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The number of infections reaches new record levels almost every day; there is still enough space in hospitals, but medical personnel are raising the alarm. Are the clinics already overloaded?
Corona cases in Germany are increasing every day, while intensive care and sick beds in German clinics are increasingly occupied by Covid 19 patients. While there is still an emergency reserve for the beds, staff at infirmary is already at the limit. That’s why an option that was common recently in neighboring countries like Belgium is refocusing: do the infected clinic staff have to keep working in Germany anyway?
What is the current situation in intensive care units?
The number of Covid-19 cases treated in intensive care has nearly tripled in the past two weeks from 769 patients (October 18) to 2,061 patients (November 1), according to the RKI situation report on Sunday night. .
The director of the German Hospital Association, Gerald Gaß, expects a new record in intensive care patients: “In two or three weeks we will exceed the maximum number of intensive care patients from April, and we can no longer avoid it. Who will be there? with us in three weeks Admitted to the hospital he is already infected today ”, he told the newspaper“ Bild ”.
According to data from the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the previous peak of Covid 19 intensive care patients was 2,933 on April 18. At that time, about 3,400 of the clinic beds were still free. By November 1, 2,061 patients with a crown and around 7,500 free places were registered in DIVI.
Last week, DIVI President Uwe Janssens warned of the worsening situation. “In 14 days we will have serious illnesses and our main centers will be under maximum stress,” he said. The problem is not so much the number of intensive care beds. “We have more beds and more fans than at the beginning of the pandemic. But we don’t have a more tired mouse on staff.” This is exactly the problem that led to the recommendation of the Robert Koch Institute in the spring.
What does the Robert Koch Institute recommend?
In a document, the Robert Koch Institute provided very accurate information on how to deal with corona infections among doctors and nurses. Basically, there are two opposing goals in the corona pandemic: the quarantine of medical personnel in contact with a corona case, and thus the protection against infection and the guarantee of acute medical care.
“If adequate patient care is no longer possible due to staff shortages, existing recommendations may need to be adapted to deal with contact persons and persons who have tested positive for SARS-CoV-2 for medical personnel.” says the RKI. To this end, the institute has developed several options for action, which should only be given if there is a significant shortage of staff and patient care is no longer guaranteed.
According to the RKI, the first measures would be the cancellation of postponed treatments as well as the transfer of patients to other clinics and the hiring of additional staff. However, there are also exceptions for medical personnel.
In the case of “relevant staff shortages”, for example, it is possible to allow medical personnel who are considered the contact persons of an infected person to work. However, you are only allowed to interrupt your quarantine for work and travel. “In no case may events, stores or restaurants be visited, for example, during the quarantine period,” emphasizes the institute. To decide whether a contact person is “authorized” to work anyway, the intensity of contact with the infected person is assessed. Depending on the case, an abbreviated quarantine of one instead of two weeks is applied.
If corona symptoms occur in medical personnel, the RKI recommends “immediate work release”, a corona test, and self-isolation until the test result.
“In situations with a relevant staff shortage, medical personnel with symptoms in the event of a negative test result and ability to work can resume medical care with medical protection for the mouth and nose,” continues the RKI. And: “Personnel who have tested positive for SARS-CoV-2 are not used in health care.” But: “In absolutely exceptional cases, the supply of Covid 19 patients is only conceivable.”
At the request of t-online, the RKI said: “In these exceptional cases, the local health department must assess the extent to which there is sufficient capacity in the care center and manage this accordingly.”
Are skills exhausted in clinics?
The number of vacant hospital and intensive care beds is by no means the only decisive factor in determining whether the capacities of German clinics have been exhausted.
Health staff and nurse Alexander Jorde emphasized in an interview with t-online: “The capacity limit for staff was reached years ago. Even before Covid-19, many hospitals had to lock beds because there were not enough staff Only beds and ventilators heal on their own without patients. ” You need specialized personnel with several years of training. “Nobody finds out about that in a few weeks.” Jorde also explains that the stay in an intensive care unit means a long ordeal for many, “with restrictions in some cases for life.”
Prof. Dr. also sees a shortage of staff in the clinics. Werner, medical director and chairman of the board of the University of Essen Medical Center. In an interview with t-online, he says: “The staff shortage in the healthcare system has been with us for a long time. Corona has only made this deficit particularly clear again.” According to him, it will take longer to resolve the nursing emergency. Currently there there are not enough nurses to be able to use all the intensive care beds available in Germany.
(Source: Jürgen Heinrich / imago images)
Alexander Jorde made his name in 2017 through his appearance in the “ARD” electoral arena when he drew attention to nursing grievances in an interview with Chancellor Merkel. Even now, the nurse has harshly criticized the conditions of his profession.
Wieland Rose, who works in nursing himself, confirms: “Even before the pandemic, it was always argued that there were enough free beds, these are the most important key figures for hospitals: an occupied bed gives money, not an empty one. And it didn’t matter if there were staff or not. “But in order to occupy all the beds that exist, there are simply no staff. The corona virus will make this even more dramatic. Also, unskilled workers must be moved quickly to nursing units. intensive care “It’s extremely dangerous,” he emphasizes, and working in the intensive care unit is a completely different challenge.
How does the RKI concept work in practice?
Already in the spring there were isolated reports that staff infected with the coronavirus can and should continue to work. For example, “Heilbronner Voice” reported on a nursing home in which more than 20 of 38 residents and 18 of 27 employees tested positive for the virus. Staff must continue to work in full protective clothing, “so that the care business does not collapse.” Something similar is now being reported from neighboring countries like Belgium.
“No one works with us who have tested positive for Covid-19,” says Professor Werner. It does not matter if the corona infection has no symptoms or not. “Anyone who has been infected with the virus has to be quarantined at home and is not used to caring for the patient. Basically, no one should work if they are sick anyway,” said Professor Werner. That’s the current situation, but the example from Belgium also shows how quickly requirements can change when situations get out of hand. Because “despite all the precautions and precautions, there is always a certain residual risk of staff being infected with Covid-19,” says Werner.
(Source: Private / Prof. Werner)
Prof. Dr. Jochen A. Werner is Medical Director and Chairman of the Board of the University of Essen Medical Center.
“I am not yet aware of such examples in Germany during the second wave of infections, but in other countries,” says Alexander Jorde. “But I think that is gross negligence and I would advise all colleagues not to work in such conditions.” Although he considers the use of masks very useful, it does not completely rule out the risk of infection. It is also not possible to keep your distance when working in the hospital. “To put it in a nutshell: we shouldn’t make up for years of nursing staff shortages by risking our lives. I could try to attract former employees instead of using infected employees with attractive bonuses, but that seems to politicians to be too expensive.
The concept can have consequences for staff and patients
And: if infected staff continue to work anyway, this can have consequences for patients too. You can protect the patient by wearing a mouth and nose cover, but the risk still increases, says Jorde. “The mask just has to sit badly or slide down. And when you sneeze, something flies past the mask and spreads across the room. So you can’t rule out a risk. It’s just not practical.”
Wieland Rose has not personally seen a case either, but has heard of the practice. “It’s also not uncommon,” he explains, “for the nursing staff to be told: with a 38-degree fever and a little cough and runny nose, you can go to work. As a nurse, you do not see this as a purely theoretical model, but as a realistic option that is implemented. Rose also emphasizes that it is difficult to maintain distance in hospital operations: “Infected employees can transmit the virus and also infect their colleagues.” Furthermore, the intensity of the disease often depends on how high the viral load is: infected people put themselves and patients at risk.
