Hospitals may soon have to decide whether to treat a single Covid patient requiring intensive care or be able to carry out surgeries on three patients suffering from other illnesses who would also need ICU treatment, according to the Chief Medical Officer of the Helsinki and Uusimaa Hospital District (HUS), Jari Petäjä.
HUS management is concerned about the prolonged effects that the Covid crisis will have on health care services in coming years.
The district recently estimated that Finland will need to spend one billion euros in additional funding to treat the population who are not vaccinated against Covid — with 200 million euros of that spent in Uusimaa.
"If that amount is left to health care services to sort out, it means other treatments will not be performed. The current system is not able to handle such pressure and [the ability to provide] other health care is threatened," Petäjä said.
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He added that there is an urgent need for a national debate on how Finland plans to deal with the additional financial burdens — both current and future — caused by Covid, as the country carries out major reforms to its social and health care system.
Petäjä said it is impossible to estimate how much caring for Covid patients will cost Finland in the long term, as the country may end up treating people with the illness for years to come. Additionally, there will also be costs to address patients suffering from 'long Covid.'
He said that as there is still a large number of people in the country who are still not vaccinated against the disease, Covid-19 will be an issue for "a long time and it will also put a strain on ICU and hospitals for a long time."
Ethical decisions loom
Queues for treatment in the HUS region are severely congested, and the hospital district has been unable to meet nationally-mandated care guarantees during the Covid crisis, with patient waiting periods up to three to four times longer than in 2018-2019.
Petäjä also noted that there are ethical issues associated with long-term Covid care, as Finland needs to find a balance between adequate specialist care of Covid patients and the needs of patients suffering from numerous other ailments.
In the HUS area, Covid patients needing intensive care spend an average of 11 days in ICU wards, while people suffering from other diseases needing such treatment spend an average of three to four days in intensive care.
"As a result, treating a Covid patient could require cancelling the surgeries of three or four other patients. The load cannot be that heavy. If capacities are full, there will be excessive pressure to prioritise [decisions on who receives] intensive care," Petäjä said.
According to the chief medical officer, Finland needs to plan for the care of Covid patients in the future.
HUS hospitals are already facing staffing shortfalls, he said.
"There was a shortage of nurses even before Covid and the crisis has not helped the situation," Petäjä said, adding that getting new staff up to speed on training is time consuming.
HUS currently treats about 40 Covid patients on a daily basis in regular wards while the district's ICUs serve seven to eight such patients a day.
Due to the country's growing Covid vaccination coverage, Petäjä said the threshold to re-introducing broad restrictions on society was high, but if they are implemented they should be necessary and effective.
"In order for restrictions to be considered effective, they should reach as many non-vaccinated people as possible," Petäjä said.
Using this measuring stick, Petäjä said that restrictions on bars and restaurants are the most effective way to prevent Covid's spread.
He is also strongly in favour of using Covid passes to keep large gatherings of people safe from Covid outbreak risks. He said if restaurant restrictions were imposed alongside the use of Covid passes, it would particularly encourage more young people to get vaccinated, as meeting with friends at public establishments would require proof of vaccinations or proof of testing negative for Covid.