Lithuanian medics forced to triage as patients flood hospitals

As Lithuania registers record numbers of Covid-19 cases, medics swamped with new patients are forced to triage – to decide who gets intensive care and a chance of recovery.

The atmosphere in an intensive care unit (ICU) is akin to a military hospital, where doctors experience fatigue, burnout, and immense emotional load, according to doctor Ričardas Peldžius.

“Will all ICU patients die? We still hope that we can help at least some of them. But I know that eight out of 10 of my patients will die. I just don’t know which ones,” Peldžius said.

An ICU is a place where the most serious patients are being treated. But in today’s reality, some patients never make it to the ICU, according to the doctor.

“If there are several critically ill patients waiting in the ICU line, we choose which ones to admit. Certainly not all severely ill patients over the age of 75 make it there,” Peldžius said.

“The ICU is a bridge to life – not a place of death. It is not worth transferring patients to an ICU for them to die there. Therefore, we started selecting patients, and we talk about this with other departments, with patients’ relatives,” the doctor added.

The current situation in Lithuanian hospitals is similar to the crisis in Italian healthcare institutions in spring. It is physically impossible to help everyone waiting in line, according to Peldžius.

“We can theoretically admit 30 Covid-19 patients, but if there are 2–4 nurses in the unit, they will die from neglect [...]. There should be 6–8 nurses. But we don’t have that many people. After all, the number of staff has not increased. Also, some of them are ill or in isolation,” the doctor said.

Medics fighting Covid-19 | J. Stacevičiaus / LRT nuotr.

What went wrong?

In October, medical experts were already signalling the worsening coronavirus situation in Lithuania. But the government ignored their recommendations to impose stricter quarantine measures and focused on the parliamentary elections.

According to medical experts, they get frustrated hearing outgoing Health Minister Aurelijus Veryga’s statements about the current Covid-19 situation.

“This week, Veryga said that more people die because more people get sick. Yes, this is the statistics, but the main question is why do more people get infected?” said Peldžius.

According to him, the government failed to arrange timely testing. The public is also not taking the virus seriously enough. But the doctor recognised that people are tired, as the seriousness of the crisis was somewhat exaggerated during the first wave of the coronavirus.

Peldžius added that the disease in Lithuania was spreading because of asymptomatic cases that infect others and make it difficult to trace back the source of the virus.

“With Ebola, only people with symptoms could infect others, so the virus carriers could be found and isolated. Now, we are facing a virus that can be transmitted by asymptomatic people as well,” Peldžius said.

“The disease spreads in a society when one person infects two, those two infect four, and the spread of the disease progresses. The virus has been transported to all regions in Lithuania. Today, the spread of the disease has become uncontrollable,” he added.

Death statistics lag behind

According to Peldžius, people with diabetes and heart diseases are at the highest risk of dying from the coronavirus.

The paradox of Covid-19 is that although the virus causes a significant decrease of oxygen concentration in the blood, the patient might not experience shortness of breath for a very long time, the doctor said.

The normal blood oxygen saturation is 92–98 percent. When it falls below 80 percent, patients start experiencing shortness of breath.

“People with the coronavirus do not feel that their blood oxygen saturation is terrible for a very long time. Some patients come with 70 percent oxygen saturation and feel well,” Peldžius said.

“However, the oxygen starvation gradually develops in tissues, leading to a reaction that is usually irreversible. Sensitive organs, such as kidneys, liver, and brain, are highly dependent on oxygen. A Covid-19 patient begins to deteriorate a week or two after getting infected,” he added.

Therefore, the peak of deaths lags several weeks behind the wave of infections. With a current rapid increase in the new coronavirus cases in Lithuania, the greatest wave of deaths is likely to reach the country around Christmas.

Older patients with chronic illnesses are the most vulnerable ones. But there are also cases when young people fall victim to the virus. According to Peldžius, younger patients get more worried when they find themselves in ICUs.

“Younger people browse on their mobile phones, see information on the media, and realise that there is a serious threat to their health and lives,” the doctor said.

Covid-19 success stories are rare, he added, as only up to 20 percent of ICU patients recover.

Medics fighting Covid-19 in Lithuania's Alytus. | D. Umbraso / LRT nuotr.

Vaccine – the only hope

In the nearest future, there will be no decrease in the number of new Covid-19 cases or virus-related deaths, said Vilnius University medicine professor Vytautas Kasiulevičius. According to him, it is likely that around Christmas, the number of daily deaths will reach 50.

“Vaccine is the only way out. It must arrive in Lithuania as soon as possible. But the European bureaucracy is, unfortunately, hindering this process,” Kasiulevičius said.

“The United Kingdom is an example that it is possible [to start vaccinating] quickly. The current month is very important, but we must wait until the vaccine is registered in the EU, so we pay the price,” he added.

There are no quick methods to get the situation under control because “the train has left the station”, Peldžius added.

But he emphasised the need for widespread testing and isolation of confirmed cases to at least not worsen the situation further.

“The mechanism of testing, contact tracing, and isolation must work well,” Peldžius said. “There are cases when people are questioned a week after their contact with an infected person. During this time, they spread the virus further.”

“Unfortunately, we did not prepare for the second wave in the summer. What do we have now? The house is burning, and the outgoing [government] is finishing it off,” he added.

According to Kasiulevičius, the key issue at the moment is the shortage of staff, which could become even worse.

“It’s not likely that the new government will be able to do something quickly,” the professor said. “We will live with the consequences of the decisions that were made earlier. Decisions to stop the spread of the virus had to be made in October.”