LAUSR

The present pandemic is far from over, when this is written a new mutation (Omicron) of the Corona19 virus with many more mutations than both beta and delta variants will have rapidly spread. Health care systems all over the world have faced difficult challenges in adapting to the increased demand for hospital access, and in particular ICU admissions. This demand has been encountered in many ways, has varied from country to country as well as within one country. In our part of the world the impact from COVID19 has been largest in Sweden, with more than twice as many ICU admissions as the rest of the Nordic countries combined.1 Hopefully, the world will return to a more normal daily life, so also for our health care systems, but the prospect that the COVID19 virus will stay with us for a long time is possible.2 What then can we learn from the way our health care systems met probably the largest challenges in modern time? The Nordic countries went into this pandemic with one of the lowest numbers of ICU beds per population unit. To count ICU beds is difficult, and in 2019 we had a “bottomup” process in Norway to get updated numbers from all hospitals which confirmed what we feared, the number of ICU beds had not increased since the Swine Flu pandemic in 2009/10.3 The number of ICU beds is around 4.5– 5 per 100,000 population unit in all five countries, substantially lower than in most EU countries.4 This is hardly enough for normal demand, and had to be increased substantially to meet forecasted demand. This increase was possible in most hospitals, but at a price. Areas in the hospital not intended for intensive care had to be quickly established, and extra hardware such as ventilators, monitors, and syringe pumps were acquired. The really difficult task was to increase ICU staffing, and the quick solution was to redistribute anesthesia nurses and physicians, both very qualified to help within intensive care. This led to the closure of operating theatres in some hospitals to allow only emergency surgery and some cancer surgery. Over time this is not without problems, and catching up will take time and probably require that we get real control of the Covid19 virus. The virus seems to be more resilient than our health care systems. How can we prepare for the unexpected? This was recently discussed in an EU report: Assessing the resilience of health systems in Europe.5 All Nordic countries except Iceland participated in this work, but not all contributed with national information collected using a specifically prepared questionnaire. Intensive care is not specifically focused on in the report that was published in 2020, just shortly after COVID19 hit Europe. There was consensus to define health care resilience as: