Yaosi Li, 37, specialist for internal medicine at the Clinic for Infectiology and Pneumology at Berlin’s Charité University Hospital
“There are currently 12 COVID-19 patients in the 18 beds at our intensive care unit. One has been here since spring, and three have been here since the summer months. Our patients are usually the most severe cases: Treating lung failure is one of our main areas of focus. Some of my colleagues are also responsible for connecting patients with particularly advanced lung failure to an artificial lung, an ECMO, at other hospitals. Afterward, they bring the patients to us by helicopter or ambulance. Our youngest COVID-19 patient was 27 years old.
Many of the patients have to lie on their stomachs as they are ventilated. We turn them over on their backs once a day for personal hygiene and to examine them. You do an ultrasound and check to see if the tube is still in place. If everything is OK, you then turn the patient back on their stomach. It’s very time consuming, especially for the nursing staff, but doctors are also busy with this procedure for an hour and a half a day for each patient. It usually takes five of us to turn a patient over. The doctor holds the patient’s head and two nurses stand on the right and the left. If the patient needs artificial respiration, we bring in a sixth colleague who pays attention to that device.
As doctors, we work 12-hour shifts and I don’t feel overtaxed yet. But if we have to treat an increasing number of patients soon and tend to more intensive care beds, I worry that the overall quality of treatment will go down.
There is far too little public discussion about the fact that very few who survive lung failure can be nursed back to their previous level of health. And if they can be, it can take months or even years before they return to normality. It’s a mistake to think that we have this disease under control as long as there is enough intensive care beds available.”
“We No Longer Had Enough Staff”
“We are still accepting all patients who want to come to us, whether for a hip, tonsil or other operation. We have to for financial reasons. The federal government’s compensation payments introduced in March for keeping beds free for COVID-19 patients expired on Oct. 1. But we continue to run up personnel costs, no matter how many beds are occupied. It tends to be the patients who have altered their behavior and are now avoiding operations again.
What’s keeping us busy and limited in what we can do it the staffing situation. People who have a cold or a sore throat are staying at home as a precaution. This means we are experiencing more people calling in sick than usual. Even worse than that, though, is when someone shows up for work who isn’t feeling well, only to test positive for COVID-19 the next day. Then we have to trace all contacts and send those colleagues into quarantine, and patients wind up having to stay in the hospital longer.
In Hamburg, different public health authorities are involved, depending on where the patient or employee lives. The health offices issue very different instructions. We had an absurd situation in which a student nurse who had COVID-19 came back from quarantine, and her ward colleagues, who all tested negative, had to stay at home for three days longer.
When eight nurses were absent for 14 days because of one infected person, we had to reduce their ward from 34 to 20 beds within two days, meaning we had to discharge patients and not admit new ones. We no longer had enough staff and we would have violated the statutory minimum limits for nursing care. That minimum was suspended in March, but it was re-instituted in intensive care and geriatric units in August. If the second wave hits us with full force, it will probably have to be lifted again. The government will also likely have to provide financial aid again if the hospitals are expected to manage the balancing act between economic survival and optimal care.
“Almost Every Third Patient Died”
“We are currently treating 114 patients who are ill with COVID-19; 31 are in intensive care units. In the summer, we only had two or three patients some weeks. For the past two weeks, the number has been rising continuously again. Some patients have to be put on ventilators for weeks without any significant improvement.
Even though their lungs are already severely damaged, many patients often hardly feel any shortness of breath at first. If COVID-19 patients also have bacterial infections in their lungs, their circulation can also collapse or they can suffer the failure of organs like the kidneys. In addition, the blood of COVID-19 patients appears to clot more than average, which can cause strokes, thromboses or embolisms.
During the first wave of the coronavirus, almost one-in-three COVID-19 patients in our intensive care unit died. The disease hasn’t changed since then. The symptoms are often manifested in somewhat milder ways, but that’s because there are many more younger people without underlying conditions who are now being affected.
We still don’t have any really effective treatments. We treat patients the same way we do all patients with acute lung failure, but we don’t have drugs that are specifically effective against the coronavirus. There has been a lot of talk about the drug remdesivir and we have also used it a lot, but no significant benefit has been proven from it so far. It’s probable that it mostly helps newly ill patients who don’t yet require invasive ventilation. It has been relatively well proven that the corticosteroid medication dexamethasone can help lead to a milder progression of the disease.
Epidemiologists and virologists have been pointing out the risks of autumn throughout the summer. During the first wave, we were unable to help many patients despite all our efforts, including young and healthy ones. I lack any comprehension for the fact that some people still misjudge or deny the dangerous nature of this disease and who disparage the very ones who are trying to educate people about it.”