Despite rising incidences, the Munich clinics see themselves on the safe side when it comes to caring for Covid patients: After two years of operation in pandemic mode, processes and procedures are well established and proven, and larger numbers of sick people can also be cared for safely. The increased need for staff – or the increased workload on the existing staff – remains problematic.
Since the beginning of the pandemic, Munich’s Covid providers have been on two tracks: they have to offer their usual clinic services on the normal wards – and then again on isolation wards, where corona positives are cared for. For the clinics, it makes little difference whether the patient is being treated for Covid or whether the disease is just a secondary diagnosis.
The Munich Clinic, for example, reports: “An elderly lady who is in poor condition after a fall and with a femoral neck fracture and whose PCR test is positive is a risk patient.” She has to be cared for in isolation with greater effort, from planning the bed space to the regularly necessary tests to discharge, she needs significantly more resources – “not only with a view to the maximum possible protection against infection for employees and fellow patients”.
Christoph Spinner, pandemic officer at the Klinikum Rechts der Isar, says that the first cases of severe pneumonia after infection with Omikron are now occurring – “and only in the unvaccinated and those who have not recovered”. Nevertheless, it is also the case in the TU hospital that most Covid patients are no longer admitted because of serious viral diseases, but for other medical reasons. But even in these cases, hygiene measures must be followed, more personnel effort is required.
If you test positive before a planned operation, you have to come later
For all newly admitted patients, a PCR test is carried out first – this is now so well established that in emergencies the result can be available within two hours. Christoph Spinner sees a “grey area” in the emergency room: Patients come there unplanned, often with acute symptoms but an unclear infection status. “But even here,” says Spinner, “we can usually bring about a clearing quickly.”
On the wards, the clinic has decided to strictly separate Covid and non-Covid areas from each other, i.e. to make two wards out of one ward, so to speak. Other alternatives would have been to set up isolation areas on the existing wards or to only occupy individual rooms with Covid patients. Spinner: “But the risk would be far too great that the nursing staff would spread the infection among the patients.” The law of the Isar does not keep separate statistics on how many patients were hospitalized with and how many because of Corona – because this is irrelevant for the care effort.
In the Munich Clinic, four hospitals owned by the city, 3,700 Covid patients have been treated since the beginning of the pandemic in January 2020, 900 of them in the intensive care units. Around 70 patients are currently being treated, around ten of them requiring intensive care. The “clear majority” of them are in the hospital because of Covid – even if the clinic is currently observing an increasing number of patients in whom the infection is only a secondary diagnosis.
For medical care, however, there is no difference here either: “All patients infected with Sars-CoV-2 must be isolated and cared for under high hygienic treatment standards,” says the clinic. On the other hand, the clinic is also doing a lot to ensure that no additional Covid patients are brought into the house: “Patients are tested before planned operations and interventions and, in the case of a Sars-CoV-2 infection, are only admitted after recovery.”
Without, but being treated for Corona: That also exists
This not only serves to protect fellow patients and staff: “If a Sars-CoV-2 infection and another serious illness that requires acute hospitalization coincide, Covid-19 is an additional risk factor that can negatively affect the course of the disease.”
The Munich clinic also refers to another factor in the workload caused by Corona that has so far received little attention: If a Covid patient tests negative during their stay in the clinic, they are excluded from the statistics, they are “de-isolated”, so they can be cared for in the normal wards will.
Nevertheless, it may be that he has to be treated for several weeks afterwards, especially in the case of previous severe courses, sometimes even in intensive care – so he is without, but being treated for Corona. In addition to the 70 acute cases, the Munich Clinic is currently treating around 20 such patients.
Like many of his colleagues, Christoph Spinner from the Klinikum Rechts der Isar is optimistic that Omicron could pave the way to endemics, i.e. the only temporary flare-up of the disease, as is known from the annual flu epidemics. But he doesn’t want to give the all-clear: “We will have to prepare for next winter. There will definitely not be normal operations.”