COVID-19 Is Here to Stay. How Do We Cope?

quality management. Initially, we met Simultaneously, many existing daily online; currently, we meet once regulations are being put on hold, a week. Furthermore, during the first enabling hospitals to focus on and wave, the CEOs of all hospitals that better deal with the tremendous new belong to our company met online challenge. The most concise piece of every day with our headquarters and information, however, was a letter we their experts in . received on March 13, 2020, from Quo Vadis? It is worth noting that each hospital in the federal health minister, Mr. Jens Germany has its individual pandemic Spahn, who, in an unusual manner, How Hospitals in Germany plan, as part of a comprehensive addressed the hospital heads directly. plan of a city and the various states, Referring to the alarming situation Are Managing the Novel and in accordance with official in Italy, he asked us (then formally By Abir requested per decree) to postpone Giacaman Corona Pandemic health guidelines. At the local level, we are embedded in ’s all medically postponable treatments crisis task force that coordinates the and surgeries. This aimed to create work between hospitals and health capacities for COVID-19 patients, enable adequate health care, and n mid-March 2020, the first wave of COVID-19 confronted bodies and other states or countries. avoid a collapse of the health care Germany with full force. Today, we are in the middle of the ICU and ventilating capacities are system, as seen in neighboring second, more vicious – in terms of numbers – wave. Nothing uploaded daily on a nationwide countries – a main goal pursued we have ever seen is in any way similar to the ongoing platform to coordinate capacities and diligently until today. Furthermore, I COVID-19 pandemic. Ebola did not reach our borders, the prevent the collapse of hospitals. Mr. Spahn asked us to double 2009 flu pandemic, including the new strain known as swine The number of decisions we make our ICU ventilation capacities. We flu, caused “only” around 85,200 cases and 30 deaths in Germany. and the volume of information that currently no longer apply the first Before the novel coronavirus hit us in Germany, the conditions in various arrives from the official bodies is part of the plan of medical-treatment countries, particularly the pictures from Italy and Spain, caused alarm and immense. We are being provided cancellations, at least so far. immediately put us in crisis-management mode, giving us a bit of preparation with input on all aspects of the The reactivatable plan to restructure time. At our hospital,i we activated our already-defined crisis task force in early novel coronavirus and on new the hospital to meet the needs of March. This included the hospital board, hygiene doctor, technical director, and or altered laws and regulations.

Berufsgenossenschaftliche Unfallklinik (Trauma Clinic), Frankfurt, Germany.

“It is well known that coronaviruses generally do not lead to long immunity. On average, it is one year for the normal ‘corona cold viruses.” Professor , director of the Institute of Medical at the University Hospital Frankfurt

44 45 COVID-19 Is Here to Stay. How Do We Cope?

special equipment for COVID-19 for other critical areas in case of patients (e.g., shielded transporters). increased incidents of sickness. An exchange platform on available With changes taking place at such PPE with affiliated hospitals a breathtaking pace, we put special was created to bridge emerging attention on regularly informing bottlenecks. the staff members via intranet and At the same time, matters such as offering support services such as expanding capacity for a potential virtual professional counseling. increase in deaths (cold rooms) – Currently, the number of persons which gladly, we have not yet needed in Germany who test positive for – had to be taken care of. Ethical COVID-19 is rapidly increasing at guidelines for borderline situations rates that are explained not only by and triage for our doctors on the

Christoph 2 Federal Government helicopter stationed at our hospital. the pandemic entailed a number June. At the same time, guidelines of measures, the first of which for diagnostics and therapy for the concerned safety. We immediately new disease were issued and are closed down unsuitable facilities regularly updated. Training staff such as group-therapy units, medical members simultaneously for hygiene pools, and the cafeteria, offering and other measures was a priority. alternative services with hygienically In order to reduce contact, videos packed food. We made sure to were produced and streamed on the shield every contact point, such as intranet. reception desks, with plexiglass. Another preventive measure was The option of working from home implementing a new entrance for administrative staff was promptly to the emergency rooms with a introduced, and all nonessential “sorting area” to pre-assess self- activities, such as training sessions referrals while correspondently and conferences, were halted. activating the fever clinic. Here We altered visiting regulations in “suspected cases” are referred and, accordance with state requirements. if confirmed, they are transported Our staff campaigning for people to stay at home: “We remain here for you, please stay at home for us.” A main task was to define and in a dedicated lift to the isolation regularly update a comprehensive ward, which was designed for this testing strategy for patients and purpose, meeting specific hygiene front line were issued in accordance expanded testing. Hospital capacities staff, recently adding antigenii and with guidelines of des Deutschen in some areas are becoming critical. iii demands. We introduced screening pool testing to the PCR-test, which for outpatients via phone prior to Ethikrats (German Ethics Council) – Mainly, we are facing a shortage remains the gold standard. In our fixing an appointment; furthermore, and which, fortunately, we have not in medical staff, which hinders our hospital, we decided against antibody we coordinated with emergency yet needed in Germany. use of the expanded capacities. tests. Currently, we test every patient services on safety measures prior to As requested, we doubled the ICU Activating trained staff for COVID-19 before admission or as a point of emergency deliveries. and ventilation capacities, including care would mean reducing the care in the emergency room. building up a new area, while regular treatment of other patients. The ongoing worldwide shortage Furthermore, testing capacities are As requested by the government – to varying degrees – of personal securing extra reserves of medical and during the first wave only, gases. For this purpose, we trained getting tight, as the health bodies protective equipment (PPE) means are partly overburdened with the the chief doctors decided which that securing PPE continues to medical staff with related expertise treatments could be postponed; for deployment to the expanded ICU. once excellently performed job of be one of the main challenges. tracking. Thus, the national testing cancellations were processed in In addition to PPE, we purchased Likewise, we trained backup teams 46 47 COVID-19 Is Here to Stay. How Do We Cope? strategy is currently being altered. A Berlin, explained that the pandemic, The currently imposed mini- partial lockdown for four weeks has seen at a global level, has “only now lockdown, as described above, been implemented for November that Leading scientists in really started.” According to Drosten, which is considered a circuit breaker, entails some closures and a series of Germany, along with the approval of a vaccine does not intends to prevent the overwhelming rules that apply especially to social many of their colleagues immediately solve the problem, due of the health care system. It is and cultural fields and defines the to logistic challenges. “It might be not the preventive measure that number of private contacts allowed worldwide, strongly a job for the entire year 2021,” he scientists prefer (see below) but at one time. There is the hope that oppose the idea of predicted. rather a compromise that attempts we might still manage to flatten the focusing only on the to keep a balance in efforts to So where do we go from here? curve, as we did in the spring. The protection of the elderly save both the economy and public reported R-values,iv one of several and other at-risk and Leading scientists in Germany and health. In a popular, award-winning worldwide have strongly opposed ix indicators, were stable well above vulnerable groups podcast, Professor Drosten used 1 throughout October; fortunately, the idea of focusing only on the the following imagery to describe they reached 0.88 on November while the rest of society protection of the elderly and other the idea of a mini-lockdown(s) as 10, 2020, falling from 1.10 on returns to business as risk groups, while the rest of society a circuit breaker: “It’s like a truck the day before, which indicated a usual – aiming to achieve returns to business as usual – aiming rolling down a mountain. Suppose steady downward trend over a few herd immunity during to achieve herd immunity. It is not we drive down a mountainside with a days, according to the Robert Koch the corona pandemic. possible to completely shield the heavy truck that cannot stop, and we Institute.v A value of < 1 is the elderly, they argue. On the other know that we will fly off the curve. Too many factors make hand, there are many at-risk patients targeted level. A comparison: the this strategy unfeasible. The brakes are broken, and we are lowest value reached since March in the younger age groups, and we allowed to step on them only for 2020 was around 0.6, the highest are currently seeing in our ICUs five seconds. What to do? It will not 2.76. young patients with no underlying be enough to pull the brakes once, diseases. According to a recent The mortality rate per million we have to do it every few hundred statement by Angela Merkel, a inhabitants is, as of today, 126, third of the German population can ranking 31st in Europe and 72nd in supports the government’s measures be considered at-risk regarding the world.vi Germany managed to in dealing with the pandemic. COVID-19. Her statement was flatten the curve during the first On November 9, 2020, the world endorsed by several experts. wave and is shown to generally received the encouraging news of In addition to be doing well in international and a breakthrough in developing the Uncontrolled contamination European comparisons. The reasons first vaccine against COVID-19 by would thus lead eventually to requiring effective are numerous: a mix of potential BioNTech and its partner Pfizer. an escalating increase in deaths crisis management and statistical distortions and factual Many other candidates from because risk groups are far too dealing with immediate, differences. The latter includes numerous countries are expected numerous, heterogeneous, and urgent needs, the current the strategy of early, quick testing to be following soon. In this regard, partly unrecognized to actively situation calls on us as shield them. The increased risk of and isolating positive cases; the there are many important issues to intelligent individuals, prevailing decentralized, flexible be dealt with, such as fair access severe COVID-19 progression occurs institutions capable of federal structures; a graduated health to the vaccines for all countries and with many factors such as obesity, system (with health departments setting the right priorities in each diabetes, cancer, renal insufficiency, continuous learning, and testing outpatients only seeking country as to who should get it chronic lung disease, liver disease, empowered societies to be tested for COVID-19, not the first. Vaccination centers are now and stroke, as well as following to seize this historic hospitals); a well-structured hospital being built here to for this transplants and during pregnancy. A occasion for change as system; and, according to my challenging task. The current plan is possible complication for survivors a fundamental duty in of COVID-19 disease is the so-called observation, a general culture that is to start with risk groups, members of light of this catastrophic perceptive and ready for commitment the medical sector, and persons with “long COVID” syndrome, a term that and “acting reasonably,” not to forget intensive contacts. One of the most summarizes various late damages to event. Evolution teaches the crucial factor of general trust renowned virologists in Germany, the respiratory, vascular, and nervous us: those who adapt in the current government and its Professor ,vii the systems or other organs, severely survive! leadership. A recent study showed chair and director of the Institute of restricting quality of life, the ability to that 80 percent of the population Virology at the Charité Hospital in work, and probably life expectancy.viii 48 49 COVID-19 Is Here to Stay. How Do We Cope?

be organized in the aftermath of all stakeholders. One thing is clear: the crisis. Zukunftsinstitut (Future our pursuit of and striving towards Institute)x has outlined four potential the objective of humanity’s collective scenarios: Total Isolation, System survival of this crisis helps us Crash, Neo-Tribes, and Adaptation. reconcile differences and treat each I will depict only the fourth scenario other with care. here. Scenario 4: Adaptation Abir Giacaman was born in Bethlehem, Palestine, and lives in The world is learning and emerges Germany. She finished her studies in stronger from the crisis. We adapt business administration at Saarland better to the circumstances and are University and followed up with more flexible in dealing with change. two years of further education in The global economy continues hospital management in Freiburg. The hospital cafeteria is closed. to grow but at a much slower She has held senior positions in the pace, partly showing stagnation. management of acute-care hospitals Companies in such environments since 2001, and is presently the CEO need new business models to of the Berufsgenossenschaftliche meters. And we must do it early groups to prevent super-spreader become more independent of growth. Unfallklinik in Frankfurt, a highly on, while we are still driving slowly events to hybrid classes and applying This automatically raises the question specialized acute-care polytrauma downhill.” Accordingly, several – in addition to known hygiene of the purpose of economies: is it hospital that treats over 50,000 mini-lockdowns that are spread over rules – new technologies such the constant striving for more profit? patients per year. a long period of time are a potential as ventilation machines, recently Alternatively, perhaps better, we measure to prevent rapid spread designed for the purpose, or CO2 find solutions that are socially and “until spring, when the situation gets measuring devices that indicate when ecologically more advantageous for better again, a vaccine is available, it is time to ventilate! and temperatures rise again,” As a number of lessons have been Drosten suggested. “The advantage i learned, experts speak of another Berufsgenossenschaftliche Unfallklinik (BGU) Frankfurt. of such a circuit-breaker over a more ii consensus: the novel coronavirus Antigen tests detect viral proteins expressed on the outer surface of the coronavirus. Antigens, a term diffuse general lockdown, as was – as stated in the theme of TWiP’s for any foreign substance, such as a virus or bacteria, are recognized by the body to induce an immune response to fight off . These tests are less accurate than PCR tests. imposed in Germany in the spring, is current issue – is here to stay. We that everyone knows from the outset: iii In the so-called pool tests, not one sample is examined individually for the coronavirus. A test of must learn to live with it. Eventually, combined smears of several, usually ten, persons is made (pools). If the test is negative, all ten people in it is temporary. This way, everyone vaccines will be available and, the pool are also considered negative. If the test is positive and the virus was detected in the pool sample, can adjust to it,” he concluded. hopefully and successfully, will the ten samples must be analysed individually to determine the infected person. iv The reproduction number, or R-value, indicates how many other people an infected person infects. For After a mini-lockdown, it is hoped reach all parts of the world. We example, at a value of 1.3, 10 infected people infect an average of 13 more people. that the number of new must rely on eventually having better v The German federal government agency for disease control and prevention. would be significantly reduced, . We will learn to take the vi Worldometers.info. allowing the system to better manage vaccine (the durability of which is vii Prof. Drosten is also the director of the Department of Virology of “Labor Berlin,” the largest laboratory case-tracking again. This method yet unknown) in the required rhythm. in Europe. Some of his research focuses on emerging viruses. He was one of the co-discoverers of the is helpful, however, only if a certain Those who fall sick could then enjoy coronavirus SARS-CoV in 2003. For the coronavirus SARS-CoV-2, the research group led by Drosten threshold of infection numbers is not adequate treatment. Moreover, the developed a test that was made available worldwide in mid-January 2020. viii Elizabeth J. Wiliamson, et al, “Factors associated with COVID-19-related death using OpenSAFELY,” exceeded. experience we are gathering and the Nature, July 2020, available at https://www.nature.com/articles/s41586-020-2521-4. Regarding the much-debated school measures we will have taken will ix The WHO requested to have the podcast translated for world accessibility, but Prof. Drosten declined, openings, the current consensus is be a valuable reference and always explaining that a translation of such content bears the high risk of misinterpretation or faulty reproduction, “reactivatable.” which might cause much harm. For those who understand German, I strongly recommend listening to to keep them open, as their closure it. https://www.ndr.de/nachrichten/info/Coronavirus-Update-Der-Podcast-mit-Christian-Drosten-Sandra- in the spring of 2020 caused much Beyond the health issue (and the Ciesek,podcastcoronavirus100.html. controversy. Currently, schools socio-economic impact not dealt x “The Corona Effect: Four Future Scenarios for the Economy and Society” (in German), available at https://www.zukunftsinstitut.de/artikel/der-corona-effekt-4-zukunftsszenarien/. are implementing various creative with here), there is the emerging measures, from dividing larger question as to how our lives will

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