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 Berlin. 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 Frankfurt’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 Sandra Ciesek, director of the Institute of Medical Virology 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.