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Hospitals in the Netherlands have begun delaying certain operations to free-up ICU beds during a record wave of Covid-19 infections, while an infectious diseases researcher has warned of an impending ‘Code Black’ in the sector.

The country set a daily national record for new Covid infections on Thursday, registering around 23,600 cases. It was the third day in a row of the figure topping 20,000.

To make more staff available for Covid wards, a number of operations, including those for cancer and heart patients, are being canceled from this week on, Dutch healthcare officials have said. Fewer than 200 beds remained available in Dutch ICUs as of Thursday, while Friday figures show almost half (47.8%) of occupied ICU beds were being used by Covid patients.

“These are cancer patients that should actually be operated-on within six weeks of diagnosis, and that won’t be met in all cases. It’s also heart patients,” said a spokesperson for the National Coordination Center for Patient Distribution (LCPS).

Meanwhile, new calculations by an infectious disease modeller at Wageningen University & Research suggest that a so-called ‘Code Black’ in hospitals is looming. The emergency designation means that patient safety is at risk and, if declared, would mean many people with life-threatening illnesses cannot go to the ICU, while doctors have to prioritize who to treat.

According to recent estimates from the Dutch Healthcare Authority (NZa), up to 200,000 operations were not performed as a result of urgently needed Covid care since the start of the pandemic. On Thursday, the NZa revealed that almost a quarter of operating rooms across the country are not currently in use due to a combination of Covid patient pressures and rising staff absences due to illness.

It is not yet clear what impact the delayed care will have on public health. In December 2020, the Dutch National Institute for Public Health and the Environment (RIVM) calculated that an estimated 34,000 to 50,000 ‘healthy life years’ had been lost due to the first Covid-19 wave alone.

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