Prof. Dr. Werner Seeger is the medical director of the University Hospital Giessen. In this interview he reveals what will happen to the clinic and patients in the corona crisis, and the future of medicine at the UKGM.
Interview from Marc Schäfer
Dr. Seeger, how is the situation at the university clinic?
Prof. Werner Seeger: We currently have 27 patients with severe Covid infections in intensive care. In our primary Covid intensive care area we have 22 places, so we had to distribute patients to a second area, in our anesthesiology. We are providing intensive care to more patients than at the peak of the first wave of infections.
Is this the case in the entire service area?
Prof. Werner Seeger: At the UKGM – as in the first wave – we have the most intensive care patients, but there are also a number of patients requiring intensive care in the other hospitals in the Giessen district, the Lahn-Dill district and Wetterau. That was not the case to that extent in the first wave. Many corona patients are also in normal wards in these buildings. Overall, the numbers in the service region are higher than at the peak of the first wave – and, unfortunately, they are continuing to rise.
Are there any other differences? Also with regard to the patients?
Prof. Werner Seeger: In the intensive care sector we now have many patients in age groups that are not in extreme danger. Of the 27 that we are providing intensive care medicine to at the UKGM – that is, who are ventilated in the vast majority of cases – two patients are in their 40s, two in their 80s and all the others in their 50s and 60s. This signals that we have very many infections in younger and middle ages, of which a minor – but a proportion – are critically ill. Fortunately, only two patients have died in our second wave so far. But we are still too early in the infection phase to consider mortality.
Statistics show that the second wave was mainly driven by infections among younger people. It was often assumed that people with a migration background have a high level of infection due to possible genetic preconditions. Can you confirm that from the clinic’s point of view?
Prof. Werner Seeger: I don’t have any numbers. But there are also many patients with a migration background with us. This may be due to the fact that there are more culturally larger gatherings there, such as on the occasion of weddings, after which the infection has spread significantly.
What did you learn from treating the first wave patients?
Prof. Werner Seeger: Dealing with these patients is extremely exhausting. They have to be repeatedly placed on the stomach because the gas exchange then improves. Many body functions and many control loops have to be kept in balance. And we have to have time, unfortunately quite often, until the lungs recover. We were only able to discharge a patient from the first wave a few days ago.
Has there been no breakthroughs in terms of medicines?
Prof. Werner Seeger: Two drugs are used: dexamethasone and remdesivir. However, the data for Remdesivir is not outstanding. Dexamethasone is also hoped to have a limited benefit. However, several studies are ongoing with innovative approaches, some of which were initiated by our center, from which we hope to improve treatment in the future.
With these points of view, what are your expectations for the future at the UKGM?
Prof. Werner Seeger: Unfortunately, I have to say that we have to expect the numbers to increase. Even if the speed of propagation is now slowed down considerably, we are at a level that keeps bringing new numbers of patients. We have a follow-up time of two to three weeks in intensive care. So we have to assume that the high number of suppliers will remain. At the same time, the patients have to be treated in intensive care for a long time. That means that the patients who are now in the intensive care unit will also be there in three weeks, and this is an optimistic outcome. If not, they very likely have passed away. Very few patients will have recovered enough in three weeks that they could leave the intensive care unit. If you look at these developments, you can see that we will soon have to care for even more seriously ill Covid patients in intensive care.
What is your strategy for this?
Prof. Werner Seeger: We can only absorb this through two mechanisms that we have already initiated. On the one hand, we have to involve the region’s Level 2 building more closely in intensive care. That is new. In Giessen, for example, it is the Evangelical Hospital. Nevertheless, we will also have increasing numbers at the UKGM. We can only compensate for this by making our intensive care medicine, which is actually intended for operations and other clinical pictures, available for Covid-19 patients. To do this, we will have to shut down the elective surgical program, which we have already started to some extent.
So the UKGM is not lacking in beds, but in staff?
Prof. Werner Seeger: Yes. The critical factor is the staff. We have a large number of available intensive care beds in Giessen. All together, with the special units and the children’s clinic, well over 150. But we also have to care for patients with strokes, cerebral hemorrhages, heart attacks and other serious illnesses there. Vital operations have to be carried out despite the pandemic. We are also well positioned with ventilators, but there is a lack of staff, primarily intensive care staff. You can’t even retrain normal nursing staff to be highly competent in intensive care. That requires years of training. We started with training, but it takes a long time.
What do you do then?
Prof. Werner Seeger: We have three possible responses. One is that we pull staff with intensive medical training out of their respective functional areas and take them to the intensive care units. However, this shuts down the functional areas, which in turn causes bottlenecks. The second is a call to medical students asking them to contribute. We did that, and well over 100 students registered. There are many with nursing training and some with intensive medical training. And the third: I would ask everyone who has trained as a nurse, especially in intensive care medicine, and is not currently working to consider supporting us in our clinic during this critical phase of the pandemic.
Does the emergency situation also apply to doctors?
Prof. Werner Seeger: We tend to have reserves with doctors. The lack of caregivers is the limiting factor. Not only with us, but nationwide.
The number of free beds in intensive care units is listed daily in the intensive care register. Does that evidently create a false sense of security?
Prof. Werner Seeger: Yes. It is wrong to say how many beds there are – it doesn’t help to put beds in halls. You have to have competent medical and nursing staff so that seriously ill patients can survive. At the beginning of the pandemic, there was a situation in New York where 90 percent of intensive care patients died. That was because the system was so overcrowded that although patients were somehow connected to a ventilator, there was not enough staff to provide adequate intensive care medicine. That was one of the reasons for these high mortality rates. We must avoid that at all costs.
How much leeway do you still have at the UKGM?
Prof. Werner Seeger: We are currently equipping more than 150 intensive care beds with staff across all areas. That is a very large number. This makes us one of the hospitals in Germany with the largest intensive care unit. But we are still looking to see what reserves we can mobilize. This includes reducing the elective surgical program when all other options have been exhausted. However, we won’t do this unless it’s a necessity because postponing elective operations also has consequences. Surgery, which may be elective today, may be urgently needed in four weeks. And who can say if in four weeks the situation will be any better? This means we also have an obligation to carry out as many of the elective measures as possible in order to meet our supply mandate.
Let’s stay with the staff. Is it true that the UKGM has employees who would actually be in quarantine?
Prof. Werner Seeger: That’s the way it is. This Aachen model was already practiced in the first wave in consultation with health authorities. During the first wave, Aachen – which was particularly affected by the proximity to Heinsberg at that time – was given the choice of closing the neonatology department due to quarantine cases or allowing the staff to continue working. The closure would have simply meant that premature babies would die there. There was no option but to let the staff continue to work under extreme protective measures, with repeated Covid testing. That method worked. There were no infections through the nursing staff. This model is also now our own. If we have nurses or doctors who have had potential Covid contact, and at the moment this always happens due to the high incidence level, we analyze the risk and coordinate with the health department whether the employee can work.
Have there been any further infections like this?
Prof. Werner Seeger: Fortunately not. The protective measures are highly effective. A test is also taken every two days. Even in the intensive care area, by carrying out our work with high protective measures, we have had virtually no infections of the staff through a work assignment. That is why the Aachen model is absolutely reasonable. We cannot do without these staff members. After all, we already had 150 employees in quarantine. Of course, we exclude those who test positively from patient care.
Against the background of your experience in everyday clinical practice, would you have wanted politicians to have enacted more significant restrictions earlier?
Prof. Werner Seeger: We are in a difficult situation in which nobody knows exactly what is coming. Basically, I think that we in Germany are dealing with this situation very responsibly. One can, of course, discuss whether the restrictions that have now been decided could have come two weeks earlier, but painful consensus building is also part of democracy. But I also think it’s sensible to leave the schools open. In any case, it is crucial that each individual implement the protective measures. If everyone did that, reducing contacts, keeping their distance, wearing a mask and ventilating, then the numbers would drop quickly and we would not need any further restrictions. I think in such a situation you can’t expect a perfect playbook from politicians.
When we talk about restrictions, you have restricted visits too. It’s late, isn’t it?
Prof. Werner Seeger: We waited a long time, but we were forced to because we have such a high incidence. For me, reducing visits is one of the dire consequences of this pandemic. Just think of a dying patient. Therefore, we try to avoid hardship cases with individual decisions.
Hardship is a good keyword. Virologist Christian Drosten attracted attention with his statement about triage. Do you fear such decisions?
Prof. Werner Seeger: It cannot be ruled out. Unfortunately. I really hope it never happens. Tell a 70-year-old that we have a good chance of saving you, but we don’t have an intensive care unit. You get a little bit of oxygen and morphine. That’s it. The patient can’t even say goodbye. You have to imagine this. I wish I will never have to do that. We will do everything, really everything, so that it does not come to that for us.