There is a massive game of human chess taking place in Belgium, as the country beats back a ferocious second wave of coronavirus infections. Every day, dozens of patients are transferred within hospital networks, outside hospital networks, and to other provinces across the country as the overwhelmed healthcare system tries to stave off collapse. 

To understand just how critical the situation has become for some hospitals, you need to head to the tarmac. Liege University Hospital (CHU Liege) is so maxed out on capacity it's now airlifting COVID-19 patients across the border to Germany for treatment in a desperate bid to free up space.   

"I have 50 patients and 50 beds. I am full," said Pierre Gillet, the medical director at CHU Liege who oversees the entire operation.  

Freddy, a 59-year-old man from the city of Liege, was flown out on Tuesday. He was the first patient CHU Liege sent abroad by helicopter. The aircrew said he was conscious and nervous about the flight.

"We evacuate patients who are stable. We prepare them the day before, so the transfer happens in complete safety and we don't reduce the chances of survival," said Gillet. 

While Freddy headed off to Munster, Germany, hospital staff inside CHU Liege continued to fight a second wave much larger than the first. A laid-back summer has given way to record hospital admissions across Belgium. As of Wednesday, there were more than 7,400 patients in hospitals nationwide and 1,412 of them were in ICUs. 

Despite attempts to increase capacity, Gillet said CHU Liege was transferring up to 20 patients a day by ambulance to other hospitals, provinces, and now other countries.  

"If we hadn't transferred the 130, we would have an occupation rate of 200 percent, which is impossible," he said.  

The transfers also help doctors avoid having to make some very serious life and death decisions. 

"At some point, we can't move the walls or put in more beds. So if the total capacity is saturated, that means we will either have to disconnect some patients who are in intensive care in order to welcome others, or tell the other patients there is no more room," said Christelle Meuris, an infectious disease specialist at the hospital. 

Among those contracting the virus are the health workers themselves. Gillet said up to 15 percent of the staff have been sick and off work. To keep the system from collapsing, some hospitals in Belgium are asking doctors and nurses who have tested positive but show no symptoms to continue working.  

Muriel Bayet, the chief nurse in one of CHU Liege's five ICU wards dedicated to COVID-19 patients, said three of her colleagues have contracted the virus. And while they feel more prepared this time around, she said the second wave was presenting new challenges, especially around patient care. 

"Most of the patients coming to us now are conscious and they are stressed out because they know what's happening. They require more attention and care. I am worried for my team and for how long we're going to have to hold on," she said.

It could be a while yet. The average stay is at least three weeks and her ICU has been completely full since mid-October. 

And while transferring patients to Germany frees up capacity and alleviates some of the pressure on health workers, it could be just a temporary fix. Germany is fighting its own surge in cases and at some point, it may deny transfers as its priorities shift to its own citizens. 

"That is the risk of course," said Gillet. "Cases are rising in Germany, too. So I'm sure the doors will close in a few days in the other provinces and in the other countries. But maybe in a month, we will be able to welcome Germans, because in a month we will be on a downward path." 

There are signs the trajectory of cases is beginning to change in Belgium. Infections have dipped slightly in the past week, but with the country still averaging 14,000 new cases a day, hospitals will likely remain full for weeks to come. And the transfer of patients like Freddy will remain crucial.