Health Board cannot set coronavirus patient limit for triage

Covid ward at North Tallinn Regional Medical Center (PERH) in Tallinn.
Covid ward at North Tallinn Regional Medical Center (PERH) in Tallinn. Source: PERH

The Health Board has said it cannot give a definite number of coronavirus patients admitted to hospital before doctors must start choosing who to treat.

The Estonian Medical Association on Wednesday called on the government to set a limit for the number of coronavirus hospitals can treat. After this, medics will need to decide who to treat - known as triage - and vaccination status may play a role, the statement said.

Head of Emergency Medicine at the Health Board Urmas Sule said on Wednesday it is not possible to give a definite number.

There are three levels of preparedness but as the number of patients fluctuates at each hospital every day is impossible to give a precise number. The third level is the most critical but hospitals have not reached it yet.

"According to the current forecast, it can be predicted that by the end of this month there could be more than 800 patients in hospital, and this is definitely a number exceeding the critical limit," Sule said. 

"But I emphasize once again that we can make all kinds of plans and decisions day by day and try to increase our capabilities in these places as much as possible."

Deputy Director General of the Health Board Mari-Anne Härma said hospitals may not experience the same level of pressure at the same time.

"Triage guidelines are actually approved by a directive, so if there is a need in a hospital, it can be implemented," Härma said but added the quality of treatment is declining every day with every new coronavirus patient admitted.

On Wednesday, 610 coronavirus patients were being treated in hospital. Initially, the health service said 600 was the limit to ensure patient care across all levels of treatment.

Jaan Sütt, the head of the Estonian Medical Association, said such a high number of coronavirus patients affects the care of every other type of patient.

He said over the last few months the University of Tartu Clinic has been unable to carry out approximately 1,300 surgeries.

"Most of our resources are spent on nursing coronavirus patients," he said.

This wave - Estonia's third - is hitting medical staff particularly hard and many healthcare workers have quit over the year leaving a shortage of staff.

Kristo Erikson, head of the North Estonian Medical Center in Tallinn, said the third wave will be longer and harder than the last two. It started three months ago and there is no hope for a lull before spring.

He is particularly concerned about the resilience of medical staff.

It may be likely that if the third stage of preparedness is reached - described as "catastrophe" level - medics will need to choose who to treat. Then vaccination status may play a part because those who are unvaccinated have worse outcomes, in general.

Erikson said: "It can be interpreted as the person's expression of will in terms of treatment. It is also the position of the Estonian Medical Association that people are free in their decisions. But if you opt out of vaccination, it is like putting down in your patient's notes that you did not [want to] take advantage of everything we have."

He said, so far, triage has been applied by assessing a person's ability to recover from the coronavirus.


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Editor: Helen Wright

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