2020: a bed alone does not create care capacity

Count what can actually operate

Intensive-care capacity is more than the number of installed beds. A treatment place needs the necessary equipment and a team able to provide care for as long as required. Additional equipment cannot instantly replace specialist training. Redeploying staff may widen some possibilities, but requires supervision and removes resources from other activities.

This interdependence changes how reserves should be understood. An unoccupied bed may be a safety margin. Conversely, a physically empty bed may not be immediately usable. A meaningful public overview distinguishes installed capacity, staffed capacity and places that could open under specified conditions. Adding different categories together offers false reassurance, particularly when several hospitals are relying on the same people or equipment.

March 2020: preserve options before rationing

On 16 March 2020, the Federal Council declared an extraordinary situation and announced support for the cantons, including hospitals and logistics. On 24 March, the Swiss Academy of Medical Sciences and the Swiss Society of Intensive Care Medicine published a second version of their guidance on triage under resource scarcity. It first considered ways to free treatment possibilities, including transfers and expanded treatment places.

The nature of the document matters. Triage criteria describe a response to scarcity; their publication does not prove that they were applied everywhere. The guidance also covered patients without Covid who needed intensive care. The hospital cannot therefore be treated as two independent systems, one of which could become overloaded without consequences for the other.

The political question arises earlier: how can teams be kept from facing rationing decisions for as long as possible? Infection prevention, hospital resources and transfer arrangements complement one another. Treating them as interchangeable alternatives conceals their different lead times and limitations.

A transfer is more than a journey

The Coordinated Medical Services concept describes a national intermediary when established networks no longer suffice. The coordination cell is intended to help balance capacity and arrange transfers, with the relevant institutions and services, to units able to receive patients. Local triage and admission decisions remain the responsibility of the hospital and its intensive-care unit.

This division avoids two illusions. One is expecting every canton to maintain all reserves needed for every possible situation independently. The other is believing a national centre can act effectively without clinical information and operational cooperation from teams. Coordination creates an overview and facilitates cooperation; it does not create nurses or eliminate transport time.

A transfer itself consumes resources: suitable transport, appropriate accompanying staff, patient preparation, continuity of information and genuinely available capacity at the receiving institution. It can relieve one site without increasing the national total. Its scope narrows when demand rises simultaneously across several regions. Health federalism therefore requires commitments to mutual support prepared before an emergency.

Other care belongs in the assessment

Reserving resources for an epidemic wave can change ordinary activity. The consequences cannot be read solely from a hospital bill: postponed procedures must be rescheduled, interrupted monitoring resumed and teams given recovery time. Assessing capacity therefore also means following deferred care and the time required to clear backlogs.

This does not mean every postponement was unjustified. A decision may be necessary on the information then available and still have consequences that require correction. The proper questions concern priority criteria, information for affected people and the ability to adjust restrictions to actual conditions. Recording unperformed activity simply as a saving would overlook that future work.

Fund a reserve with a defined purpose

A usable reserve costs money before it is used. A policy that pays only for billed activity can weaken the preparation that protects people in exceptional events. However, reserve funding must correspond to defined capacity: available teams, maintained equipment, exercises and verifiable coordination. A general promise of availability is insufficient.

For the PCP, the lesson of 2020 is to recognise preparedness as an explicit public task. Cantons must be able to plan capacity and cooperate across their boundaries; the Confederation must secure the coordination tools within its responsibilities. Service agreements should distinguish ordinary treatment, exceptional readiness and the actual costs of mobilisation.

Protecting staff is central to this approach. A reserve repeatedly dependent on exhausting the same teams does not provide lasting security. Training, replacements and rest preserve the capability that gives an equipped bed its practical meaning. Assessment must connect what the system promises, what it can open and what its teams can sustain over time.