On Monday, a good 3000 beds were still free in intensive care units in Germany. More than 2,500 people required intensive care due to Covid-19. On a weekly average, 200 Corona patients are currently being added every day, with the number recently rising significantly and possibly accelerating further. Roughly speaking, there are still a good two weeks to go before the intensive care units are overcrowded across the board. And it becomes less likely every day that this can still be prevented.

Mathematician Andreas Schuppert from RWTH Aachen University, together with intensive care physician and head of the Divi intensive care registry, Christian Karagiannidis, has calculated what the utilization of intensive care units could look like in the coming weeks. Their model calculation assumes 3500 Covid ICU patients in the best case scenario. However, this would require an abrupt slowdown in the incidence of infections. The R-value, which indicates how many people an infected person passes the virus on to on average, would have to drop to a value of one or less. Since early October, this measure of infection dynamics has been above that. The weekly incidence is not expected to rise above 250 reported new infections per 100,000 population. Over the past weekend, this value has already reached 200.

The model calculation by Schuppert and Karagiannidis shows that a total of almost 6,000 intensive care beds would be necessary only for covid patients if the R value only drops to one or below at an incidence of 400. A severe flu epidemic that would require additional ICU treatments is not yet included in these calculations.

In addition, the burden on intensive care units varies widely by region. In more than 80 counties, only ten percent of intensive care beds are still free. Apart from Bremen, Hamburg, and Berlin, Bavaria currently has the highest utilization rate. There, an average of only 10.4 percent of intensive care beds are free, reports the Intensive Care Register. A good 20 percent of intensive care beds in Bavaria are occupied by corona patients.

The fact that the situation varies greatly from region to region is mainly due to the different vaccination rates. However, in the fourth wave, fewer intensive care beds are available overall than a year ago. According to the intensive care register, a good 5,000 available beds were lost within a year. The beds are still there, but there is a lack of staff to adequately care for patients in them.

That is why many clinics are currently already reaching the limits of their capacity. Although there were no vaccinations at the time, the situation twelve months ago was far less tense. At the beginning of November 2020, more than 1,000 of the approximately 1,600 intensive care units in Germany were still able to maintain their regular operations, i.e. they did not have to postpone any operations or redistribute new patients to other hospitals. Currently, more than 600 hospitals report the restricted operation of their intensive care units, and more than 300 have "partially restricted" operations.

It is not the number of patients alone that is leading to overcrowding in intensive care units. Their average age has also dropped because many are unvaccinated, especially among the younger ones. Younger people are less likely to die from the virus than the very old, but they wrestle with it longer in the ICU. As a result, they have to stay there much longer. For staff and bed capacities, the absolute number of patients during an infection wave is not decisive, but only how many patients currently need to be cared for. The hospitals cite overwork as the reason for the staff shortage. Many nurses are burned out and frustrated after 18 months of pandemic and have resigned. This was already apparent last winter. However, there has been a failure to improve working conditions. As a result, a situation that is actually more favorable due to the vaccinations has been able to develop into one that will soon be as desperate as it was a year ago.

If nothing changes in the situation of the hospitals, total overload may henceforth become the normal state of affairs. The winter half-year has always been particularly strenuous for nursing staff, even without Corona. Influenza viruses make many thousands of hospital treatments necessary every year. Last year, this did not happen because of the protective measures.

Schuppert and Karagiannidis therefore also present scenarios for the next few years in their report. As long as there is no comprehensive community immunity, it can be expected that there will always be severe corona outbreaks in winter, almost parallel to the influenza season. "If the increase in incidences from year to year is smaller, and so is the associated intense burden, the corona pandemic could peter out like an oscillation that diminishes from season to season," they write. However, incidences are likely to rise only as high at a time as can be achieved with intensive care. "Closing the vaccination gap, on the other hand, would resolve all the preceding issues in an ad hoc manner and allow for largely normal life."