Thread by @m_sciencerocks

"But if Czechia is doing so much worse than we in Austria, how come we don't hear horror stories from overcrowded hospitals or morgues?"
Is it all not so bad? Or are we just not hearing about it?
I did a back-of-envelope calculation to get an idea. #ICUs #Czechia 1/

/// So instead of going to sleep I spent last night doing this calculation and the results were pretty terrible. I think it's important but because it is so important I decided to put in a bit more time and have it checked by critical friends.

So I took the original thread down. Once I'm done with review, I'll bring it back up here, promised. Especially when results are harsh, I'd like to stick to how science works. First peer review, then sharing with the public. Thanks for your understanding!

Update: Here’s my revised thread on how Czechia is "managing" with such high numbers. It’s less mathematical than yesterday's, and thanks to @polejit and @BaraWeber it is more nuanced and better referenced.

For my original calculation, I looked up ICU capacity in Czechia. According to these numbers (from 2012!) Czechia would have around 1200 ICU beds.
pubmed.ncbi.nlm.nih.gov/22777516/

Clearly, with almost 3000 people who died only in the last 2 weeks, this number would nowhere nearly suffice to provide best care for each critically sick patient.

If Czechia only had 1200 ICU beds, this would clearly mean massive triage. This is *not* what appears to be happening. In reality the situation is more subtle, but not necessarily much better.

Czechia actually has an extensive dashboard showing hospital capacity and degree of utilization (currently it’s down for restructuring). It has detailed information not just on beds but on a number of different equipment, incl ventilators, ECMOs etc.

It is hard to read, but it is color-coded, with red fields indicating (near-)exhaustion of a resource. At the moment, most resources are displayed not to be too close to exhaustion on a national level.

But in some regions such as Prague, you’ll see red fields. I did not manage to extract exactly what the number of ICU beds available for COVID patients (or in total) is nationwide, but on the dashboard the message is: they’re not exhausted.

How is this possible? Czechia appears to have massively stocked up on beds and all other things, at a loss of quality of other medical operations. They currently report to have 1874 people in intensive care.
onemocneni-aktualne.mzcr.cz/covid-19

The restrictions put in place are such as to not exceed this increased capacity, and on paper this looks like it may be working. The apparent plan is to have huge capacity, and use it to the max. So is all good? No. For two reasons.

One is that one of the most important resources is missing from the dashboard: qualified staff. Soldiers, students and others have been recruited to help in improvised hospitals, and doctors across specialisations help out at COVID-19 units.
acr.army.cz/informacni-ser…

But a real scale up of qualified personnel in such a short time is unrealistic.

Most of the current Czech patients may technically be in a well equipped hospital bed, but it is highly unlikely they are all receiving the appropriate care needed to benefit from the machines. This means a larger fraction of patients will die compared to if numbers were lower.

The second is that even if this was not an issue, having many people in a critical condition means that many will die, even with the best possible care. All of that months before all these people can get vaccinated.

As one Czech doctor said about the strategy to maximize capacity: “The more doctors we have, the more dead we have.”
reflex.cz/clanek/prostor…

So much about hospital capacity. What about morgues? Hard to say. But there were reports of cooling trucks to store bodies and buffer a shortage in cremation capacity. Just like last year in spring in Italy, Spain, NYC.

In January, crematoria received a permit to exceed emission limits so that they could increase their capacity. “The goal is to burn 800 bodies per day.”
idnes.cz/zpravy/domaci/…

So why don’t we hear about it? For one, if numbers are officially within capacity, superficially things look good.

And then, both Czech media (many under influence of prime minister Babis) and the public seem to suffer from apathy. The frustration with pretty much everything is just too big.

Although overall the situation in Austria is currently much better, some themes are familiar: confusing communication around capacities, dashboards signaling everything is ok.

And fast expansion of capacity which in fact signify “soft” forms of triage (Vienna’s Stufenplan), and politics that seem to be OK with using capacities to the maximum instead of lowering the risk for everyone and allow herd immunity by vaccination.

Czechia is, measured by cumulative COVID deaths/capita the worst country on earth. The Czech strategy is heavily costing lives and quality of life. It should not serve as an example for us.