Omicron exposes inflexibility of Europe’s public hospitals

Medical staff members care for a COVID-19 patient in the intensive care unit at the Strasbourg University Hospital, eastern France, Thursday Jan. 13, 2022. (AP)
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Updated 16 January 2022

Omicron exposes inflexibility of Europe’s public hospitals

  • That includes doctors, nurses and technicians at public hospitals

STRASBOURG, France: A World Health Organization official warned last week of a “closing window of opportunity” for European countries to prevent their health care systems from being overwhelmed as the omicron variant produces near-vertical growth in coronavirus infections.
In France, Britain and Spain, nations with comparatively strong national health programs, that window may already be closed.
The director of an intensive care unit at a hospital in Strasbourg is turning patients away. A surgeon at a London hospital describes a critical delay in a man’s cancer diagnosis. Spain is seeing its determination to prevent a system collapse tested as omicron keeps medical personnel off work.
“There are a lot of patients we can’t admit, and it’s the non-COVID patients who are the collateral victims of all this,” said Dr. Julie Helms, who runs the ICU at Strasbourg University Hospital in far eastern France.
Two years into the pandemic, with the exceptionally contagious omicron impacting public services of various kinds, the variant’s effect on medical facilities has many reevaluating the resilience of public health systems that are considered essential to providing equal care.
The problem, experts say, is that few health systems built up enough flexibility to handle a crisis like the coronavirus before it emerged, while repeated infection spikes have kept the rest too preoccupied to implement changes during the long emergency.
Hospital admissions per capita right now are as high in France, Italy and Spain as they were last spring, when the three countries had lockdowns or other restrictive measures in place. England’s hospitalization rate of people with COVID-19 for the week ending Jan. 9 was slightly higher than it was in early February 2021, before most residents were vaccinated.
This time, there are no lockdowns. The Institute for Health Metrics and Evaluation, a population health research organization based at the University of Washington, predicts that more than half of the people in WHO Europe’s 53-country region will be infected with omicron within two months.
That includes doctors, nurses and technicians at public hospitals.
About 15 percent of the Strasbourg hospital system’s staff of 13,000 was out this week. In some hospitals, the employee absentee rate is 20 percent. Schedules are made and reset to plug gaps; patients whose needs aren’t critical must wait.
The French public hospital’s 26 ICU beds are almost all occupied by unvaccinated patients, people ”who refuse care, who refuse the medicine or who demand medicines that have no effectiveness,” Helms said.
She denied 12 requests for admission Tuesday, and 10 on Wednesday night.
“When you have three patients for a single bed, we try to take the one who has the best odds of benefiting from it,” Helms said.
In Britain, like France, omicron is causing cracks in the health system even though the variant appears to cause milder illness than its predecessors. The British government this month assigned military personnel, including medics, to fill in at London hospitals, adding to the ranks of service members already helping administer vaccines and operate ambulances.
At the Royal Free Hospital in London, Dr. Leye Ajayi described a patient who faced delays in his initial cancer diagnosis.
“Unfortunately, when we eventually got round to seeing the patient, his cancer had already spread,” Ajayi told Sky News. “So we’re now dealing with a young patient in his mid-50s who, perhaps if we’d seen him a year ago, could have offered curative surgery. We’re now dealing with palliative care.”
Nearly 13,000 patients in England were forced to wait on stretchers more than 12 hours before a hospital bed opened, according to figures released last week from the National Health Service.
Britain has a backlog of around 5.9 million people awaiting cancer screenings, scheduled surgeries and other planned care. Some experts estimate that figure could double in the next three years.
“We need to focus on why performance has continued to fall and struggle for years and build the solutions to drive improvement in both the short and long term,” said Dr. Tim Cooksley, president of the Society for Acute Medicine.
Having the capacity to accommodate a surge is crucial, and it’s just this surge capacity that many in Europe were surprised to learn their countries lacked. The people in a position to turn that around were the same ones dealing with the crisis daily.
In the midst of the first wave, in April 2020, WHO’s Europe office put out a how-to guide for health systems to build slack into their systems for new outbreaks, including identifying a temporary health workforce.
“Despite the fact that countries thought they were prepared for a pandemic that might come along, they were not. So it’s building the ship as it sails,” said Dr. David Heymann, who previously led the World Health Organization’s infectious diseases department.
But France had been cutting back hospital beds — and doctors and nurses — for years before the pandemic. Building it back up in a matter of months proved too much when the current wave infected hospital staff by the hundreds each day. Even allowing symptomatic COVID-19-positive health workers to report for work hasn’t been enough.
Britain’s NHS Confederation, a membership organization for sponsors and providers, says the public health service went into the pandemic with a shortage of 100,000 health workers that has only worsened.
The first wave of the pandemic pushed Spain’s health system to its limit. Hospitals improvised ways to treat more patients by setting up ICUs in operating rooms, gymnasiums and libraries. The public witnessed, appalled, retirees dying in nursing homes without ever being taken to state hospitals that were already well over capacity.
After that, the Spanish government vowed not to let such a collapse happen again. Working with regional health departments, it designed what officials call “elasticity plans” to deal with sudden variations in service demands, especially in ICUs.
The idea is that hospitals have the equipment and, in theory, the personnel, to increase capacity depending on the need. But critics of government health policy say they’ve warned for years of inadequate hospital staffing, a key driver of the difficulty delivering care in the current wave.
“The key thing is flexibility, having flexible buildings that can expand, having staff that are flexible in terms of accepting task shifting, having flexibility in terms of sharing loads more of a regional structure,” said Dr. Martin McKee, a public health professor at the London School of Hygiene and Tropical Medicine.
Ultimately, though, McLee said: “A bed is an item of furniture. What counts is the staff around it,” McKee said.
Helms, the Strasbourg intensive care doctor, knows that all too well. Her unit has space for 30 beds. But it has only enough staff to care for the patients in the 26 beds currently occupied, a situation unlikely to change quickly after omicron burns through the region.
In the same hospital’s infectious diseases unit, frantic schedulers are borrowing staff from elsewhere in the facility, even if it means non-COVID-19 patients get less care.
“We’re still in the middle of a complex epidemic that is changing every day. It’s hard to imagine what we need to build for the future for other epidemics, but we’re going to have to reflect on the system of how we organize care,” said Dr. Nicolas Lefebvre, who runs the infectious diseases unit at the Strasbourg hospital.
He said Europe is prepared to handle isolated outbreaks as it has in the past, but the pandemic has exposed weakened foundations across entire health systems, even those considered among the world’s best.
Frédéric Valletoux, the head of the French Hospital Federation, said policymakers at the national level are acutely aware of the problem now. For 2022, the federation has requested more resources from nursing staff on up.
“The difficulty in our system is to shake things up, especially when we’re in the heart of the crisis,” Valletoux said.


UK police end Downing Street party inquiry, 126 fines issued

Updated 19 May 2022

UK police end Downing Street party inquiry, 126 fines issued

LONDON: British police said on Thursday they had ended their investigation into COVID-19 lockdown parties held at Prime Minister Boris Johnson’s Downing Street office, saying they had issued a total of 126 fines.
“Our investigation was thorough and impartial and was completed as quickly as we could, given the amount of information that needed to be reviewed and the importance of ensuring that we had strong evidence for each FPN (fixed penalty notice) referral,” London Police Acting Deputy Commissioner Helen Ball said.
“This investigation is now complete.”


One person wounded in German school shooting — police

Updated 19 May 2022

One person wounded in German school shooting — police

BERLIN: Shots were fired at a German school in the northern city of Bremerhaven on Thursday and one person was wounded, police said.
One person was detained after the shooting and the injured person was taken to hospital, they said.
German paper Bild had reported that a second suspect was on the run, armed with a crossbow. Police said they were looking into whether more than one person was involved.
The shooting took place at the Lloyd Gymnasium, Bild reported.
Online newspaper Nord24 said a schoolgirl who heard shots had called the police. Students barricaded themselves in their classrooms, it added.

North Korea completes preparation for nuclear weapon test: Seoul lawmaker

Updated 19 May 2022

North Korea completes preparation for nuclear weapon test: Seoul lawmaker

  • Biden will arrive in Seoul late Friday for a series of summits
  • North Korea announced its first COVID-19 cases last week, and is now reporting hundreds of thousands of cases of “fever” daily

SEOUL: North Korea has completed preparations for a nuclear test and is seeking the best moment to carry it out, a South Korean lawmaker said Thursday, a day before US President Joe Biden is due to arrive in Seoul.
Despite North Korea’s recent Covid-19 outbreak, “preparations for a nuclear test have been completed and they are only looking for the right time,” lawmaker Ha Tae-keung told reporters after being briefed by Seoul’s National Intelligence Service.
The United States said earlier it believes there is a “genuine possibility” that North Korea could conduct a nuclear test while Biden is on his first trip as president to Asia.
Biden will arrive in Seoul late Friday for a series of summits.
“Our intelligence does reflect the genuine possibility” of nuclear-capable missile tests or a nuclear weapon test around the time of Biden’s trip, National Security Adviser Jake Sullivan said.
Satellite imagery indicates North Korea is preparing to conduct a nuclear test, and the United States and South Korea have been warning for weeks that it could come any day.
North Korea announced its first COVID-19 cases last week, and is now reporting hundreds of thousands of cases of “fever” daily, with analysts saying a test could help distract the regime from the outbreak.


Battle for Mariupol draws toward close after surrender

Updated 19 May 2022

Battle for Mariupol draws toward close after surrender

  • The plant was the only thing standing in the way of Russia declaring the full capture of Mariupol

KYIV: The battle that turned Mariupol into a worldwide symbol of defiance and suffering drew toward a close as Russia said nearly 1,000 last-ditch Ukrainian fighters who held out inside a pulverized steel plant had surrendered.
Meanwhile, the first captured Russian soldier to be put on trial by Ukraine on war-crimes charges pleaded guilty Wednesday to killing a civilian and could get life in prison. Finland and Sweden applied to join NATO, abandoning generations of neutrality for fear that Russian President Vladimir Putin will not stop with Ukraine.
The Ukrainian fighters who emerged from the ruined Azovstal steelworks after being ordered by their military to abandon the last stronghold of resistance in the now-flattened port city face an uncertain fate. Some were taken by the Russians to a former penal colony in territory controlled by Moscow-backed separatists.
While Ukraine said it hopes to get the soldiers back in a prisoner swap, Russia threatened to put some of them on trial for war crimes.
Amnesty International said the Red Cross should be given immediate access to the fighters. Denis Krivosheev, Amnesty’s deputy director for the region, cited lawless executions allegedly carried out by Russian forces in Ukraine and said the Azovstal defenders “must not meet the same fate.”
It was unclear how many fighters remained inside the plant’s labyrinth of tunnels and bunkers, where 2,000 were believed to be holed up at one point. A separatist leader in the region said no top commanders had emerged from the steelworks.
The plant was the only thing standing in the way of Russia declaring the full capture of Mariupol. Its fall would make Mariupol the biggest Ukrainian city to be taken by Moscow’s forces, giving a boost to Putin in a war where many of his plans have gone awry.
Military analysts, though, said the city’s capture at this point would hold more symbolic importance than anything else, since Mariupol is already effectively under Moscow’s control and most of the Russian forces that were tied down by the drawn-out fighting have already left.
Russian Defense Ministry spokesman Maj. Gen. Igor Konashenkov said 959 Ukrainian troops have abandoned the stronghold since they started coming out Monday.
Video showed the fighters carrying out their wounded on stretchers and undergoing pat-down searches before being taken away on buses escorted by military vehicles bearing the pro-Kremlin “Z” sign.
The US has gathered intelligence that shows some Russian officials have become concerned that Kremlin forces in Mariupol are carrying out abuses, including beating and electrocuting city officials and robbing homes, according to a USofficial familiar with the findings.
The Russian officials are concerned that the abuses will further inspire residents to resist the occupation and that the treatment runs counter to Russia’s claims that its military has liberated Russian speakers, according to the official, who was not authorized to comment.
Resistance fighting was reported in the occupied southern city of Melitopol, where the regional military administration said Ukrainians killed several high-ranking Russian officers and a Russian armored train carrying troops and ammunition overturned, causing the munitions to detonate.
The administration said on Telegram that the Russian military does not maintain the tracks and overloads the trains, and “with help” from resistance fighters the train derailed. The reports could not be independently confirmed.
In a sign of normalcy returning to Kyiv, the US Embassy reopened on Wednesday, one month after Russian forces abandoned their bid to seize the capital and three months after the outpost was closed. A dozen embassy employees watched solemnly as the American flag was raised. Other Western countries have been reopening their embassies in Kyiv as well.
In the war-crimes case in Kyiv, Russian Sgt. Vadim Shishimarin, a 21-year-old member of a tank unit, pleaded guilty to shooting an unarmed 62-year-old Ukrainian man in the head through a car window in the opening days of the war. Ukraine’s top prosecutor has said some 40 more war-crimes cases are being readied.
On the diplomatic front, Finland and Sweden could become members of NATO in a matter of months, though objections from Turkish President Recep Tayyip Erdogan threaten to disrupt things. Turkey accuses the two countries of harboring Kurdish militants and others it considers a threat to its security.
Ibrahim Kalin, a foreign policy adviser and spokesman for Erdogan, said there will be “no progress” on the membership applications unless Turkey’s concerns are met. Each of NATO’s 30 countries has an effective veto over new members.
Mariupol’s defenders grimly clung to the steel mill for months and against the odds, preventing Russia from completing its occupation of the city and its port.
Its full capture would give Russia an unbroken land bridge to the Crimean Peninsula, which it seized from Ukraine in 2014. It also would allow Russia to focus fully on the larger battle for the Donbas, Ukraine’s industrial east.
For Ukraine, the order to the fighters to surrender could leave President Volodymyr Zelensky’s government open to allegations it abandoned the troops he described as heroes.
“Zelensky may face unpleasant questions,” said Volodymyr Fesenko, who heads the independent Penta think tank in Kyiv. “There have been voices of discontent and accusations of betraying Ukrainian soldiers.”
A hoped-for prisoner swap could also fall through, he cautioned.
Russia’s main federal investigative body said it intends to interrogate the surrendering troops to “identify the nationalists” and determine whether they were involved in crimes against civilians.
Also, Russia’s top prosecutor asked the country’s Supreme Court to designate Ukraine’s Azov Regiment — among the troops that made up the Azovstal garrison — as a terrorist organization. The regiment has roots in the far right.
The Russian parliament was scheduled to consider a resolution to ban the exchange of any Azov Regiment fighters but didn’t take up the issue Wednesday.
Mariupol was a target of the Russians from the outset. The city — its prewar population of about 430,000 now reduced by about three-quarters — has largely been reduced to rubble by relentless bombardment, and Ukraine says over 20,000 civilians have been killed there.
In other developments, Russian Deputy Prime Minister Yuri Borisov said Russia has begun using a prototype new laser weapon in Ukraine that is capable of hitting a target 5 kilometers (3 miles) away, state news agency Tass quoted him as saying on national television. He said it was tested Tuesday against a drone and incinerated it within five seconds.
Borisov said a new generation of laser weapons will eventually allow Russia to conserve its expensive long-range missiles.
Speaking late Wednesday in his nightly video address, Zelensky likened the Russian boast to Nazi Germany’s claims of Wunderwaffe, or wonder weapons, as the tide began to turn against it during World War II.
A senior US defense official said Wednesday that the US has seen nothing to corroborate the claims. The official spoke on condition of anonymity to discuss the US military assessment.


North Korea’s suspected COVID-19 caseload nears 2 million

The official Korean Central News Agency said over 1.98 million people have become sick with fever since late April. (AFP)
Updated 19 May 2022

North Korea’s suspected COVID-19 caseload nears 2 million

  • The official Korean Central News Agency said more than 1.98 million people have become sick with fever since late April

SEOUL: North Korea on Thursday reported 262,270 more suspected COVID-19 cases as its pandemic caseload neared 2 million — a week after the country acknowledged the outbreak and scrambled to slow infections in its unvaccinated population.
The country is also trying to prevent its fragile economy from deteriorating further, but the outbreak could be worse than officially reported since the country lacks virus tests and other health care resources and may be underreporting deaths to soften the political impact on authoritarian leader Kim Jong Un.
North Korea’s anti-virus headquarters reported a single additional death, raising its toll to 63, which experts have said is abnormally small compared to the suspected number of coronavirus infections.
The official Korean Central News Agency said more than 1.98 million people have become sick with fever since late April. Most are believed to have COVID-19, though only a few omicron variant infections have been confirmed. At least 740,160 people are in quarantine, the news agency reported.
North Korea’s outbreak comes amid a provocative streak of weapons demonstrations, including its first test of an intercontinental ballistic missile in nearly five years in March. Experts don’t believe the COVID-19 outbreak will slow Kim’s brinkmanship aimed at pressuring the United States to accept the idea of the North as a nuclear power and negotiating economic and security concessions from a position of strength.
After maintaining a dubious claim that it had kept the virus out of the country for two and a half years, North Korea acknowledged its first COVID-19 infections May 12 and has described a rapid spread since. Kim has called the outbreak a “great upheaval,” berated officials for letting the virus spread and restricted the movement of people and supplies between cities and regions.
Workers were mobilized to find people with suspected COVID-19 symptoms who were then sent to quarantine — the main method of curbing the outbreak since North Korea is short of medical supplies and intensive care units that lowered COVID-19 hospitalizations and deaths in other nations.
State media images showed health workers in hazmat suits guarding Pyongyang’s closed-off streets, disinfecting buildings and streets and delivering food and other supplies to apartment blocks.

 The official Korean Central News Agency said more than 1.98 million people have become sick with fever since late April
The official Korean Central News Agency said more than 1.98 million people have become sick with fever since late April. (AFP)

Despite the vast numbers of sick people and the efforts to curb the outbreak, state media describe large groups of workers continuing to gather at farms, mining facilities, power stations and construction sites. Experts say North Korea cannot afford a lockdown that would hinder production in an economy already broken by mismanagement, crippling US-led sanctions over Kim’s nuclear weapons ambitions and pandemic border closures.