The corona numbers are falling, and the virus has long since disappeared from the minds of many people. The omicron variant is not as harmless as some believe, says Divi President Gernot Marx. Much has improved since the beginning of the pandemic. But “no one can completely rule out situations like that in Bergamo”.
Nobody knows what will surprise the corona pandemic next, says Gernot Marx, Director of the Clinic for Surgical Intensive Care Medicine and Intermediate Care at the University Hospital Aachen. There is no reason for exaggerated concern for the President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI). On the contrary.
FOCUS Online: Professor Marx, many are currently wondering how Corona will continue. What do you say? Has the virus lost its horror? Is the pandemic over?
Gernot Marx: Of course I’m speaking as an intensive care doctor and not as a virologist or epidemiologist. From our point of view, the situation has clearly eased. There are currently 815 patients with Covid-19 in intensive care nationwide. Only two to five percent of the beds are occupied by corona patients. So the development is clearly going in the right direction and the virus is very easy to control, at least in intensive care medicine.
… not otherwise?
Marx: Well, acute medicine is one thing… Let’s not forget the long-term consequences. As far as Omikron is concerned, we will probably have to wait a little longer until we have reliable data and can make corresponding statements. My impression is: many who were infected are surprised at how long it takes to recover. In any case, this much is already clear: the virus is by no means harmless, as some people think. And Corona is certainly not over either.
However, according to a new study by the Robert Koch Institute (RKI), only seven percent of people in Germany are immunologically naïve, i.e. neither vaccinated nor come into contact with the virus through infection. Doesn’t that mean good protection for the fall?
Marx: As I said, I am not a virologist and even if I were, I would be careful with statements here. This virus has surprised us many times over the past two and a half years. We simply cannot know to what extent it continues to do so. Whether there will be new variants, for example. In this respect, I think it makes a lot of sense how the Federal Minister of Health is acting.
We must not be chasing after possible next waves again, we have to be faster than the virus. I think it is expedient that Karl Lauterbach has tried to order enough vaccine for the population. For a possible fourth – and maybe even a fifth – vaccination…
… for which – should it become necessary – intensive educational work will probably be necessary. People who have been vaccinated are also infected, as some have argued against the benefits of vaccination for some time.
Marx: Careful. It is true that a large proportion of the 815 corona patients who are currently in intensive care have been vaccinated. With the overall high vaccination rate of the population, however, a slightly distorted picture emerges here. Yes, we even see a few patients who have been vaccinated four times and now need intensive medical care. Very often, however, these people are already ill. Autoimmune diseases, for example, play a role, as do post-cancer chemotherapy, which weakens the immune system. All in all, it is confirmed to us every day that the vaccination protects very clearly against a severe course!
Otherwise we would definitely have many more people with severe courses in intensive care units and in hospitals in general. Incidentally, I experience that vaccinated people become infected and are still grateful for the measure taken. “How would my course have looked like without previous vaccination?” I hear this question again and again and it is absolutely justified.
You say that Germany is prepared for the supply of vaccines. But what about intensive care? Could there be similar dramatic situations as last year? An imminent overload of the healthcare system was definitely an issue again and again at the end of 2021.
Marx: Fortunately, there was never any question of a general overload, not even all the spare beds were used, so not all clinics have withdrawn from the elective surgery program across the board. The situation was serious though, yes.
In principle, however, your question is of course justified and it would not be serious if I said: We will never get into a situation in which all 20,000 intensive care beds nationwide are occupied plus the reserve beds. There are no guarantees, because again: This virus is unpredictable. The good news is that not only did the Federal Minister of Health do his homework, “lessons learned” also apply to intensive care medicine. We are in a much better position today than at the beginning of the pandemic. What has actually happened?
Marx: An important building block is telemedicine, and we were really lucky here to a certain extent. Even before Corona, there were some major research projects in this area. These came to an end just at the beginning of the pandemic, and the corresponding know-how could be used at short notice. Look, at first things went a bit like Bergamo in Italy: All patients with Covid-19 came to the university clinics.
According to the motto: Here you are in the best hands. Of course there are bottlenecks. Thanks to telemedicine, the distribution could be made more effective. In the case of ECMO patients, for example, in whom the respiratory function is partly or completely taken over by a machine outside the body, it was clear: there is no alternative to university. However, others affected could be treated well in the local hospital.
We know that thanks to telemedicine, significantly more ventilated Covid-19 patients have survived on average nationwide. Adjusting the system at this point has clearly paid off. And yet another building block has made care more efficient: the cloverleaf system for Germany-wide distribution of seriously ill patients. The development here was actually something that we call a pandemic response in modern German: We reacted very specifically to the crisis.
You don’t think there was anything in the drawer like telemedicine. What is the cloverleaf system about?
Marx: The various Covid-19 peaks looked quite different nationwide. There were phases when the situation in southern Germany was very tense, but in NRW the intensive care beds were only two-thirds full with Covid patients. A central distribution committee uses the cloverleaf system to transfer patients nationwide.
The system is called cloverleaf because several federal states are combined depending on the population and capacity in the clinics and five regions have emerged. By the way: Not only patients with Covid-19 benefited from a significantly improved care situation at the turn of the year 2020/21 and then again at the second peak at the end of 2021. Even for someone who has a serious traffic accident, for example, the care situation has been better than before for some time. And now, in the Ukraine crisis, the improved effectiveness of the system is paying off again.
Are you talking about intensive medical care for war wounded?
Marx: Yes, the Federal Republic, like many other countries, is involved in supplying them. When these people are flown to Germany, the shamrock takes hold again: The patients are distributed to the individual federal states, thus ensuring optimal care. Incidentally, this was already the case in places with the flood in the Ahr Valley.
Sounds like intensive care has been prepared for just about anything lately…
Marx: That’s exactly the point. No one saw the catastrophes we faced recently coming. So the last two years have been damn hard. Nevertheless, we were and are prepared – flexible and efficient.
Can we perhaps take a “pandemic” look towards autumn at this point? Are the improved structures in the intensive care area something that you think encourages?
Marx: Absolutely. First Corona, then the flood, now the war in Ukraine… the crises are here and it is not just felt that they are piling up. Overall, however, we are increasingly able to react to the various catastrophes. We have been able to save so many lives and will continue to do so. I do find that there is something calming about it.
