UKGM chief discusses Corona: “What is surprising is that the lung failure drags on for so long.”

For more than three decades Werner Seeger has been researching sudden lung failure caused by viruses. Nevertheless, the coronavirus also has surprising effects even for Seeger, who is the medical director of the University Hospital. In this interview, Seeger talks about the coronavirus situation at the UKGM, as well as promising studies and a research cooperation with 16 other hospitals. He also explains what he thinks about political decisions made during this pandemic.

Author: Marc Schäfer

How are you feeling?

Seeger: Quite well, thank you. Rarely have so many people inquired about my well-being as at the moment.

As the head of the UKGM, you have an exceptional position at this time.

Seeger: I have to admit that I also feel a certain tension as to whether I am able to meet all of the necessities. But the situation is not fundamentally different than usual. Managing a hospital always means a burden of responsibility. However, at the moment, there is also the responsibility for a total of 17 hospitals in the supply region with which we are in agreement and which are coordinated from Giessen. Fortunately, there is already a very good cooperation structure in this region anyway, which our colleague Friedrich Grimminger has built up and which is now very helpful to us. Everything has gone very satisfactorily in our region under the early signs of coronavirus , and I hope that we can continue to avoid a bad medical situation.

"Many questions remain open regarding the course of the disease"
Seeger on Coronavirus

How much does the coronavirus situation weigh on you?

Seeger: It’s very stressful for all employees. But we have excellent medical and nursing staff at UKGM and in the other hospitals in the region. This gives us a very good basis for dealing with critical situations. This is reassuring, although there is no denying that we are cautiously tense. After all, we can’t predict how the pandemic will develop.

Is there already routine in dealing with COVID-19 patients?

Seeger: Initially, the biggest problem was to reorganize the clinical processes in many ways. We did this in different stages, each time adapted to the increasing number of COVID-19 patients. Such things never become routine. It has become more routine to deal with patients, from the very sick who need ventilation to those we can release in home quarantine. But there are still many unanswered questions regarding the course of the disease, which cannot be answered yet. In this regard, the days are  partly routine, but we are also breaking new ground daily.

What is the current situation at the hospital?

Seeger: At the UKGM, as in the whole of Hessen, the infection situation has always been very manageable. At present, we usually have about 18 patients in the specially equipped COVID-19 intensive care unit on artificial respiration. And we always have about 10 to 12 patients who require in-patient care but do not need artificial respiration, and therefore do not require maximum intensive care treatment.

"What is surprising is that the lung failure drags on for so long"
Seeger on Coronavirus

18 patients doesn’t sound so intimidating now.

Seeger: Primarily measured by the fact that we have 156 intensive care beds with ventilation facilities in Giessen. We are the hospital with the most intensive care beds in Hessen, but many are naturally occupied by other patients, for example after heart surgery or organ transplants. In total, about 200 patients with severe coronavirus infections have been treated as inpatients in our care region so far.

How many beds do you have available for COVID-19 patients?

Seeger: At present, we’ve made room for up to 30 COVID-19 patients on artificial respiration. However, due to the special susceptibility, the high nursing effort of COVID-19 patients and the extreme hygiene measures, we clearly need much more personnel for care than for other patients in the ICU.

You have spent many years researching lung diseases. What did you know about the threat of coronavirus?

Seeger: At the lung research center in Giessen, which is led by myself and my colleague Dr. Grimminger, we have been dealing with problems of acute lung failure induced by different microbial pathogens, among other things, for more than three decades. In this respect, we have a wealth of experience in the basic understanding of this organ failure and in the clinical handling of these critical patients. In addition, our research network includes a research group led by Susanne Herold and financed by the German Research Foundation (DFG), which is specifically investigating the mechanisms and new therapeutic aspects of viral-induced lung failure: In addition to influenza viruses and the former SARS virus, these investigations now naturally also include studies on lung failure caused by COVID-19.

"A great strain on general welfare"
Seeger on Coronavirus

Which current research project could already help in the clinic?

Seeger: Under our leadership, a large study has already been underway for three years to improve the immune and regenerative capacity of the lungs in virus-induced lung failure by administering a special growth factor to the lungs of ventilated patients via aerosol application. This study now also includes coronavirus patients. It’s currently being expanded to include a large study to test this treatment principle in affected coronavirus patients before they require ventilation, in order to prevent the progression of lung damage until they need to be ventilated. This shows that we benefit from our lung research structure in Giessen to develop new therapeutic concepts for the current pandemic.

What surprised you about the new virus?

Seeger: What is surprising is that the lung failure drags on for so long. We have many patients who we artificially ventilate for more than three weeks, and we find that the regeneration of their lungs is very slow. This is very unusual. Of course, these patients have a risk of dying from complications in this process. We need a lot of patience and persistent optimal care until the lung tissue has recovered.

What does it mean for a person if he has to be ventilated for more than three weeks?

Seeger: Three or more weeks of intensive medical treatment with artificial respiration are a great strain on the body’s general condition, with a considerable loss of muscle mass, weight and strength. In addition, there is the psychological trauma of having suffered a serious illness that is close to death. Fortunately, in most cases a complete physical recovery is achieved, and the mental stress can also be managed very well by the vast majority of patients. There are open questions regarding the lungs’ ability to regenerate: “normal” pneumonia can usually be completely overcome. The lung is able to completely restore the delicate architecture of the lung tissue. However, if the course of the disease is very long, chronic changes may occur, and we cannot yet fully assess for pneumonia caused by coronavirus infection. However, we know from other lung infections the reaction pattern of an incipient chronic damage caused by a long course of disease and ventilation. We hope to be able to prevent this to a large extent in coronavirus patients through clever therapeutic management.

Is this not exactly where the study you mentioned about supporting regeneration might help?

Seeger: Yes, because it’s a different approach from current therapeutic concepts that are primarily aimed at preventing the virus from entering the cells of the lung or multiplying in these cells. Our approach aims to strengthen the lungs in their natural regenerative powers. This is of interest beyond the specificity of the virus, because such an approach could also be valid for future attacks on the lung with modified viruses.

You mentioned the supply region. How does the cooperation work in concrete terms?

Seeger: The 17 hospitals from the Giessen district, the Lahn-Dill district and the Wetterau district are divided into levels 1 to 4. Level 1, which includes us and the Kerckhoff Clinic, are hospitals of absolute maximum care, in which extracorporeal membrane oxygenation, or ECMO, can also be carried out as standard. This is an artificial lung replacement procedure that is used when patients are in such a severe stage of lung failure that they cannot survive even with machine ventilation. Levels 2 and 3 are graded levels of care, and Level 4 are homes that do not actually take COVID-19 patients, but are designed to relieve the burden on other homes by taking in non-COVID-19 patients.

"In Germany we are very well positioned in intensive care medicine"
Seeger on Coronavirus

What is the result of the unusual cooperation so far?

Seeger: The cooperation is going very well and provides an overall view of the condition of patients suffering from severe COVID-19 disease in the region. We go through the patients every day in a telephone conference with the responsible heads of the hospitals and coordinate the procedure. In particular, we decide whether patients need to be transferred from a lower level home to a level 1 home when their condition has reached a certain severity. Material shortages are also compensated.

If you look out of the city at the Seltersberg, the clinic is like a battleship that guards Giessen. And you are the captain. Would this be an accurate comparison?

Seeger: In such a crisis, a leading institute plays a central role. And that is a good thing. You can see from the international infection and death figures that we in Germany are very well positioned in intensive care medicine. But, of course, a maximum-care hospital can only fulfill its role if it’s well integrated in the region, has a team of excellent, very experienced doctors and competent, highly motivated intensive care staff. All of them, as well as the committed various professional groups also involved, are the supporting pillars in this stressful situation. In this respect I will be very modest: A leading role in a complex structure such as a clinic is only possible if there is a cooperation structure that has grown over many years and there is willingness from everyone to make a maximum contribution to the care of seriously ill patients. It fills me with gratitude to have these prerequisites in Giessen.

But employees also are waiting for the day when things will be back to the way they were before. Will that day come?

Seeger: That is difficult to say. We will probably rather experience a “new normality”. If it’s not possible to create immunity for large population groups in the foreseeable future with a vaccination, it seems that this viral infection will accompany us for a very long time, even if it may subside a bit seasonally. Even if there are already a considerable number of infected people in Germany and the number of unreported cases may be many times higher, we will probably have considerably less than two million people with coronavirus immunity in Germany at present. And with 80 million citizens, anyone can calculate that it would take a very long time before “herd immunity” is achieved.

So does that mean, waiting for vaccination?

Seeger: Yes. According to current knowledge, this waiting time can only be shortened dramatically by vaccination. I think we will first have to get used to this virus, control it in terms of outbreak intensity and adjust the health care system accordingly. At the same time, the challenge is to simultaneously provide more and more care for uninfected patients who are currently somewhat relegated to the background. After all, non-coronavirus patients are not suddenly “second-class patients”, they must be given the same optimal care as they were before the coronavirus pandemic. For us, this means that we have to remain flexible, return to “normal operations” and at the same time remain prepared for coronavirus patients.

"Infected areas in hospitals are almostly hermetically separated from other areas"
Seeger on Coronavirus

To do this, you have to take away people’s fear of infections while in the hospital.

Seeger: Yes. It’s not like we rabidly shut down routine operations. We are currently still refraining from very elective procedures that can be postponed without consequences, but we are still carrying out everything that is medically necessary. But it’s also the case that many patients do not come to the clinic at all due to fear of infection. We urgently need to correct this, because we definitely see many patients in the emergency room who come much later than would be necessary for optimal treatment. Some even come so late that they cannot be helped. This is wrong. The infection areas in the hospital are virtually hermetically separated from the other areas, and the routes of infection are so controlled that I think it’s easier to become infected in a shop in the city center than in our hospital.

When you sit with a glass of wine in the evening, what goes through your mind? 

Seeger: I consider whether I have considered everything necessary and whether we are sufficiently prepared for new developments. But that is not unusual for a hospital director. This accompanying concern is always there, almost routine. Of course, I look at worldwide figures and sometimes I think, dear God, how are we supposed to deal with this situation beyond the health care system – in the economy, in social matters, with regard to many personal fates? And how will this pandemic strike in much less developed regions, and what can we do then?

And what does the medical profession think about politicians? 

Seeger: I think that politicians in Germany have done a very good job so far. There are always one or two things that could have been done differently. But since it has definitely become clear what problems we are dealing with and what catastrophes this virus can lead to, very consistently effective measures have been implemented which – in my opinion – have a high level of acceptance among the population. However, it’s also normal that a discussion should now begin on the extent to which individual measures can be withdrawn, because these naturally have serious, sometimes devastating, effects. On the other hand, we must not allow the health system to become relaxed. All in all, we in Germany can be somewhat proud of the fact that a democracy is very capable of taking action even in critical situations, with broad support from the vast majority of citizens. That is a very good sign!

This interview by Marc Schäfer was first published as „Experte zu Corona: Chronische Schädigung der Lunge möglich?“ in the „Gießener Allgemeine Zeitung“.

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