From fear to routine: One German hospital’s Covid-19 marathon

No matter if a viable vaccine is coming on the market soon or not, Germany's Aachen hospital already knows there will still be a marathon to run when it comes to treating patients worst hit by the coronavirus.

From fear to routine: One German hospital's Covid-19 marathon
The exterior of the University Hospital in Aachen. Photo. Ina Fassbender/AFP
No matter if a viable vaccine is coming on the market soon or not, Germany's Aachen hospital already knows there will still be a marathon to run when it comes to treating patients worst hit by the coronavirus.
“We've learnt that it's an illness with very long legs, and we must not give up after 10 or 15 days but keep at it,” Gernot Marx, who heads the intensive care unit at the university hospital, told AFP.
“The patients who have received the longest treatment were with us in intensive care for 60 days and they really came back from the brink. That is certainly a very important lesson we have learnt.”
Marx and his team were on the frontlines when the pandemic first hit Germany in the spring.
During that first wave, half of the Covid-19 patients in Germany who were put on ventilators succumbed to the disease.
This time round, Marx, 54, hopes more lives can be saved as healthcare practitioners have a better understanding of how best to treat the most severe cases.
Recalling a patient in his fifties who ended up in intensive care even though he had no pre-conditions, the doctor said: “We fought for weeks. He was put on all sorts of machines that we had available and today, he's back home and in pretty good shape. That shows that every effort is worth it.”
A nurse takes care of a Covid-19 patient in the intensive care ward at Aachen hospital. Photo: Ina Fassbender/AFP
'Fear gives way to routine'
Behind the glass door of one of the hospital's critical care units, four patients are kept alive thanks to respiratory machines and infusions. Wearing masks, surgical gowns, glasses and two pairs of gloves each, Marx and his team are on their ward rounds.
Today, it's the patient in bed 9 who needs the most attention.
An ultrasound examination is followed by a discussion. Her treatment is adjusted, as doctors hope to save one more life.
More than 12,000 people in Germany have died after catching the virus, the grim toll dwarfed by devastating numbers recorded in other European countries, including Britain where over 50,000 have succumbed.
At the next bed, Marx checks on a patient who has a respirator with its multiple tubes as well as drips inserted into his upper body, feeding him drugs that help with blood circulation, send him to sleep among others.
“If he doesn't receive this medication, he will die in a few minutes,” said Marx.
Just across the aisle at bed 12, there's encouraging news. Preparations are underway to move the patient whose condition has stabilised.
The next step for him would be to learn to breathe on his own again, before a physical rehabilitation that would run for a further few weeks.
“The first time round, everything was new. There was a lot of fear and uncertainties,” recalled Marx of the emergency in March and April as the world was just waking up to the pandemic. With experience, all that has given way to routine.”
A doctor take care of a Covid-19 patient in the intensive care ward at Aachen hospital. Photo: Ina Fassbender/AFP
Germany has so far coped with growing hospitalisations, with 6,000 intensive care beds still available.
But health officials have repeatedly warned that infection numbers must urgently come down if hospitals are to be able to handle new admissions in coming weeks.
Official data show those admitted to intensive care stay on average nine days while those requiring ventilation stay 18.
On Monday, the number of coronavirus patients in intensive care exceeded the record reached in the first wave.
With thousands of new daily infections, “the number can only rise in the next weeks,” said Marx.
Around two percent of those afflicted with Covid-19 end up taking a bad turn, usually after 10 or 12 days of illness.
Aachen hospital is now treating around 40 patients with coronavirus, more than half of them in intensive care.
Marx says the hospital can cope, but warned that a chronic deficit of healthcare personnel countrywide is worsening because some staff are put on quarantine over infection fears while others are downed by the winter seasonal flu.
Some non-urgent operations are already being postponed. Unlike in spring, however, there has not been a total halt to such surgeries yet.
“We are adapting,” said Marx. “We can take in new patients at any time but are taking on fewer (non-urgent) operations.”
In Berlin, a makeshift medical centre with 90 beds that was set up in the capital's huge exhibition halls is likely to remain in place until May 2021.
Over in Aachen, bed number 12 will likely be ready for a new patient.

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EXPLAINED: The new rules around getting a sick note over the phone in Germany

Due to high Covid infection numbers throughout the summer, it’s now possible to get a sick note from a doctor over the phone again for some illnesses. Here’s what you need to know.

EXPLAINED: The new rules around getting a sick note over the phone in Germany

What’s happened?

In spring 2020, German authorities changed the law so that people with a mild upper respiratory tract illness, such as the common cold, were able to get an incapacity to work certificate or AU-Bescheinigung by simply calling and speaking to their GP.

The rule was extended several times and finally reversed on June 1st this year due to falling infection figures. Since then people have had to go back to the practice – or do a video call if the doctor’s office has that system in place – to get a sick note.

Now, due to a decision by the Joint Federal Committee, the regulation has been reintroduced and patients can call their GP again for a sick note.

Can I get a sick note over the phone for any illness?

No. As before, the regulation only applies to patients suffering from a mild upper respiratory tract illness. Though Covid has not explicitly been named in the announcement, it seems that it is intended to be covered by the regulation.

If the doctor is convinced that the patient is unfit for work after a telephone consultation, then they can issue a sick note for up to seven days.

READ ALSO: EXPLAINED: The changes around doctor’s notes in Germany you should know

If the symptoms persist after seven days, the certificate can be extended once more for another week.

Why now?

According to the Chairman of the G-BA, Josef Hecken, the regulation has been introduced now as a response to rising Covid numbers and in anticipation of the cold and flu season in the coming months: “We want to avoid full waiting rooms in doctors’ offices and the emergence of new infection chains,” he said.

The telephone sick leave rule is a simple, proven and uniform nationwide solution for that, he said. The rule is also necessary because video consultation hours are not yet available everywhere.

What else should I know?

The health insurer DAK is calling for telephone sick leave in the case of light respiratory diseases to be made possible on a permanent basis in Germany. DAK’s CEO Andreas Storm said that this should “not always be up for debate, because it has proven itself.” 

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

The social association VdK also welcomed the reintroduction of the rule. The VdK’s President Verena Bentele said that the regulation would help to protect high-risk groups in particular from potential infections.

What are the rules to know about sick notes in Germany?

Germany has a strict system in place. If you are sick, you need to give your employer a Krankmeldung (notification of sickness) before the start of work on the first day (of your illness).

However, you also need to hand in a Krankschreibung (doctor’s note) on the fourth day of your illness. Some employments contracts, however, require you to submit a sick not earlier than the fourth day so check with your boss or HR on that point.