Rodriguez-Llanes Jose M, Castro Delgado Rafael, Pedersen Morten Gram, Meneghini Matteo, Arcos González Pedro
European Commission Joint Research Centre, Ispra, Italy.
Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Spain.
Prog Disaster Sci. 2020 Dec;8:100136. doi: 10.1016/j.pdisas.2020.100136. Epub 2020 Nov 17.
The COVID-19 pandemic has shocked health systems worldwide, with visible impacts on intensive care units and emergency departments. The concept of "surge capacity" should be analyzed within this context as this crisis could be seen as an opportunity to improve the knowledge base of intensive care units and emergency departments. We reflected, based on our experience from work at the frontlines, on health service planning and with epidemiological data, about the importance of surging critical care capacity for COVID, now and as lessons for the future. We summarize and relate virus clinical characteristics, epidemiological patterns and critical care surge capacity as important factors to consider for effective health systems response. Some practical aspects are described, but also the role that mathematical models can play to improve intensive care units surge capacity by considering its importance as a predictor of needs according to epidemiological patterns. Also, in the transitional phase, we consider the importance of coexisting COVID-19 and non-covid-19 health care services, and the importance of a new surge capacity for postponed activities. In this new transitional phase, also emergency departments will have to adapt their surge capacity for a rebound effect due to delayed visits from non-COVID-19 health conditions during the pandemic. Health systems and society must remain vigilant for potential resurgence of cases as measures are relaxed to restart the economy and a new normal. Emergency departments and intensive care units have to develop surge strategies to deal together with COVID-19 and non-COVID-19 flow of patients.
新冠疫情冲击了全球医疗系统，对重症监护病房和急诊科产生了显著影响。“激增能力”的概念应在此背景下进行分析，因为这场危机可被视为一个契机，以增进对重症监护病房和急诊科的认知。基于我们在一线工作的经验、卫生服务规划以及流行病学数据，我们思考了为应对新冠疫情而激增重症护理能力的重要性，以及这对当下和未来的借鉴意义。我们总结并阐述了病毒临床特征、流行病学模式和重症护理激增能力，将其视为有效应对卫生系统的重要考量因素。文中描述了一些实际情况，还探讨了数学模型在根据流行病学模式预测需求从而提升重症监护病房激增能力方面所能发挥的作用。此外，在过渡阶段，我们考虑了新冠疫情与非新冠医疗服务并存的重要性，以及为延期活动设立新的激增能力的重要性。在这个新的过渡阶段，由于疫情期间非新冠健康状况导致的就诊延迟，急诊科也必须调整其激增能力以应对反弹效应。随着为重启经济和恢复新常态而放松防控措施，卫生系统和社会必须对病例可能的卷土重来保持警惕。急诊科和重症监护病房必须制定激增策略，以共同应对新冠和非新冠患者的流量。
