3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
Prioritisation and roll-out of COVID-19 vaccinations
On 27th December 2020, the roll-out of COVID-19 vaccinations started. The prioritisation focuses on medical criteria for people with a high risk of severe and fatal outcomes when infected with SARS-CoV-2, or with high exposition while being part of essential services (e.g. health care staff, long-term care staff). The objective is to reduce COVID-19 illnesses, avoid severe cases of COVID-19 and COVID-19 deaths with scarcity of vaccines present. Risk groups include the following: persons with trisomy 21 and organ transplants, dementia patients, people with intellectual or physical disabilities, chronic dialysis patients, people with adipositas (BMI>30), people with chronic kidney disease or chronic liver disease, people with immunodeficiency, diabetes mellitues, arrythmia, HIV infection, coronary heart disease/insufficiency, cerebrovascular disease/apoplex, autoimmune diseases, COPD, cancer, arterial hypertony, rheumatic disease, asthma bronchiale. Children and people under 16 years of age do not receive the vaccination.
The seven-level classification for prioritising vaccinations is as follows (dating from recommendations of the national vaccination board from 26th Dec 2020):
(1) very high: people aged 80 years and older, residents of care homes, care home staff, health care staff with high levels of exposition or with close contact to vulnerable groups (e.g. emergency care, medical care for COVID-19 patients, testing staff).
(2) high: people aged 75 to 79 years, risk groups (see definition above) and their close contact persons. Health care staff with high expositions (e.g. working in emergency care, GPs, paediatricians), mobile long-term care staff, 24-hours care.
(3) elevated: people aged 70 to 74 years. Risk groups and their close contact persons. Also, shared residences like homeless residencies fall under this category. Also, contact persons of pregnant women, and health care staff with moderate exposition.
(4) moderately elevated: people aged 65 to 69 years, health care staff with low exposition, school and kindergarten staff. In this category also people are included who work in areas where the virus may be transmitted easily (e.g. due to low distance, high aerosol concentration, low air circulation). Also, people in critical positions in public administration and the government as well as employees in critical infrastructure are included (e.g. military services, fire brigades, public transport, waste management).
(5) moderate: people aged 60 to 64 years, employees in retail, in gastronomy, tourism and people travelling across borders for professional reasons in public transport (e.g. trains, planes). People working in non-medical services in close contact with people are included. Also, artists, professional sportsmen/sportswomen and other professions with close personal contacts are included.
(6) slightly elevated: amateur sportsmen/sportswomen with personal contacts, amateur artists (e.g. choirs, theatres), teachers at universities, or higher-level education, and people travelling for professional purposes.
(7) general: people aged 16 to 60 years
First batches of vaccines were assigned to residents of retirement and nursing homes, the respective personnel and to health care workers and were administered on site. These groups were followed by the general population of and over the age of 80. With more doses available, vaccines were further administered to people over 65, people under 65 with preexisting conditions listed in the regulation on the COVID-19 risk group (RIS - COVID-19-Risikogruppe-Verordnung), people in need of care and the caregivers as well as people sharing a household with pregnant women. The prioritization scheme is based on the recommendation of the National Committee on Vaccinations (COVID-19-Impfungen: Priorisierung des Nationalen Impfgremiums) and can also be reviewed in the COVID-19 vaccination plan. Currently, in the so-called ‘Phase 3’ of the COVID-19 vaccination programme in Austria, the whole population under the age of 65 is eligible for the vaccine prioritized by age and health risks and also considering work and living environment. Vaccines may also be administered in participating companies to their employees. The vaccine is free of charge.
Documentation plays a crucial role in the Austrian vaccination strategy. Entries into the National Vaccination Register are to be made on site by the health care provider. This process is facilitated by the recently rolled out electronic vaccination system.
Requirements for doctors administering COVID-19 vaccines and for the delegation to nursing staff can be found in the respective legal document (Berufsrechtliche Voraussetzungen zur Durchführung von COVID-19-Impfungen).
The administration of vaccines in participating doctor’s offices is currently in progress depending on vaccine supply. In addition, mobile vaccination sites (‘Impfboxen’) were installed to offer low-threshold access to the COVID-19 vaccination. By April 19, 2021, 23.36% of the Austrian population have received at least one dose of the COVID-19 vaccination
The general prioritization scheme is still in force, with the current ‘phase 3’ prevailing since May (vaccination of the general population). By May 18, 2021, 40.08% of the Austrian population have received at least one dose of the COVID-19 vaccination. A dashboard is available with online tracking of the progress and actual delivery of vaccine doses: https://info.gesundheitsministerium.at/
The licensed vaccines in Austria are the vaccine of BioNTech, Moderna, AstraZeneca and Janssen-Cilag. The National Committee on Vaccinations released a statement addressing the concerns around the use of the AstraZeneca vaccine. This statement confirmed the unmodified continuation of the Austrian COVID-19 vaccination plan, with reference to the statement by EMA, which pointed out that the benefits of the vaccine outweigh the risks of side effects
As of April 8, the situation in Austrian hospitals appears manageable with sufficient bed and ventilator capacities for COVID-19 patients.
Measures to avoid shortages in hospitals in the course of the COVID-19 crisis have been implemented. These include the reorientation of departments, postponement of elective surgeries and non-urgent interventions. Specific hospitals or new hospital units have been designated and created in each region to administer and treat patients with suspected or confirmed COVID-19 cases. Further, strict Standard Operating Procedures (SOPs) apply in regard to separate hospital entrances for people with symptoms of COVID-19 to protect other patients and staff.
Capacities are also used from rehabilitation centres that are currently not operating and might be used as long-term care wards. Furthermore, empty conference centres (e.g. in Vienna, Salzburg) have been reoriented in preparation for accommodating non-acute COVID-19 patients. These centres are currently sparsely used.
Teleconsultations in psychotherapy have been made possible and are reimbursed by the social health insurance. In addition, e-medication is being facilitated, and sickness absences may be issued by GPs over the telephone.
Specific guidelines issued at federal level for hospitals: https://www.sozialministerium.at/Informationen-zum-Coronavirus/Coronavirus---Fachinformationen.html (accessed on 3rd April 2020)