One wave has just subsided, the next is already looming on the horizon. The seven-day incidence in Munich increased from 203 to the current 305.8 within just one week. What exactly Omikron means for hospitals is still unclear.
In this phase you can only hold out, says Dominik Hinzmann, emergency physician and one of the two hospital coordinators for Munich. The situation has just stabilized somewhat compared to the end of November. “But there is still a sustained extreme utilization of the intensive care units and a high demand for ECMO places.” This means machines to which people with lung failure are connected, so-called artificial lungs. The clinics have already reported one or two severe cases with Omikron. “It is important that we are ready, also because we do not know what exactly is in store for us with Omikron. The hospital occupancy can increase extremely.”
The hospital coordinators are also concerned that the staff in the clinics may be absent en masse due to quarantine after contact with Omikron. “In addition to the potential for hospitalizations, the greatest challenge is the staff,” says emergency physician and second hospital coordinator Viktoria Bogner-Flatz.
Pairs were formed between small and large houses
With the certainty of having a few more beds in reserve, you will sleep better. Therefore, one instrument should be retained for the time being, as Hinzmann confirms: the order of the government of Upper Bavaria, which obliges hospitals to participate in the care of corona patients. What many larger hospitals with emergency rooms have been doing for months anyway – postponing non-urgent medical interventions to free up capacity for Covid-19 – should also be done by some smaller, privately run clinics in the city from the end of November. “These clinics, which have so far not treated Covid 19 patients or have only treated them to a limited extent, should now also reserve inpatient capacities (…),” said the order of November 30th. Something that, for example, Axel Fischer, managing director of the Munich Clinic, which carries the largest corona load in the city, had repeatedly requested. What has happened since then?
“No new emergency rooms have been built now, that would not have made sense either,” says Bogner-Flatz. The purpose of the order was to relieve acute clinics. “This is mainly achieved by moving patients. For this purpose, pairs were formed between small and large hospitals,” she explains. For example, the Isarklinikum at Sendlinger Tor cooperates with the LMU-Klinikum – this agreement was made before the order was issued. Or the orthopedic Sana clinic in Sendling with the clinic on the right of the Isar. A spokeswoman says that eight normal ward beds are currently available for the care of Covid 19 patients. A spokeswoman for the Schön Clinic in Harlaching also reported that they had volunteered before the order was issued in order to care for Covid 19 patients and to keep “appropriate bed capacities” free.
Most clinics are very helpful
The idea behind it is always the same: patients who are not or no longer requiring intensive care and are stable should be “relocated” from the normal wards of the large hospitals, as it is called in technical jargon, and thus freed up capacities for difficult cases. In this way it was possible to send more staff to the intensive care units again, reports Hinzmann. A percentage of their capacities were agreed with each clinic individually, which they could make available. “In this way we have made the large clinics more capable of acting”, says Bogner-Flatz. There have been a few stubborn clinics that could only have been moved by the order. This is combined with a flat fee for the vacated beds. Most of the clinics, however, said they were “very willing to help” even before the order was issued by the government, according to Bogner-Flatz.
This is also reported by the medical director and chief physician of the hospital for natural healing, Michaela Moosburner. Since the house is on the grounds of the Munich Clinic Harlaching, there is an exchange with colleagues there, she says. “When the situation threatened to escalate in November, we agreed with our colleagues from pulmonology how we could take some relief.” Since then, about 20 Covid patients not requiring intensive care have been taken over from over there, a ward had to be closed for this. There are still four of them with them today – “the lay times are very long, they are very sick people,” says Moosburner.
Many specialized houses do not even have the staff for complex corona cases
Most of these newly signed clinics are highly specialized, for example in certain orthopedic interventions. Simply hooking up to Covid care at the same level as the large hospitals have been doing since the beginning of the pandemic would not have been possible at all. Dominik Hinzmann also points out this fact: “Many of them specialize in very special procedures, for example joint operations. They don’t even have the staff for complex cases.” In retrospect, a general obligation like in the first wave did not make sense. “We learned from that.”