Gommers says that Code Black was very close. But also that a minimum of 1,150 ICU beds is an impossible task

“Dear House of Representatives, do not adopt the bill for a mandatory capacity of 1,150 ICU beds in hospitals.” Intensivist Diederik Gommers, during his hearing on Monday morning in the Covid-19 parliamentary inquiry, seizes the opportunity to warn the current parliament that the number of specialized nurses is still too small to keep large numbers of intensive care beds open. “Without sufficient staff you have a bogus treatment for the patient.”

Code Black – the scenario in which doctors have to choose on ethical grounds (including age and vulnerability) who they can help and who they cannot – was very close at the end of March 2020, Gommers told the inquiry committee. At the beginning of March that year, ten Covid patients were on ventilators and by March 30 there were already 1,100. “It grew exponentially. The phone call from Germany on April 6 that they had 640 ICU beds available for Dutch Covid patients was, according to him, a relief.

The Netherlands sails “closely to the wind” and “pays attention to costs”, which means that this country structurally has fewer IC beds per capita than neighboring countries Belgium and Germany. “You suffer from that during a pandemic.”

And yet, Gommers says, it is impossible to expand the current 900 ICU beds to 1,150, as stated in the bill. “For 250 extra ICU beds you need 1,000 extra people – with day and night shifts – and they are not available. Moreover, those 1,000 specialized people are then twiddling their thumbs in normal times, because then we only have 800 ICU patients.” People could be trained and deployed flexibly – including in other departments when there is no crisis. The professional association of intensivists, NVIC, is now working on such a plan.

But a lack of staff and cost awareness are not the only reasons that the Netherlands has relatively few IC beds, Gommers tells the committee. “We remove patients from the ICU faster than in other countries and since the pandemic they are also referred to the ICU less often.”

The 80 year limit was bad

Gommers’ interrogation shows that there were a number of heated “quarrels” in the Catshuis in 2020. “I really had to convince the cabinet that we did not have more than 1,150 ICU beds available. At one point the staff ran out. You pull a rubber band and at a certain point you run out of resources.”

The age limit of 80 years, which the intensivists had included in the code black protocol in the spring of 2020, also went down “very poorly” with former Prime Minister Rutte and Minister of Health, Welfare and Sport Hugo de Jonge. “That surprised me. In healthcare we constantly choose: is this treatment still useful? It is not about an absolute age, 80 years for example, but about vulnerability. Is the patient too vulnerable to benefit from treatment?” For each day in Intensive Care, a recovery time of one week applies. The calculation is then three weeks in IC, which means 21 weeks of recovery. Gommers: “We then removed the age of 80 and added the international age frailty score deployed.” That is a way of assessing a patient’s vulnerability.

Another conflict arose at the beginning of the second Corona wave. The rising infections in September 2020 prompted Gommers and Ernst Kuipers to ask the cabinet to take tough lockdown measures again to limit the spread of the virus. “We were not listened to at the time. This time they wanted to let the virus circulate until the hospitals were full. A bad choice. As a result, the final lockdowns, which only came into effect in mid-October, lasted six months.” According to Gommers, it is essential to immediately contain a virus with tough measures that then last much shorter than half measures.

Gommers is still speaking. This message is being supplemented.

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