Within ten months, 9,000 intensive care units have disappeared from German hospitals and 7,000 planned units have not even appeared. Whenever the plight of the pandemic is at its greatest, capacities steer rigorously on course “five after twelve”. This can be considered a coincidence, the result of messed up politics or a decline according to plan. The fact is: before each stage of the decline, a law from the house of Jens Spahn gave the starting signal.
In addition to the so - called nine infections, the incidence and R-value as well as the corona deaths, it is a central indicator of the crisis: the utilization of intensive care units. The tighter it gets in the emergency departments of the German clinics, the higher the fever curve of the general excitement increases. In this country, apparently dwindling capacities have now even risen to the king number of the pandemic. What the numbers of cases and deaths no longer give in terms of drama, worried in these days and weeks talk of the “full-fledged clinics” and as a water level detector No. 1 the DIVI register operates in the country. The database, which has been compiled by the German Interdisciplinary Association for Intensive Care and Emergency Medicine together with the Robert Koch Institute (RKI), has been providing an inventory of the number of patients diagnosed with Covid - 19 in intensive care and the number of intensive care beds still available every 24 hours for over a year.
The association is no longer content with presenting dry status reports. The DIVI is now something like the loudest alarm system in the Corona panic orchestra and the most important keyword for the warners and admonishers of the variety Merkel, Spahn, Drosten, Wieler, Lauterbach and Söder. Hardly a day goes by when DIVI President Gernot Marx does not paint the devil on the wall, complain about “clinics at the limit” at “five after twelve” and evoke the need for even more drastic measures. And each time, the political crisis managers eagerly take up the templates to justify their own hard-line approach.
No reliable Monitoring
There are certainly people from the field who see the situation more relaxed. For example, these days Thomas Hermann Voshaar, Chief physician of the Lungenklinik Bethanien Moers, told the" Bild-Zeitung": “We are and were at no time at the edge of our capacities.“Not even a quarter of the 22,000 intensive care beds in Germany are occupied with Covid-19 patients. He therefore called DIVI’s alarmism “irresponsible"and " disproportionate”. “I’m not afraid of a collapse, but a difficult situation until the summer,” said Rolf Dembinski, head of the Clinic for Intensive Care and Emergency Medicine at the Klinikum Bremen Mitte. The situation was “tense, but still manageable”.
For Francesco De Meo, chairman of the Helios clinics, the largest hospital chain in Europe, full intensive care units are “nothing new” and also specific for Germany, as he told the “Frankfurter Allgemeine Zeitung” a week ago. As a” contribution to transparency and a number-based assessment of the current situation”, the Helios Group publishes the figures on bed occupancy at the 89 German locations. Yesterday’s statistics showed almost 15,300 patients in the normal ward, including 771 with Covid-19, and 1,142 intensive care patients, including 334 Covid - 19 cases.
According to De Meo, the figures are “still below what we managed in the second wave in winter”. In addition, he referred to the German peculiarity, according to which “patients were transferred comparatively quickly to the intensive care unit”. Compared to Spain, there are “three times as many” intensive care patients, but “the mortality rate is then roughly the same in both countries”. According to the Helios boss, the necessary monitoring is lacking for a reliable risk assessment. “How many patients are in the intensive care units, how old are they, how long and how are they treated, how many die?“It don’t need much, you could use the “already existing data, the so-called routine data”, which would also be reported to the insurance companies. However, the Federal Ministry of Health (BMG) had missed the opportunity to change the legal basis so that the registration data of intensive care physicians could also be “used more easily”. The seven-day incidence of new infections per 100,000 inhabitants would only be truly” meaningful " if further indicators were added and linked together, De Meo noted.
Fake Corona Cases
As has already been discussed, a big blind spot in public perception is that the circle of “real” corona sufferers is massively overestimated. An evaluation of the “routine data” referred to by De Meo by the Initiative Qualitätsmedizin (IQM) had shown that of the Covid-19 patients hospitalized over the year 2020, only 45 percent had actually undergone a PCR-proven SARS-Cov-2 infection. The other 55 percent were either not tested at all or tested negative and were only declared a Covid-19 case on suspicion by a clinical-epidemiological assessment. However, the mortality and treatment routine data obtained for IQM suggest that” these patients are a different population than the proven Covid-19 cases".
According to the latest key figures for the first quarter of 2021, the ratio has shifted in favor of laboratory-confirmed cases (53 percent versus 47 percent). Nevertheless, it remains the case: very many so-called corona patients are in fact no corona cases at all, but are nevertheless treated and treated as such-sometimes wrongly. The apparently massive misdiagnoses could also explain why the system has not reached its limits long ago. If every Covid-19 label was in fact a" real " corona case, the clinics would probably be confronted with an overload that goes beyond the already demanding daily business in autumn and winter. However, the occupancy rates in width are in the normal range of previous years. Recently, a study by the University of Technology Berlin, that the intensive beds in the first pandemic year in small houses were occupied by an average of less than 64 percent, in large locations 71 percent. Especially in intensive care, this can hardly be explained by the large – scale postponed operations and treatments-an emergency cannot simply be cancelled.
Volatile bed load
However, such backgrounds are consistently hidden by the media master stream. If they were to be taken into account, they would have to be thoroughly dismantled in terms of hysteria because of the apparently Covid-19-overflowing clinics. But hysteria is and remains a constant in the pandemic. More than that, it belongs to the business, the political anyway, but no less to that of the German hospital managers. This is particularly evident in the fact that the figures for the stock of intensive capacities are not constant at the moment. On the contrary, they are even highly volatile.
We take the 28. April: Because of the DIVI-day report 21.924 on encrypted occupied and 2.730 free slots, for a total of 23.924 beds, plus a reserve of nearly 10,000. Only four days earlier, on 25 April, the capacity was estimated at 23,713, about 200 fewer seats, with the reserve at 10,149. The impression of “moving station” is even stronger, if you look further back. While the number of intensive care beds currently at the top is around 24,000, there were more than 3,000 more three months ago at 26,957. Where are all the beautiful beds that are so bitterly needed now that the third wave is sweeping across the country?
Sahra Wagenknecht from the Left Party recently asked himself this question: “In the second half of 2020, 6,000 intensive care beds have somehow disappeared from the statistics. Nobody knows why.“Yes, yes, one certainly knows what’s going on: Federal Health Minister Jens Spahn (CDU). He has created the incentives through various laws for the intensive care beds to come and go as it fits into the stuff, i.e. into the balance sheets. The computer scientist, Tom and his research team of engineers, doctors and lawyers went to the operations on the Basis of the official DIVI-data and has transported Amazing things to light. According to the information provided by the hospitals, the DIVI “does not know at all how many patients have ever been in intensive care units with Covid”, says Lausen.
Double and triple counts
As an example, he points out that a single patient is led by the statistics several times in the case of transfers. The DIVI register admits this on its web pages – “multiple counts possible” – but without quantifying this. On the other hand, the medical journal wrote in March, citing “AOK data up to the end of July 2020”, that “10.8 percent of all inpatient Covid-19 cases had changed the ward at least once”, “among the ventilated patients it was 31.9 percent”. If this is true, this could significantly inflate the data on utilization. But the organized intensive care physicians are not interested in such blurring and they do not even bother to clean up the statistics accordingly. Lausen wanted to get information from the DIVI and received the answer, one does not want to know about heavy courses, “they only want to count the beds”.
But how can we count 6,000, how Wagenknecht complained and what made her wonder: “What has changed dramatically is the free capacity ( … ), but not because there are more intensive care patients, but because the beds have been reduced more and more.“In fact, the number of losses could be even greater. Between April and July 2020 alone, around 7,000 seats had somehow disappeared into thin air. With his “Hospital Relief Act”, which was introduced in March, BMG boss Spahn had promised an increase in capacity to up to 40,000. He made it cost taxpayers half a billion euros to award each new bed 50,000 euros. In addition, he temporarily suspended the previously applicable “nursing staff limits”. Thus, a nurse suddenly had to take care of more patients than before, with which the sufferers were at least “applause from the balcony” safe.
All this led to a significant increase in beds to the level of almost 33,000 in the second half of July. But that was miles away from the actually due 39,700. At some point, the minister had to rub his eyes and take note that the nice money for carry-on effects died. But also the beds on the paper thinned, the longer the summer dragged on and the less the sparse corona cases justified the effort. In August, the federal government also reactivated the old staff limits. Now a nurse was only allowed to take care of a maximum of two and a half intensive care beds during the day, which at least added a bit of a sense of reality to the system. Because an intensive bed without adequate staffing is not good for anything in need.
Consequently, thousands of beds came out of the dust at once, or appeared in parts in the emergency reserve capacity. After all, this could explain the panicked admissions of some hospital bosses when the occupancy is heading towards the reserve. There may be a fifth wheel on the car, but no one can mount it. From late summer to autumn the bed shrinkage hardly knew a hold. The trend was fuelled by the end of the so-called free-keeping allowance on 30 September. Until then, the provision of beds for possible Covid-19 patients, who simply did not come for weeks, was rewarded, for example by postponing non-essential surgeries. Because the entire beds did not earn any money from then on, they were quickly converted back in large numbers into holdings of the normal ward.
By the beginning of November alone, more than 4,500 intensive care beds had been lost, while the government and its advisors were tirelessly terrified of the second wave. When the number of cases had actually increased noticeably in November, Spahn began the next precipitation: the “Hospital Financing Law”. The new regulation adopted by the Bundestag on 18 November compensates hospitals for outages caused by the pandemic. However, only those institutions whose intensive care units are at least 75 percent full receive grants. A quantitatively well developed intensive care device there to the exclusion criterion. “Better” is there, who has few beds and who gets as full as possible. So it came as it had to come. Many hospitals artificially and radically reduced their intensive care bed stocks, which caused the workload to increase proportionately.
DIVI " highly amazed”
According to computer scientist Lausen, this was observed in “very many hospitals”, especially in those that had a surplus of capacity before. He cited Leipzig, Bottrop, Goslar, Starnberg and Eisenach as examples. Using the case of a clinic in Pinneberg, he impressively demonstrates how the “need” for beds was flexibly and “as desired” up and down, depending on the amount of occupancy, so as not to slip below the 75 percent mark. The fluctuations are not only due to possible Covid-19 new arrivals, but to all kinds of cases of illness. Here one should remember once again the words of Helios boss De Mea, according to which patients in this country end up comparatively quickly in the intensive care unit.
After Spahn’s masterpiece, the intensive capacities rushed rapidly into the cellar. On November 11, the DIVI register counted about 28,500 places, at the end of 2020 there were almost 2,000 fewer places, namely almost 26,700. In the first weeks of 2021, at the peak of the second wave, the descent was even more rapid. Within four months, more than 3,000 more beds disappeared from the screen, although worse reports of terror from overcrowded hospitals poured into the German living rooms every day. A rogue, who suspects intention behind it.
With the DIVI you somehow did not notice anything of all this. Lausen went over his charts for two hours on the phone with a press officer. She was “highly astonished” “about what she was presented with visualized at once”. For the computer scientist, it is clear that the DIVI daily reports “may not be used for a population-wide control of measures”. In short: “These figures are not valid!”