the situation requires it, we will support the Zug Cantonal Hospital in the care of Covid-19 patients. This was already the case in the spring. Several nursing staff with additional training in intensive care, as well as staff doctors from our anaesthesia unit, worked in the Zug Cantonal Hospital for several weeks. These people are already familiar with local conditions.

Could former employees also be asked to help?
Winistörfer: Our current plans do not provide for this. As of today, we assume that we will once again increase the number of employees with part-time work and, if necessary, switch from three-shift operation to two-shift operation. We cannot work in two shifts for any length of time, however, as shifts of twelve hours are very strenuous.

Consumable materials were scarce in the spring. What is the current situation?
Winistörfer: The situation here today is much more relaxed than in the spring. Our warehouses are well stocked, and we have supplies for plus/minus three months. More material could not be procured, unfortunately, as the suppliers had to make allocations because of the many orders.