How Skåne handled its Covid-19 peak this January

How Skåne handled its Covid-19 peak this January
Skåne University Hospital's Chief Nursing Officer David Sparv at the new Covid-19 cohort constructed in Lund. Photo: Johan Nilsson/TT
In mid-January, all 65 intensive care places for Covid-19 patients in Skåne were occupied, the highest number yet seen in the pandemic. David Sparv, Skåne's chief nursing officer, told The Local how the region had handled the surge.

The peak in intensive care places came a week after the total number of people hospitalised hit its pandemic peak on January 7th, with 569 Covid-19 patients under care.

According to Sparv, the region's hospitals have so far never been overwhelmed. 
 
“I'm very proud of the way that Skåne University Hospital has been able to deal with it so far,” he said. “Knock on wood, this has been very controlled all the way — and that has been so important for our staff, and, not least, the patients.” 
 
Even at the peak, he said, the region has not had to postpone or cancel any necessary, urgent or life-saving operations. 
 
“We have been able to do the highest priority surgery, what we call priority one to three, and that's cancer and heart surgery and life threatening events. That has been equally important for us to manage, and we have done so, thanks to our staff.” 
 
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While there remains a risk that a relaxation in behaviour, or the arrival of a more infectious Covid-19 strain could push the number being treated back up, last week the number being treated fell significantly. 
 
Skåne was on Friday, January 22nd, treating 351 Covid-19 patients in its hospitals, more than a third fewer than it was treating at the peak two weeks earlier. It has now started to convert back some of its emergency Covid-19 wards for other types of treatment. 
 

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Sparv credits the regional health authority's controlled handling of the surge over the last month to the extra time it has had to prepare. Unlike Stockholm, Skåne was very lightly affected during the spring, with the number of Covid-19 patients treated remaining under 70, even when the nationwide spread of the virus was at its highest level in May. 
 
“We had the benefit during the spring of a slightly more modest incidence of Covid-19 and that gave  us valuable time to to develop structures and methods to be able to escalate and also the opportunity, of course, to learn from other countries and other regions that were more affected,” Sparv explained. 
 
The health authority had also developed a detailed Covid-19 response plan as early as February 1st last year, under which Covid-19 patients would be treated completely separately from other patients from the moment they arrive in the hospitals' emergency rooms. 
 
The initial assessment and treatment planning, or triage, for all Covid-19 patients would also be carried out solely by the hospital's Department of Infectious Diseases, meaning the department maintained close control. 
 
The hospital also drew up an escalation plan listing which departments would be converted for Covid-19 care in a pre-planned sequence.
 
“Knock on wood, it now looks like our plan was sufficient. We have always been able to be at least one week ahead of the virus,” Sparv said. 
 
The Runda Huset building is specially designed for pandemic situations. Photo: C.F. Møller Architects/Jørgen True
 
Skåne's response was aided by the fact that Runda Huset, or 'the Round House', the hospital building erected in Malmö in 2009, was designed in the wake of the SARS epidemic with a future pandemic in mind.
 
The infectious diseases department has 50 large single rooms with air-locked double entries and advanced ventilation features. The rooms are large enough for three patients, meaning that when the number of Covid patients increased, the hospital was able to expand the capacity for cohort care quite effectively. 
 
The Department for Infectious Diseases is situated in the building, and patients at the hospital can be taken directly to an isolated room without passing any common areas, using a corridor that runs in a ring around the building. There are also external lifts reserved only for infectious patients. 
 
“It was very, very convenient to have that here. And we have used that as our first escalation step, obviously,” said Sparv.
 
“In the first escalation escalation step, which was very controlled, with a very careful daily steering based on incoming patients, we were able to transform that building.
 
“And then when the second wave hits we had the follow the plan, and we could expand that in very controlled steps to different parts of the hospital.”
 
Sparv was confident that the region could have expanded to treat more than the 568 patients it was treating on January 7th.  
 
Last week, the hospital completed a new multi-bed ward in Lund, which had been constructed in just 20 days in an area previously used for storage. 
 
“Our construction company had built a very old fashioned cohort care ward with room for 45 patients, but that has never been used so far,” Sparv said. 
 
If the number of patients had continued to escalate, the hospital had already earmarked a ward for the new patients. 
 
“We were ready to take one of the important medical wards in Lund and transform it into Covid care,” Sparv said. 
 
The new 45-bed Covid-19 unit in Lund has yet to be used. Photo: Johan Nilsson/TT
 
The region triggered a crisis clause on December 29th, allowing it to suspend union working hours agreements and make nurses temporarily work 48 hours a week for a maximum of four weeks. 
 
While the crisis clause has helped bolster capacity, Sparv said that the region had been careful to use the powers “very carefully and with great restraint.” 
 
“From the experience of other regions in the spring, we learned that as an employer, we have a great responsibility to use this very carefully, together with the union, and together with lots of information,” he said. 
 
Nurses at the intensive care unit in Malmö and the intermediate care unit in Lund have so far been the only staff to work such long weeks, providing much-needed extra capacity. 
 
Almost all staff in the hospital's intensive care unit have now received their first round of the coronavirus vaccine, and the hospital has this week started to vaccinate emergency room staff. 
 
“It's a very important step. It's like the light at the end of the tunnel,” Sparv said. “But so far it's very difficult to draw conclusions on when it will have an effect on our capacity.” 
 
Despite the controlled approach, the long hours and the high pressure have undoubtedly led to high stress levels and fatigue among staff. But internal surveys suggest that even during the worst periods, morale has generally remained high. 
 
“From the surveys, we can see that there are obviously negative and positive aspects of this kind of care,” Sparv reported. 
 
“We have gotten a very clear message from the majority of people questioned that it was so important for them to be able to help with this pandemic. They are absolutely amazing, our staff members.” 
 
 
 

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