Intensive care units: Divi President Gernot Marx explains problems

The number of corona patients is increasing. Federal Health Minister Karl Lauterbach is therefore alarmed. Representatives from medicine, however, wave off. The hospitals currently have a completely different problem than the increasing incidence of hospitalization, says Gernot Marx, for example. The President of the German Interdisciplinary Association for Emergency Medicine (Divi) and Head of Intensive Care Medicine in Aachen is more concerned about the staff. Because that is shrinking due to frequent corona infections.

Currently, 58 percent of all intensive care units in Germany have to limit their operations (as of July 12, 2022). Hardly anything can be changed about this in the short term, says Marx. In an interview with the star he talks about the current situation in the intensive care units, his wishes for the Federal Minister of Health and the medical care of the future.

Prof. Marx, you head the Clinic for Operative Intensive Care Medicine and Intermediate Care at the University Hospital Aachen. Please describe the situation in your hospital.

There are some corona patients, but not many. There are currently 1,144 Covid-19 patients in intensive care units across Germany. That makes an average of just under one patient per intensive care unit. Compared to the past pandemic waves, this is a significantly lower burden.

Nevertheless, hospitals are complaining about the corona situation. Why is that?

On the one hand, the number of intensive care beds that can be operated on almost every ward has been reduced since the beginning of the pandemic. Last year at the same time in summer we had around 22,000 beds, now it’s only 20,000. In addition, many employees are absent due to illness. We don’t always know exactly what our colleagues have, but because of the high incidence, it has to be assumed that many will now be infected with the corona virus again. The current situation is therefore quite unusual for a summer.

What do you mean?

Normally, the summer months between June and August are rather quiet in the intensive care units – even regardless of Corona. Fewer surgeries are being performed, and many are on vacation during the summer holidays. But now there are twice as many patients as last year and four times as many patients as in 2020 with COVID in the intensive care units and the staff is absent due to illness. The burden is correspondingly high. Fewer staff have to manage a significantly higher number of patients.

What would you wish from the Federal Minister of Health to improve the situation in hospitals?

I would like to see an infection protection law that we can use to react quickly if the autumn wave is more pronounced than we hope.

No new staff?

This is a crucial point. We always talk about the nursing shortage, but it actually affects all professional groups – physiotherapists, doctors, not just nursing. The entire team has two particularly demanding years behind them. Some employees have left medicine, most have reduced their working hours by 20 percent because they could no longer work 100 percent.

We at DIVI are also worried that young people will no longer choose this profession. As a population, we are getting older in this country, which means more patients in the intensive care units in the next ten years. We already treat two million patients a year. Ascending trend. But the number of carers is not increasing. This is a real problem!

How could that be changed?

With two things. On the one hand with working conditions under which young people do this work well and with pleasure. We need more flexible working hours and it must be ensured that free time really is free time. At the moment I have to constantly call people who are actually free at the weekend so that they can fill in for sick colleagues. They then worry about the next free weekend and I can’t promise them that they will really be free then. But the employees have to be able to rely on it. And we need to become more family-friendly. It always sounds as if intensive care is just a demanding and stressful profession – which is not entirely true.

And the second point?

We need the readiness for technical innovation. I’m worried that because of the global political situation, savings will again be made on things that have proven to be useful. For example in telemedicine. We need digitized hospitals to be able to save more people than today. The DIVI is currently developing a new structure recommendation, which will be updated at the end of the year after more than ten years and which we then want to talk to the BMG and those responsible in the federal states.

Do you assume that the situation in the intensive care units will improve again after the summer phase?

That depends on various factors. It is questionable, for example, whether the now dominant BA5 variant will be followed by others that are less pathogenic, i.e. less pathogenic. I’m confident about that, but you have to assume that the risk of infection will increase again in autumn and winter. There will still be many people in the intensive care units, but also in completely different areas, who will not be able to go about their work.

How could this be mitigated?

Indoors and in large crowds, we will have to wear masks again. In addition, I consider the vaccination, both the second booster that the EMA has just recommended and vaccination with the adapted vaccines that are still being developed, to be highly relevant. Because we see that the corona patients in the intensive care units are mostly older people: 77.6 percent are over 60 years old, so they belong to particularly vulnerable groups. We intensive care physicians are also concerned that we will also face an influenza wave like the one we are currently experiencing in Australia. That’s why a flu shot can be very useful.

Delta was always considered the variant that provoked the worst course of the disease. How surprising is it that the intensive care beds are already filling up?

Delta was actually particularly dangerous: in November and December last year alone, 6,500 intensive care patients died from the variant. That was an unusually high number for us. If more people become infected again, as is the case now, the number of those with a severe course of the disease will of course also increase statistically.

Was that to be expected? After the protective measures were lifted, Karl Lauterbach always warned of an autumn wave.

The current wave is not surprising, but it was difficult to predict how it would develop. Of course, the decisive factor is that we have been able to observe a seasonal effect in recent years, but now far more contagious variants are circulating. When it gets colder again and more people meet indoors again, then we have to be ready to take more precautionary measures again.

At the beginning of the pandemic, triage was a nightmare scenario for many people in Germany. Is that a threat again?

Luckily we haven’t had a triage situation to date. That would mean that we would not have a single free bed in Germany for patients with life-threatening illnesses and would have to make active decisions about life and death. In the Expert Council’s report, this is the worst-case scenario. You can’t rule that out. In fact, we would then be talking about a new pandemic.

But it’s still the same virus.

Pandemics usually take the same course as they are now: a pathogen develops further, but becomes less pathogenic – i.e. pathogenic. In the worst-case scenario, we would have to start from scratch with a new variant. Corona already had various surprises in store. If it were to happen again, we would be heavily burdened and overburdened in the intensive care units and also in the entire health system. A high number of additional patients with a disease for which there is no panacea and which can be fatal is extremely stressful, both mentally and physically. Also because the patients require a lot of time and care. We therefore hope that this absolute emergency scenario will not occur.

Because we are not prepared for it either?

We weren’t prepared for the first wave either, but we reacted anyway. Since then, we have learned new medical skills, have significantly more tools and are certainly better positioned than in February 2020. In North Rhine-Westphalia, for example, we were able to reduce the mortality rate of ventilated Covid-19 patients to well below the national average through telemedical support. In recent years we have talked a lot about terror, pandemics, environmental disasters and wars. The lesson from this: we have to make ourselves disaster-resistant.

What should the healthcare of the future look like then?

For one thing, we need to make better use of patient data. Yes, privacy is important, but let’s not forget that data usage is just as important. You can create large databases and develop algorithms that can predict lung failure or blood poisoning hours or days in advance. On the other hand, we need a new structure of health networks. That means: centers of expertise that are networked with clinics in different regions and where patients can be treated appropriately according to their illness. That would be a structure where not every institution tries to do everything. That is simply no longer expedient and also no longer up to date. Because as I said: Our biggest problem is the lack of staff. So we need to rethink.