The spread of the coronavirus is putting pressure on the complex German healthcare system. Those affected feel it on both sides of the hotlines and practice doors. A look inside the crisis management apparatus.
Michael Kegler did not expect so much attention. Last Sunday, the 53-year-old translator from the Frankfurt area posted a tweet that has now been retweeted more than 2,000 times. “I am experiencing firsthand how seriously the #coronavirus in #Hessen is taken: I learned yesterday from the Portuguese press that a writer with whom I worked in Póvoa de Varzim has contracted # COVID19”.
Then Kegler describes in a thread his official odyssey: How he calls the coronavirus hotline of the Hessian Ministry for Social Affairs and Integration, the medical on-call service, the health department responsible for him, his family doctor, a doctor recommended by the health department and the Frankfurt University Clinic. to get tested. How he hardly got any further after 24 hours. How he is called by the health department after almost a whole day and finally examined and tested.
Kegler emphasized in an interview with DW that he had heard of other experiences and had been pleasantly surprised by the response from the health department. On Monday evening, however, he was nerve-wracked. “At some point, you get a little bit into this whole story and always think: Why am I doing this? I was ultimately frightened and amazed that it is not as easy as that I would have thought. “
As contact for a confirmed coronavirus sufferer, he expected to be sent directly to a ministry hotline where he would be tested. “Maybe that was my fallacy,” asks Kegler.
“I didn’t feel well informed in any way”
Kai Clemens * (name changed by the editors) also had personal experiences with how Germany is trying to contain the coronavirus, which has meanwhile infected at least 534 people in the country. The early 30-year-old from Baden-Württemberg recently spent a few days in quarantine in the hospital, from where he tweeted under the username Corona Influenza. He is currently in 14-day domestic isolation ordered by the health department.
His girlfriend had had flu-like symptoms after a business meeting and later learned that she had had contact with an infected person there. The medical on-call service sent both to a clinic, where they were separated. Clemens was negative three times, his girlfriend tested positive.
In his eyes, doctors and the health department did their best, says Clemens. However, he “did not feel well informed in any way. That is still a big problem. For example, the doctors said: For health reasons, we don’t actually have to keep you here. Home isolation protects others just as well from the infection, but Now you are here and we have unclear criteria or contradictions or no clear statements about when or how we can let you go. ”
The health department made an overwhelmed impression on the phone, says Clemens. He was “rather unclear” why the Federal Government did not set up a central hotline for the coronavirus, which advices around the clock, for example, people with mild symptoms and sends suspected cases to the public health office.
One system, many actors
This is exactly what the nationwide hotline of the emergency medical service (116117) does, which can also be reached outside the opening hours of medical practices. However, he still has to take care of all other inquiries – from vomiting diarrhea to acute back pain.
A spokesman said more than 140,000 calls were received last weekend. Among other things, the service wants to relieve general practitioners’ practices. Currently, he can still handle the number of calls, even if there are sometimes waiting times, said the spokesman.
The coronavirus clearly shows how complex the decentralized German healthcare system is. The Federal Ministry of Health and the federal states also offer citizen telephones at certain times for questions about the virus. In addition to a national pandemic plan, the countries have drawn up their own plans. The federal and state governments, the Robert Koch Institute (RKI) and local authorities are in constant contact with one another.
The central actors on-site are general practitioners, clinics and the local health authorities. The latter is responsible for disease control, receive instructions from the state governments and follow the recommendations of the RKI. Like general practitioners, they can deviate from them. This leads to different approaches across Germany when dealing with corona patients.
“Not all processes have been imported yet”
A few calls and e-mails show that the health authorities have their hands full these days. Four offices requested by DW were unable to find time for a telephone interview. A spokeswoman for the city of Bonn said in writing that the entire staff is currently deployed.
Colleagues from other areas are also working on the citizen phone, where around 100 calls were received per day (recently there were 700). According to information from the WDR, medical offices approved by numerous health offices in North Rhine-Westphalia are vacant.
“In the regions affected, all players are currently under great pressure,” said Federal Health Minister Jens Spahn (CDU) , “of course not all processes have been brought in yet”. From Veit Wambach’s point of view, the deputy federal chairman of the Association of Resident Doctors in Germany (NAV-Virchow-Bund), there is one main reason for this: the speed with which the situation has developed and new information becoming public.
According to the Federal Minister of Health Spahn, the spread of corona in Germany has not yet peaked
“At the very beginning, it was said that any suspicion should first be kept in the inpatient area. Now it is said that we definitely have to reserve the inpatient area for those who need it medically. That was, of course, a big change, but such adjustments are always necessary when the situation changes – and it really does change continuously, “says Wambach.
He himself discussed things differently with his practice team two weeks ago than ten or eight days ago. Wambach explains: “Someone who looks at it from the outside may find it insecure or confusing.”
Advances in protective materials and testing
“In really complex systems, not everything can always run 100 percent smoothly,” admits Wambach. The doctor is expecting considerable additional expenditure for general practitioners in the next few weeks and months. At the moment, however, most practices in Germany are “properly set up” with regard to the virus. However, there are considerable problems with the provision of protective material such as breathing masks and full-body protective suits.
Following a decision by the crisis team, the federal government now wants to procure protective clothing centrally. Another innovation: In view of the coronavirus in certain wards, clinics no longer have to adhere to the minimum staff limit for nurses.
According to the managing director of the Deutsche Krankenhausgesellschaft (DKG), Georg Baum, the hospitals are “in the best possible position and are preparing intensively for increasing numbers of infections and patients”. The practical implementation of pandemic plans is regularly trained.
Progress has also been made with regard to the tests. These are carried out in university clinics, private laboratories, general practices, larger hospitals, and other facilities. In Bavaria, the medical on-call service has also been offering home visits since this week, so that you can make compromises if necessary and bring them to laboratories.
The Association of Statutory Health Insurance Physicians in Schleswig-Holstein wants to set up tents and containers in front of certain practices in which tests can be carried out. The Berlin Charité in Berlin has also set up such a tent. According to the National Association of Statutory Health Insurance Physicians (KBV), there are currently capacities for around 12,000 tests a day.
14 days “Corona vacation”?
The virologist Alexander Kekulé has meanwhile called for significantly stricter measures than previously. In order to curb the spread of the coronavirus in Germany, all kindergartens and schools nationwide would have to be closed for 14 days, the director at the Institute for Medical Microbiology at the University of Halle demands.
The “Corona vacation” should also include the cancellation of all major events. The German Teachers’ Association and Minister of Health Spahn spoke out against comprehensive school closings.
With a little luck, the Corona quarantine will end for Kai Clemens this coming weekend. “I am most looking forward to the time when I can look back on my blatant experience with friends and family – above all my girlfriend who has fully recovered – with a smile,” he says.
Michael Kegler from Hesse, on the other hand, can already look forward to the all-clear: shortly before the incubation period expired, his test was negative. According to him, he had to wait 54 hours for the result.