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Health Minister Spahn plans to set up fever clinics to avoid the rush to visit doctors’ offices in winter. The coronavirus should be kept away from other patients. But not everyone is convinced of the need for ambulances. The implementation also raises some questions.
The number of corona cases in Germany is increasing again as flu season approaches. Therefore, Health Minister Jens Spahn is pushing a new fall strategy in the fight against the corona virus. So that patients do not become infected with Covid-19 in the waiting room of doctors’ offices, he suggests establishing fever clinics. Patients with respiratory symptoms should go there to distinguish a coronavirus infection from influenza or a severe infection. This is also intended to cushion the attack from general practitioners, as the plan says that most outpatient departments are out of practice.
Basically, fever clinics are not a new idea. They have been around since the beginning of the pandemic, under a different name: “Usually they are called corona testing centers and that’s what we mean,” says the spokesman for the board of the German Society for Hospital Hygiene (DGKH ), Peter Walger ntv.de. The name of fever clinics suggests that it is a uniform concept. “But it is not that,” says the infectologist. The implementation is regionally different. “Fever clinics come in all sorts of variations. They can be hospital facilities, containers, tents, or other rooms near the doctor’s office.”
For example, in Berlin: there are already 30 fever clinics there, says the spokesperson for the Association of Statutory Health Insurance Physicians, Dörthe Arnold, ntv.de. These practices have been around since the spring, but the term “Covid-19 practices” has prevailed in place of fever clinics. However, they met the same requirements: if possible, three treatment rooms, a separate entrance to the house, and enough space for patients to be kept at a sufficient distance from each other. Medical practices are designed so that patients do not endanger each other.
According to Spahn’s idea, fever clinics should now be established and used more intensively throughout Germany. Ultimately, it’s about risk management, says Walger. It is critical for individual outpatient departments that patients with Covid-19 symptoms are treated separately from other patients. “That makes a lot of sense, because both medical offices and hospitals faced the problem of separation at the beginning of the pandemic.” The main focus in fever clinics is diagnosis and not treatment. Patients with symptoms of Covid 19 must first be tested for the virus so that they can then decide in a second step which treatment makes sense for them.
Lack of staff for ambulances
Reactions to the proposal vary. The Marburger Bund Doctors Union describes the fever clinics as “very useful.” It could prevent patients with other illnesses from avoiding a visit to the doctor or clinic for fear of a coronavirus infection. Frankfurt virologist Sandra Ciesek also considers the proposed fever clinics to be “a good idea for the fall and winter.” Such special facilities reduced the risk of infection for other patients in the waiting room, he said Tuesday on NDR’s Coronavirus Update podcast. The German Foundation for Patient Protection also supports Spahn’s proposal, but warns of a serious shortage in nursing homes. “It should not be repeated that infected nurses continue to work just because there is no substitute.”
The professional association of otolaryngologists is also critical of the issue of additional staff required in outpatient departments. In principle, it makes sense to take a closer look at corona strategies for the next cold period, explains its president, Dirk Heinrich. However, in the past, an unnecessary increase in staff has been observed at Corona test centers. The number of patients there was much smaller than originally assumed. Heinrich also sees this danger for fever clinics. “Colleagues who have been on duty there on a voluntary basis and generally, in addition to regular office hours, should be available in their own office in winter to combat the corona pandemic.”
Unfounded fear of infection in waiting rooms?
Infectiologist Walger also admits that the issue of staffing in fever clinics is becoming one of the “regional challenges.” However, it has been learned from the initial phase experiences in the Corona testing centers and the knowledge could now be incorporated into the management of the new outpatient departments. The Otolaryngology Association, on the other hand, added that medical practices are poised for a double wave of infections and have also treated suspected corona patients on an outpatient basis in the past. Most otolaryngology practices have operational processes to treat suspected cases of corona. The minister could also rely on that in winter. “No patient has to stay home for fear of Corona due to another illness,” says Heinrich. Therefore, people with symptoms of Covid-19 should find out which doctor’s office offers a separate consultation for infected patients and when.
The name fever clinics is also misleading, says virologist Ciesek on NDR’s Corona-Update podcast. “It wasn’t that successful.” It could mean that only people with a fever visit these outpatient departments, but not all Covid-19 patients develop a fever. That could lead to confusion, says the director of the Institute for Medical Virology at the Frankfurt University Hospital. Ciesek considers the suggestion to offer an antigen test in outpatient clinics erroneous. This type of test gives a result after a few minutes, the most significant PCR test takes several hours. “In the case of symptomatic patients, you must have the correct diagnosis with a sensitive test, that is, CRP, if possible.”
However, other rules still apply to children. If you have a cough, runny nose or fever, you should still see your pediatrician, Wagler says. This could also lead to an overload in waiting rooms in the fall and winter. However, children continue to play a less important role in the pandemic. The course of the disease is generally not severe and the risk of infection is not particularly high.
It remains to be seen what hygiene concepts should look like in fever clinics outside of medical practices. To keep the risk of infection low within the outpatient clinic, even stricter hygiene measures should be applied than those already in place. “Staff should wear special protective clothing and patient paths should be arranged so that they do not cross,” says Walger. But that is just a matter of logistics. It is not yet clear who will take over the organization of the fever clinics. In the past, these were the statutory health insurance associations. But Bavaria has already made it clear in a statement that they were “surprised” by Spahn’s initiative and that they already have functional structures that “guarantee the care of symptomatic patients.” The question also arises of who should pay the costs. Ultimately, this must be decided regionally and in close coordination with the personnel situation, Wagler says. Spahn’s new strategy should take effect in mid-October.
