Stress test for the German healthcare system
In Italy, war-like conditions are already prevalent in the hospitals due to the rapid spread of the new coronavirus Sars-CoV-2. Infection cases are also increasing in Germany - not as quickly as in Italy, but hospitals in the Federal Republic also have to be prepared for a stress test. How well prepared is the German healthcare system?
The corona virus is testing the health systems of many countries. Hospitals in northern Italy are working at the limits of their capacity. What does the pandemic mean for German clinics?
Hospitals are preparing for the corona crisis
"Crazy, disastrous, catastrophic", Uwe Janssens come up with drastic adjectives when describing the current situation in Italian hospitals. "Colleagues report that it's like war," says the general secretary of the German Society for Internal Intensive Care Medicine and Emergency Medicine. The clinics groan under the burden of the many infected. But also in Germany, the corona virus is a stress test for hospitals - including staff.
Speed of spread is crucial
Janssens himself works in a clinic in Eschweiler, just a few kilometers away from Gangelt in the particularly affected district of Heinsberg in North Rhine-Westphalia. "Highly contaminated, employees and patients alike," says Janssens. "I call it a risk area." Why the Robert Koch Institute (RKI) only uses the term "particularly affected region" here is not clear to him.
"We have to develop a feeling for the disease"
When asked if the German health system could withstand the pressure, experts repeated like a prayer wheel that this particularly depends on the speed of the spread. "We have an illness for which we still have to develop a feeling," says Uta Merle. The doctor from the Heidelberg University Hospital looks after the intensive care unit with the current Covid 19 patients. "The patients just can't come all at once."
Germany has one of the largest bed densities in the world
According to the RKI, 60 to 70 percent of the population in Germany could become infected with the new corona virus within a period of one to two years. In Germany there are about 28,000 beds for intensive care patients. “If we were Italy, we would have transferred 11,000 beds to our size. You can see the reserve potential there, ”says Reinhard Busse, Professor of Management in Health Care at the Technical University of Berlin.
Germany has one of the largest bed densities in the world, says Jörn Wegner from the German Hospital Society. According to current knowledge, this is crucial in terms of the level of death from Covid-19. Intensive care beds are equipped with complex monitoring devices and are looked after by more nurses. The RKI wants to develop a tool that can be used in the event of an overload in a particular hospital to see where there are still free beds nearby.
Equipped with ventilators
In addition to intensive care beds, respiratory equipment is also scarce in Italy. According to the RKI, around five percent of all those affected in China have contracted Covid-19 pneumonia so severely that they had to be connected to a ventilator in intensive care units.
If a Covid 19 patient has to be ventilated, it usually takes a long time, explains Michael Pfeifer, President of the German Society for Pneumology and Respiratory Medicine. This could take several weeks for a patient. "When newcomers come, the place is occupied."
25,000 ventilation options - 10,000 more are to follow
Federal Minister of Health Jens Spahn (CDU) says that there are ventilation options with 25,000 beds - additional devices should be purchased. The medical technology manufacturer Drägerwerk, for example, has received an order from the Federal Government for 10,000 ventilators. As a company spokeswoman explains, the weekly production of a device type that is often used in corona patients has recently increased significantly. These devices are manufactured in Germany - but bottlenecks due to global supply chains and reduced transport capacities cannot be completely ruled out.
Germany could handle Italian conditions
The Federal Government, under the leadership of the Bundeswehr Procurement Office, also bought medical supplies worth 163 million euros to deal with the Corona crisis. "We wouldn't be overwhelmed by the Italian situation," said the Berlin TU expert Busse. "Always provided we can protect the staff and we wouldn't miss it."
Shortage of staff as the main concern
This is exactly what Michael Pfeifer does. "What worries us more than the equipment is the staff." The human resource in the intensive care units is scarce. Personnel who are not trained in intensive medicine must be trained at an early stage so that they can also be deployed in crisis situations.
The staff in the hospitals are under great pressure: in addition to a high workload, many are afraid of falling ill or unconsciously infecting others with the virus, says medical officer Janssens. "What they do is gigantic."
Home quarantine cannot be implemented by nursing staff
The RKI recommends quarantine at home for medical personnel who have had close, unprotected contact with a confirmed case as part of the care or medical examination and who did not wear protective equipment. Janssens thinks this is “simply not practical” if you don't want to bring the healthcare system down.
In Eschweiler, for example, a nurse is ill. If the RKI had been followed, almost 70 employees would have had to be quarantined. Janssens: "Then we should have switched off the emergency care." In general, almost all employees in the clinics in the clinic were contaminated. In Eschweiler, the staff affected can therefore be tested regularly.
Bottleneck: Funding of the corona tests
Here another eye of the needle shows up, says Janssens. The financing of the regular re-tests is largely unclear. The clinic would have 150 tests a day - if at all. The laboratories are already overloaded. Cooperation with the health authorities works in individual cases. Nevertheless, there are always differing statements, "which in some cases also differ from the recommendations of the RKI". This creates a lot of uncertainties.
Scheduled operations are canceled
At some point the point will be reached where the health system must concentrate its resources, Minister Spahn said recently. Additional capacities should arise from the fact that - as far as medically justifiable - all inpatient treatments and operations that can be planned are postponed indefinitely. The federal and state governments had agreed on this on Thursday. The resulting economic consequences for hospitals are offset by the statutory health insurance companies. There is also a bonus for each intensive care bed that is also kept available.
The population has to think along
In order to get through the epidemic lightly, the population has to think along, says Clemens Wendtner, chief physician of infectious diseases and tropical medicine in Munich. He treated the first German Covid 19 patients there. In principle, the stationary capacities are available in Germany. "We just have to use the resources very sensibly and not block each other." (Vb; source: Anne Pollmann, dpa)