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coronavirus

„There is a department called Lombardy” – healthcare workers speak out about the pandemic

Some patients have to wait seven hours to get an ambulance, because there are too many calls. The ambulance stand in front of the hospitals as if it was New Year’s Eve in toxicology. One in eight patients is ventilated regardless of their age, and five to six die each day. Patients are struggling for air, while there are only two nurses for thirty patients. Atlatszo reporters interviewed healthcare professionals about the third wave of the pandemic, and how they turned from applauded heroes to mentally and physically exhausted robots.

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Sometimes it takes seven hours to get an ambulance

„Yesterday, the rescuers set another record” – National Ambulance Service (OMSZ) wrote on Facebook on March 17. According to the entry, „Due to the epidemic, ambulances are working at increased capacity, with almost a hundred extra units on duty every day to help those in need, so the huge number of cases did not cause disruption.”

The OMSZ employee we interviewed saw all this differently: Some people have to wait for the ambulance for 7 hours, because we have so many titles, let’s not call it a smooth operation” – he said angrily. “Our unit went to the first address at 8 in the morning, we got back to the site at 3 in the morning, rested a little, and then marched around again at 5. In the meantime, we asked for control three times to let us take out the lunch break, but it was not allowed.

„We received more than 100 cases during that shift, so so many waited for the ambulance to arrive,” he continued. “I don’t understand why we can’t set up separate COVID ambulances to take patients to the hospital, we could do what we’ve done so far.”

The ambulances stood in front of the hospitals as f it was New Year’s Eve in the toxicology, there was no room to turn around!

It is certain that the virus has changed since the first wave, it causes more serious problems much faster. And there are more and more young people who got sick. These were the experiences reported by other health care workers as well.

In the county, 5oo-6oo samples are taken daily, 40% of which (rapid test) are positive. Negative rapid tests are subjected to a PCR test. Thus, the 60% negative rapid test is only an estimate, because at least 10% of them are also infected.

The rescue situation is also quite disappointing, in Pest the system is just about to collapse. Rescue units are withdrawn from the countryside in order to perform the necessary tasks there. This has been necessary since 2018”- one rescue officer explains.

The workload is well characterized by the fact that we work nearly 300 hours a month altogether with the rescue and the testing.

The testing is recorded as a voluntary additional task of maximum 72 hours/month – he points out.

Gergely Barna, graduate ambulance officer (j) and Gábor Kovács, station and car driver, staff of the mobile intensive rescue unit of the Inter-Európa Ambulance Service’s Special Public Nonprofit Ltd. in the marching car in front of the Ödön Jávorszky Hospital in Vác on November 17, 2020 MTI / Zoltán Balogh

The new healthcare employment law only made things worse

„I am tired and disappointed because of the new healt-care employment law”- the ambulance officer notes. “Patient care itself doesn’t wear me out it, but 300 hours of work does. One of my colleauge died in COVID in November, it was devastating, he was around 40 years old. The death of my patients doesn’t affect me that much, I don’t know why, but if it would, I might not be suitable for this job.

The law also didn’t help because the fact that it can be amended any time by the government clearly undermines our trust in them.

“What also affects me badly is that if the rescue situation requires it, they can ask us to work away from our home without any support.”- the rescue officer argues, adding that „we should admit that the situation is bad.”

“Vocation for life,” OMSZ wrote next to the picture on November 20, 2020. Source: Facebook / OMSZ

Regarding the COVID pandemic, the lack of uniformity at the healthcare and institutional level and the obedience of the population are the most important problems. „One time I was going to an apartment to take a control test because the previous one was positive 1 week ago. I called the patient that I am waiting in front of the house, and he answered by saying that he needs 5 minutes to get back because he is currently shopping” – says the ambulance officer.

„There is a department called Lombardy”

The situation is really serious in every hospital, but no one dares to talk openly about the problems. Everyone is afraid to lose their” – a nurse told Atlatszo.hu. „Ambulance cars are lined up in front of the hospital. When the ambulance arrives, a “triage man” asks what type of patient they are bringing. Ambulances arrive at the hospital after the COVID rapid test has already been performed on site. If it turns out to be positive, you can only deliver them to COVID department.

Unfortunately, there are fewer and fewer COVID places in Budapest, there are those who take the patient to Pest county, say Cegléd or Vác, depending on where they can find a free bed. There has been a huge increase in the patient transfer time as well: if an ambulance arrives at a hospital as the seventh or eighth car, unless they are taking a ventilated patient, unfortunately, they have to line up.

The triage nurse who picks up and decides what condition the patient is in plays a very important role in the whole process. When the ambulance brings them in, each patient goes through a triage, when the nurse examines basic life functions, and give each patiet a red, yellow, or green armband according to their conditions.

Red means that someone is in a critical condition, yellow is for someone who needs oxygen, green is a patient in a stable condition.

He also talked about the fact that in front of the emergency, where ambulance cars are waiting, there are large and small bottles of oxygen, and as long as the ambulances are waiting in line, they replenish their oxygen supply from there. They do this before entering emergency room, which is full of people.

Nurse at the Department of Pulmonary Medicine of the National Korányi Institute of Pulmonology on February 18, 2021. MTI / Zoltán Balogh

„There are patients who have to wait 5-6-7 hours with an oxygen cylinder next to them if they need it. Relatives can’t go in there, so from the moment the ambulance brings them to the hospital, they are completely left alone. That’s where volunteers could help a lot: for example by giving them a drink, monitoring their condition, or checking their temperature and blood oxygen” – he emphasizes.

According to the nurse, the emergency department has a section called Lombardy, where patients who are in an unstable condition and need oxygen or mask ventilation. The whole hospital has been transformed into a COVID-care facility.

„There is a terrible psychological burden on the nurses. By now the capacity is completely exhausted, very often there is no immediate oxygen, there is no continuous reserve from anything” – he points out.

As it turns out, the protective clothing is disinfected and put on for a second or third day.

„It’s not that every time you go into the red zone, you take the clean clothes out of the foiled bag. We haven’t had that in a long time. Instead, we use a surface disinfectant. And there is an intensive care unit in Budapest where nurses do not have an FFP2 or FFP3 mask, it’s only available if you buy it and take it with you.

It feels really bad to care for one’s own colleague, one’s own relative or a colleague’s relative, or a pregnant woman, for example. This is the worst. So I strongly oppose that nurses who are not yet vaccinated can also work in COVID care.” – he says.

There are plenty of infected but they are afraid to go to the hospital

When we asked if he thinks there are anyone who are mistakenly administered as a COVID patient, he shakes his head. „No. I think it’s more like the other way around. There are far more infected than what we really know.”

Another healthcare worker who, in his spare time, participates in COVID testing at a private company, told us that every third and fourth of 180-200 tests per day at a Budapest testing station came out positive.

„There was someone who said that he has to raise his children, so it’s very important to find out if he’s infected. The ambulance would have been able to test him in 3-4 days, but said he couldn’t wait until then because he should know if he caught the disease or not, so he won’t pay his electricity bill this month and would rather spend that 19,500 forints on a test. I think that’s what the state does very badly too, that there are too few tests” – the nurse adds.

We also asked how is it possible that the mortality rate is so much worse now than in the first and second waves of the pandemic.  „People are afraid of going to the hospital. They have lost their faith and trust in the fact that they can be saved in the hospital ” – he points out.

Budapest, April 24, 2020. A nurse works with a patient infected with a coronavirus in the intensive care unit of the St. Imre University Teaching Hospital, April 24, 2020. MTI / Tamás Kovács

Every eighth patient is ventilated

„In a lot of places we can see that over a certain age, patient are no longer put on ventilator. These people who for example have only high blood pressure and no other illness, think that no one in the hospital will help them, and that they are already excluded. But unfortunately, there is some truth in it, because of the fact that there is no oxygen for every patient ” – he admits.

According to the nurse, one in eight patients are on a ventilator, regardless of their age. „A lot of people say that they are fine, and in the evening their breathing crashes. This virus is terribly powerful. And the mental burden on the healthcare workers is unbearable.  I worked continuously for 7 days because I would go crazy at home. For me now, this face shield means a lot because at least they don’t see me crying…

The worst part is when you can’t decide who to give the oxygen to because there is simply not enough for everyone. 

The nurse said that opening a large room where patients in need of non-intensive care could be cared for would be really helpful, because this could free up hospitals, the nurse believes. „Currently, you see in an emergency department that patients have been sitting there for 10 to 12 hours, clutching the oxygen cylinder, and they haven’t even had a chest CT to see how advanced the disease is. This virus can destroy with such tremendous force in 1-2 hours that you are talking to the patient, and in a few hours he will be lying in the hallway in a black bag… ”

Six deceased every day

Another nurse working in a hospital in Budapest confirmed these statements too. According to him, there are military guards at every entrance: „If I dared to take pictures with my phone, I would take three scenes that are very typical and tell everything about the epidemic,” – he says.

A nurse wearing protective equipment at the intensive care unit of the National Korányi Pulmonology Institute for the reception of patients infected with coronavirus on December 11, 2020. MTI / Zoltán Balogh

„The first: the ambulance comes in at night. The patient waits for the next steps with an enlarged pupil, while the nurse sleeps with her head tilted forward, the driver rests on the steering wheel.

The second one would be the room that is used as a bed storage, i.e. the beds are pushed close together. On each bed there are people of different condition, age and gender lying a few inches apart. If someone is taken for examination, the beds are first sorted in order to gain access to the patient.

And the third is a corridor that can accommodate 8 to 10 people according to the epidemic regulations. Now about thirty people are sitting close to each other and even on the floor.

It is one of the most important events of the last hundred years of Hungary  and yet, it cannot be documented, only the censored images are available. Maybe over time, a photo from the phone of a deceased or a survivor will pop up. Randomly.

According to a medical operations assistant from Nógrád county, the healthcare workers are getting more and more tired. „A lot of people didn’t work in this field before. The defense is also getting weaker. By this I mean that there is no time to put on protective equipment again and again among all patients, because then we will never get to the end of the tasks. We prefer not to even wear it, just a mask and gloves.

We asked if there might be a case where someone is not COVID positive and yet according to the administration, they are categorised as infected. He thinks there were a lot of them. At the beginning, it was typical that anyone who died in the hospital or at home was registered as a COVID-19 death.”

One nurse explained that it is not possible to make a clear distinction between the deaths as a result of coronavirus or other underlying disease, as autopsies are rare due to the risk of infection. Of course, there are typical symptoms and complications. In the hospital, however, any deceased who has produced a COVID-positive in the past six months are registered as another victim of the pandemic.

Insults instead of applause

A nurse from Nógrád county from the COVID department told us that there were extremely bad conditions in the county in the field of healthcare even before the pandemic.

„I’ve been in the COVID department for almost a year now, I was immediately relocated because of my professional qualifications,” – he recounts.

In the first wave, there were hardly any patients. At that time our work was highy appreciated, we were almost considered “saints”.

According to him, the situation is much better in terms of equipment, but more and more patients are getting sick. „Many die (about five a day), it was like we were two for thirty patients, COVID-intensive we are usually three for 10 patients. ” – he details.

„There are a lot of people who don’t know anything about intensive care. If resources were better distributed, the situation could be improved” – he believes. At the same time, he said, it would be important to inform the population objectively and not to increase the panic. Just as healthcare workers should be informed much more transparently. Communication changes very quickly, they receive different information about therapies, medicines and methodology every day.

What is also a problem is that often only the COVID infection is treated, regardless of whether a patient has other health problems and would need complex therapy. Other hospital wards were narrowed down and patient admissions were curtailed.

„I can’t even imagine what will happen if tumor surgeries restart. I am afraid that there will be those who can no longer be saved.”

Deaths also affect him, as he develops some kind of relationship with every patient he communicates with on a daily basis. „In the first wave, the psychologist visited us twice and there was a group therapy. Now there aren’t any therapies anymore, they said we have to solve these problems on our own – many people try to do it with alcohol.

„I can’t even relax at home, because we get a new schedule every day and sometimes we have to go to trainings on our day off (online). At the same time, patients greatly underestimate our work: verbal and even physical abuse is common” – he adds.

A nurse works with a coronavirus-infected patient in the intensive care unit of St. Imre University Teaching Hospital on April 24, 2020. MTI / Tamás Kovács

„I’m used to birth, not death”

We also managed to talk to a midwife, who is currently working with COVID patients in a hospital in the capital. “Having to work 250 hours a month is very tiring, but now I’ve been relocated so I’m working with dying patients instead of doing what my profession is. I am not familiar with these medicines and now I am responsible for the whole ward which is a very big responsibility without any experience. In my last shift, 4 ambulances came in half an hour, one of them, az elderly woman died by the morning though at night I had to chase invisible cats away from her. There is enough equipment, but there are very few of us.

The situation is also emotionally demanding: I am used to birth, not death. Patients come and go and we really don’t see the end of it.

„ I’ve been doing it since November. My hair falls in clumps, my skin is eczematous all over the body because of the sweaty, heavily disinfected dress I wear under my protective suit.” – another healthcare worker told our paper.

Everyone has a lot of problems, but we keep going because that’s our profession. We learned to build a castle out of shit, so that the patiens do not not injure. We are exhausted to the end. Exhausted man will not rebel. He sleeps when he can. So I’m going to sleep because I’m about to go back to the hospital… ”

A nurse dressed in a protective suit in a ward set up to receive patients infected with the coronavirus at St. John’s Hospital in the capital on December 15, 2020. MTI / Zoltán Balogh

Many people become infected at the hospital

One doctor, who is also involved in both emergency and COVID care, said immediate and radical restrictions would be needed to stop the spread of the virus, because recruiting volunteers alone would not be able to help the fully filled emergency care.

„People should understand that this virus is not the same as the one we struggled with during fall.

This variant multiplies faster,  is passed on to more people, and patients get into a critical condition sooner, ”- the specialist points out.

„Patients are constantly pouring into hospital emergency departments. Until now, the capacity of the healthcare system was “expandable” to supply more and more people, but now we have crossed all boundaries. The reorganization is going on wildly, but in reality there is really no one to reassign to another place… ”

A clinical doctor states that volunteers can be of great help in moving patients, transporting them to CT, but effective nursing work and professional decisions cannot be expected from them with the knowledge acquired in a few hours.

According to the expert, an untreatable amount of patients have been admitted to the hospital for days and nearly half of them have a positive test. And while they do everything they can to separate the infected, many catch the virus during emergency care. It can happen that patients lie next to each other for up to 20 hours and it turns out later that one of them is infected.

„The emergency departments can’t put everyone on a ventilator. Almost all rooms have been evacuated for coronavirus patients, and there are also ventilated patients in the operating room.

The truth is that the system focuses only on the care of coronavirus patients, also at the expense of care for non-COVID patients. „There is no human, no room for their care, so in these cases the mortality rate multiplies and these “secondary victims” of the coronavirus do not appear in the statistics” – the doctor says.

„Now would be the time to get scared”

The doctor believes that due to the inadequacy of the information provided by the government, people are unaware of how serious the situation is, because now it would be “time to get scared”. According to the expert, the following would be important in order to curb the rapid deterioration of the situation:

  • those who are getting vaccinated should wear a FFP2 mask as people often spend an hour and a half waiting in a crowded, small room which means higher risks for infection
  • many people think that the first vaccine is already enough to get full protection, although in reality, in the first 2-3 weeks the vaccine can only provide minimal protection
  • from the current situation, the only escape route would be the increase of the vaccination rate, which is also slowed down by the fact that many people “drop out” after the first vaccination (they catch the virus and cannot go for a second vaccination at the time originally planned). It would be better for GPs to be given more freedom in the order of vaccinations, because it is not possible to react centrally to such a rapidly changing situation.
  • it is a problem that now GPs are also involved in hospital care and non-coronavirus patients do not receive any care. This is exactly the opposite of what is happening in the West, where they tend to take the vaccination centres away from the hospitals.
  • a radical reduction in contact numbers would be needed to stop the further spread of the virus. Despite the current, bad situation, there are still many who do not take the rules seriously. The mortality rate in Hungary is even worse than it seems at first glance, if we take into account the short time in which so many deaths due to COVID-19 occurred here.

The doctor also talked about the fact that while at the time of the first wave of the pandemic, when the situation was much less difficult, the healthcare professionals were greeted with applause, and now feel that the mood is turning against them as they are being held accountable for not giving faster, better care. Though everyone is completely exhausted, they try to care for all patients with their last efforts.

Dóra Ildikó Horváth, a specialist, vaccinated a patient with the Russian-developed Sputnik V coronavirus vaccine (officially called Gam-COVID-Vac) at the vaccination station of the Bács-Kiskun County Training Hospital in Kecskemét on February 21, 2021. MTI / Bús Csaba

While a lot of patients arrive at the hospital emergency departments, others line up 50 meters away in order to get their vaccine. “This is not good, as there is a high risk of infection, it would be much better to vaccinate the population in other large buildings (stadiums, empty schools, churches) just like in Western Europe, away from hospitals and doctor’s offices,” – the doctor emphasizes.

But there are other problems as well: a healthcare worker told our paper that illegal vaccination is also common, when celebrities, politicians or other influential people are getting the vaccine out of turn. Some lawyers also abused the dr. abbreviation is in front of their name, so apparently it doesn’t matter if someone is a doctor of law or a healthcare worker, because they get vaccinated in both cases.

Translated by Zita Szopkó. The original, Hungarian article was written by Emese Bánhidi, Gabriella Horn, Eszter Katus, Irén Kármán, László Pusztai, Éva Takács and Zsuzsa Zimre, and can be found here

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