Staffed beds¶

A hospital counts its capacity in beds. In an epidemic the people who staff them set it. A bed with nobody to watch the patient treats nobody, and the wave that fills the wards also sends nurses home sick.

Beds without nurses¶

In autumn 2020 Czechia built two temporary hospitals, 500 beds in Prague and 300 in Brno. Neither was used, “as the capacity constraints were caused by staffing rather than bed shortages” (European Observatory). The first wave had brought no staff shortages related to COVID-19. The autumn did, especially of nurses. Hospitals called in medical, nursing and social-services students, took volunteer health workers from abroad, moved staff to the hospitals in greatest need, cancelled non-urgent treatment to redeploy staff across wards, and leaned on overtime until the mental health of the staff became a concern.

Each of those measures moves people rather than adding them. A nurse moved to a COVID-19 ward leaves a gap on the ward behind, and the overtime comes out of the same nurses’ rest. Outside an epidemic the constraint is the same, only slower: beds without staff.

Fuller wards¶

In the full-wards loop, a fuller ward raises the share of infected people who die. One study measures part of that link. Among 7,133 adults admitted to intensive care in England with COVID-19 between April and December 2020, the odds of dying were 23% higher when more than 85% of the beds able to take a ventilator were occupied than at 45 to 85%, and 17% lower below 45%. The estimates were adjusted for age, sex, ethnicity, deprivation and chronic illness (Wilde et al.). The authors treat occupancy as a proxy for strain and leave open whether the link is causal “or whether it reflects strain on other operational factors such as staff”. It is one country, one disease and intensive care only.

After the wave¶

Postponed treatment waits. The pandemic left backlogs of patients on surgical waiting lists in several European countries, and for cataract surgery the share of patients waiting more than three months rose in most countries between 2019 and 2023 (OECD and European Commission).

The staff carried the waves as well. In Belgium the share of health workers intending to leave the profession rose from under 10% before the pandemic to 28% by September 2021. In France, 54% of nurses in public facilities reported burnout in December 2021. The OECD and the Commission describe a vicious circle observed in several EU countries after the acute phase: “understaffing creates stressful working conditions, leading to increased resignations and declining interest in health professions” (OECD and European Commission).

An epidemic can therefore end with a hospital holding the same beds and fewer people to staff them, and a longer queue for the operations it put off.