ROME - With public health experts warning a tipping point for coronavirus is getting closer, European authorities are racing to try to ready their health systems to cope with a flood of sick and highly contagious patients.
European countries are still in containment mode but they’re also trying simultaneously to prepare their health services and hospitals for a possible pandemic and to delay any patient surge within their borders. They acknowledge that with some evidence emerging, as yet unconfirmed, that the virus can be spread by asymptomatic people, infection control — from containment to delaying a spread — is becoming harder.
Ukraine, which has not had any confirmed cases of COVID-19, has stepped up what it calls “sanitary controls” on its borders, now that neighboring countries are reporting cases. Those entering the country are meant to have their temperatures checked and officials are urging Ukrainians to refrain from travel to European Union countries. Anyone who has, especially to countries affected by the virus, is being asked to isolate themselves.
In the meantime, Ukrainian authorities are preparing to reorganize the country’s hospital network and have advised medical centers to consider postponing scheduled operations to leave beds free for a possible outbreak. Local authorities have been ordered to pick two hospitals in their area to be designated to handle suspected coronavirus patients. World Health Organization specialists have started to train Ukrainian medical personnel on how to handle patients who test positive.
“We are ready to brace for the coronavirus. At the same time, we are doing everything to prevent it from getting into the country,” Deputy Health Minister Viktor Lyashko said Friday.
EU public health officials say the continent is better prepared to cope with a pandemic than others, thanks to the development over many years of Europe-wide medical networks able to quickly disseminate the latest clinical research and to collate data. Herman Goossens, director of a network known as the Platform for European Preparedness Against Emerging Epidemics, told reporters last week that acting fast and taking proactive action is critical in managing viral outbreaks.
In Britain, where 20 have tested positive for the virus out of nearly 8,000 people tested, the rapid spread in some parts of Europe, especially Italy, is dispelling hopes that containment alone can help the country escape the virus unscathed.
On Monday, Prime Minister Boris Johnson, will chair a meeting of the country’s COBRA emergency committee of ministers to discuss preparations. The British strategy so far, according to Health Secretary Matt Hancock, is “contain, delay, research and mitigate.”
Chris Whitty, the chief medical officer for England, said midweek the hope is that Britain can avoid an epidemic until later in the year, when more may be known about the virus and how to combat it. Also, the country’s winter will be over and the demands on the National Health Service reduced. Infection-control and containment measures appear to be working currently. Britons returning from affected countries are being asked to isolate themselves, and those who are sick are being treated in specialist units with anyone they had contact with prior to diagnosis traced and ordered to isolate themselves.
Officials say, though, that it is “only a matter of time” before there’s a spread in Britain, and there are worries about whether the hard-pressed National Health Service, which is short of staff and capacity after years of reduced funding, will be able to cope in the face of a full-throttle emergency. The agency’s telephone advice service has been overwhelmed by a high volume of calls and there have been complaints that anxious callers are being given contradictory advice.
Health officials have dusted off a 2009 battle plan drawn up to cope with a possible swine flu pandemic. Under that plan the National Health Service would prioritize access, postpone non-emergency operations and possibly treat only emergency patients. Most controversially of all, lifesaving care during a severe coronavirus outbreak could be denied to those deemed most likely not to survive. Ventilators and beds, if intensive care units are struggling to cope, would be rationed.
British officials say that single-payer health systems such as the National Health Service may have an advantages over countries with privately financed health systems as they have clearer command-and-control structures. In Britain, as elsewhere though, the big question is whether sheer numbers could be overwhelming for a service that many complain has been inadequate since funding cuts were imposed in the wake of the 2008 financial crash.
Ministers are drafting emergency legislation ready for a serious upsurge and, under the plans, medical staff and other armed forces and British Red Cross personnel could be drafted to help the health service cope and to replace sick hospital staff.
However, some British doctors say government ministers are being dishonest in suggesting the NHS is well prepared. They say the country’s critical-care capacity is already overstretched and would buckle in the face of a pandemic.
A critical care consultant from a major London hospital told Britain’s Independent newspaper Saturday, “There isn’t any slack in the system. We are grossly under resourced. I hear them say the NHS is well prepared. We are not well prepared, it is media spin. As an NHS, we would crumble under the weight of those who need critical care.” The British Thoracic Society warned Saturday that respiratory wards are already “understaffed and overstretched” just coping with the winter season of flu and bronchitis cases.
A government spokesman, though, said in a statement, “The UK is a world leader in preparing for and managing disease outbreaks, and our approach will always be led by medical experts. We have been clear from the outset that we expect coronavirus to have some impact on the UK and a global pandemic could have a pronounced effect on the NHS, which is why we are planning for every eventuality.”
In France, Prime Minister Edouard Philippe has been convening emergency meetings in an effort to increase the French medical system’s readiness. An extra 70 hospitals are now being prepared to receive coronavirus patients, bringing to 108 the number of hospitals being readied for an outbreak. Each mainland departement of France has a designated coronavirus hospital.
France had 57 confirmed cases as of Friday, with all but a dozen having been diagnosed since the major outbreak in neighboring Italy a week before. The country is boosting its testing capacity for the virus. Health Minister Olivier Veran said this week, “I have called the head of the University Hospital Institute of Infectious Diseases in Marseille, it is able to perform 1,000 tests per day in the area of Marseille alone. In the hospitals of Paris we are at 400 tests per day. We are going to be able to amplify the screening to be able to answer all the requests at that scale across France.”
Like other European countries, France is scrambling to obtain high-quality protective masks and clothing for health workers. French ministers, like their counterparts in Germany, say they’re ready to follow Italy’s example and to lock down villages or towns that witness a cluster of cases. “We are preparing for an epidemic. We are now moving to stage 2. The virus is circulating in our country and we must stop its spread,” Veran said Friday.
However, with cases now in Italy, France and Britain of people contracting the virus with no identifiable link to overseas travel, time may be running out, public health officials admit.