With the first confirmed case of COVID in the Rhine-Neckar County, a new chapter began for UKHD and MFHD in late February 2020. Employees faced the challenge posed by the pandemic with team spirit, interprofessional collaboration, and a plethora of ideas. Hear and read more about our daily routine during Corona, the innovative initiative of the Corona Taxi and about the projects in the University Medicine Research Network (NUM).
540
In-hospital COVID-19 patients in 2020
211
Graduates of the summer semester 2020
507
Home visits Corona Taxi May through December 2020
Working in Corona times: What has changed, what have we learned?
The emergence of the first COVID cases in Germany was followed by an intensive phase with tensions and the confrontation with an increasingly serious situation. The hospitals in the metropolitan Rhine-Neckar Region bundled their capacities and forces and assumed more responsibility for the workers and the people in the region. UKHD coordinated the care of COVID-19 patients centrally and managed emergency concepts and infection protection measures. The Medical Faculty also launched the summer semester of 2020 under these special circumstances. Almost all course offerings of “Preclinical Studies”, the first phase of the study of medicine, were prepared in digital form and integrated into an online teaching and learning platform.
Listen now: Prof. Dr. Uta Merle and Carina Schweitzer in the podcast
How does it feel to be fighting on the frontlines? How has the pandemic changed the work and the everyday routines at UKHD? Moderator Robin Krüger, a male nurse at the Department of Neurology, speaks with Prof. Dr. Uta Merle, acting Medical Director of the Clinic for Gastroenterology, Infections and Poisonings) and Carina Schweitzer, an anesthetic and intensive-care nurse.
Carina Schweitzer, anesthetic and intensive-care nurse
Prof. Dr. Uta Merle, internist
Carina Schweitzer & Prof. Dr. Uta Merle
Everyday life with Corona means solving problems in record time. (German only)
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Robin Krüger: Welcome to our podcast with Carina Schweitzer, an anesthetic and Intensive-care nurse in the Gastroenterological Intensive Care Unit at the Medical Center in Heidelberg and Prof. Uta Merle, acting Medical Director of Gastroenterology at the Medical Center in Heidelberg. We are speaking about the coronavirus pandemic today. Professor Merle, what have we learned from the pandemic?
Uta Merle: It was possible to engage in research in an accelerated form for the purpose of learning more during the pandemic. We were compelled, of course, to act very quickly and to conduct research, but at the same time, we did not have the pressure of having to read the guidelines before doing anything, because there were no guidelines initially. Due to the acute situation, we also had more liberty to trigger research projects, generate knowledge, and discover new aspects of the disease every day. This led to extremely agile collaborations. We built up and expanded a network and the interaction with various other departments and the Thoraxklinik (Lung Clinic). This resulted in follow-up projects, which were not only related to COVID-19, and to interactions and networks throughout Germany.
Robin Krüger: Carina, what challenges did you face? When you look back and think about the situation, what were the one or two most difficult problems that you had?
Carina Schweitzer: The pandemic revealed that the usual strategies were no longer possible because there was a demand for a high degree of flexibility, especially due to the fluctuating infection rates. Ultimately the most difficult problem was planning the deployment of our nursing staff and, of course, bed planning as well. The question of how many COVID patients we can care for was another challenge. For us, the patient comes first, and we always wanted to maintain the best possible care of our patients. Interface management was also difficult because, of course, not only was the focus on nursing care during the pandemic, but also the interfaces to the laundry or cleaning services. These are all people who have been trained in hygiene and they also had to react flexibly, of course. The treatment also presented us with challenges because the virus is mutating and therefore, the patients’ symptoms are changing as well. This means that the first wave could not be equated with the second or third wave, as far as the impact on the treatment and ventilation strategy was concerned. All the problems had to be resolved in record time and I am very proud to be able to say that we, the team of the Gastroenterology ICU, managed to do so.
Robin Krüger: What touched you especially during the COVID pandemic and during your work?
Carina Schweitzer: We were confronted with fates that really went to the heart. For me, the worst thing was seeing how people were scared to death the only person who was able to give them a bit of confidence at that time was me. Having these images in front of your eyes – it is very hard for me to put this into words – how these persons watched me and depended on me; it was like they were saying: please help me, I cannot go on like this, I cannot breathe. And yes, I still have these images in my head and that really touches me. I hope that I was able to give these people a bit of confidence and security at that time.
Robin Krüger: Professor Merle, what are you still doing with the issue of long COVID?
Uta Merle: Quite a lot really. Long COVID is an interesting and challenging syndrome. We now have a special outpatient clinic for long COVID at the Center and are working together on a project with the Department of General Practice and Health Services Research. Long COVID also frightens patients. This is because these are people who used to be healthy and had a mild course of the illness. But then they did not recover or developed symptoms during the infection. We receive many inquiries from patients who want to come to our outpatient clinic. However, we still know very little about long COVID and still do not have any treatment approaches available. For this reason, the project that is funded by the State of Baden-Wuerttemberg is precisely the right one to promote rapid knowledge about long COVID, and in a network with family physicians and the special outpatient clinic, if possible. Because what you really need is to accrue this knowledge as quickly as possible in all areas, including among family physicians. You cannot and do not want to treat all patients affected at the university hospital. This does not make any sense, so that now we are working on building up an agile, functioning network with family physicians to disseminate the knowledge acquired as quickly as possible, to exchange information, and to learn, and to accompany this whole process scientifically. The network components play an important role in improving the workflows, especially in diagnostics, to avoid duplicate tests, among other things. As our next step, we want to expand these bundled activities on long COVID across all locations in Baden-Wuerttemberg and are planning to apply to the BMBF1 for funding. This is also our new topic which has led to working in a network and to new collaborations – in the case of general medicine. And this a new pet project of mine.
Robin Krüger: 2020 in short. Would you like to mention anything that is particularly close to your heart?
Uta Merle: Yes, I find you cannot do enough to make people aware of how fantastic the teamwork and team performance was during the pandemic. In a situation, where we did not even know how the coronavirus infection was precisely transmitted and whether you could get the virus by simply touching something. Therefore, we should not forget what our colleagues have accomplished because they simply had to jump in and deal with the situation.
The pandemic has further increased collaboration and interaction between professional groups, departments and clinics.
Due to the constant changes in the pandemic situation, the most difficult thing was planning staff deployment and beds.
“In the ongoing crisis, the strength of the campus was demonstrated through the many links in networks and collaborations, both locally and nationally. The pandemic would not have been able to be overcome without the lasting engagement of the nursing staff, the physicians, and all other employees.”
Looking back on an unusual time: Interview with Edgar Reisch, Director of Nursing.
How are the nursing staff doing after a year and a half of the pandemic?
The last few months have been an exceptional situation for everyone, both professionally and privately. For the nursing staff in particular, the pandemic brought with it a lot of additional work and emotional stress over a very long period. Due to the restricted and necessary visiting arrangements, our employees were in many cases the most important contact for seriously ill people. This leaves no one untouched. At the same time, the nursing staff, like all of us, lacked compensation through leisure activities or social contacts. Over the summer, we currently had no or hardly any intensive care patients through Corona, so our employees could finally breathe a sigh of relief. Despite everything, we continue to be prepared and monitor the situation in the hope that we will be spared a fourth wave.
How did you personally experience this period?
In the beginning, as a member of the pandemic task force, I sat in meetings with the crisis team almost every day. In terms of local and regional supplies, there was a lot to discuss and decide. It started with the procurement of masks and ended with the protection of patients and employees. I am glad that despite the uncertainties and challenges that this pandemic brought, the care of those affected by COVID was always ensured. The coordination center, which distributed sufferers in Heidelberg and the entire region, also contributed to this. But even beyond that, we were able to guarantee care for all other illnesses and emergencies at the hospital at all times. And last but not least, there was always a great deal of solidarity: employees increased their working hours, nursing staff from other areas provided support on the wards. This cohesion has touched me very much and made me proud.
The Corona Taxi was our answer to the pandemic
Crises make people inventive. An interprofessional project launched as an initiative taken by the nursing staff together with the physicians and the city health department proves this.
“One of our first patients, who had previously been only mildly ill, suddenly showed a deterioration on the seventh day and developed a need for oxygen. He had still been fit on the day before”, recalls Prof. Dr. Uta Merle, acting Medical Director of the Clinic for Gastroenterology, Infectious Diseases and Poisonings at Heidelberg University Hospital (UKHD)”. We were really shocked about this then still unexpected course. At the same time, we were worried that such an acute deterioration could also affect outpatients who were quarantined at home.”
To prevent this, the idea of a corona taxi arose: The project, which also drew international attention, had the goal of closely looking after patients quarantined at home via the telephone and with home visits. In this way, it was possible to recognize at an early stage when hospitalization is required.
The first COVID taxi was deployed on March 14, 2020. Karin Tarbet, a specialist nurse at the Medical Center has been involved in this project since Easter 2020 and is still regularly underway with the COVID taxi. She always goes on her “quarantine tour” together with an employee from the city health department. “Depending on the symptoms, we measure the patient’s blood pressure, monitor the level of oxygen saturation in the blood, and take a blood sample. The lab diagnostic tests are performed centrally at UKHD”, explains Tarbet.
If a home visit to a COVID-19-patients in quarantine is required, the COVID Taxi will start.
In the early days, the project was carried out by nurses and medical students in cooperation with the health department and the coordination office of the Rhine-Neckar district.
The exemplary Corona Taxi project was organized in a very short time and attracted worldwide attention.
Initially, the project was carried out by nurses and medical students in cooperation with the city health department and the Coordination Office of the Rhine-Neckar County. All positively tested persons in Heidelberg and in the Rhine-Neckar County were registered by the city health department and reported to the “Corona Call Center” at UKHD daily. Students and medical students in their practical year of studies contacted the persons affected and asked them about their symptoms and health status.” A challenge in the project was the predictability. It was difficult to predict how many people we would be looking after and visiting per week, especially in 2020, due to the fluctuating incidence rates. “Accordingly, we had to react very flexibly”, says Alexandra Noll, Coordinator of the Corona Taxi deployments and manager of nursing at the Medical Center. “In these turbulent times many colleagues managing wards and their employees actively supported us”.
As of September 2020, the Call Center was replaced by an app into which the patients were able to enter their findings, which in turn were monitored by the medical staff. If those infected with COVID displayed stronger symptoms or complained about respiratory distress or problems with food or liquid intake, the nurses discussed this with the Prof. Dr. Uta Merle, the Medical Director, and arranged for hospitalization if necessary.
In many cases, the telephonic contact and monitoring via an app was sufficient to evaluate the situation. With about three percent of the afflicted, a phone call was enough to determine that a person had to be admitted to the hospital. In addition to monitoring the health data, may patients report that the contact with the nurses helped them a lot to cope with their fears and uncertainties during the quarantine. In the meantime, psychosomatics is also a fixed element of the project, so that people who are mentally under a lot of stress due to this situation can be helped quickly and professionally.
The Corona Taxi is a stroke of luck for the region. The active monitoring of COVID-19 patients was able to prevent a severe course of the disease in many cases. “During peaks, we were on the road with eight taxis. Now we only have one taxi in operation and visit about two patents per day. Things are looking up”, Tarbet is pleased to report.
Federal research with a vision: Research Network of University Medicine (NUM)
The challenges posed by the novel coronavirus SARS-CoV-2 have made us fully aware of the value of healthcare and research. In April 2020, during the first wave of the coronavirus pandemic, the German Federal Minister of Education and Research Anja Karliczek therefore initiated the Research Network of University Medicine (NUM).
After intensive preparation, NUM launched 13 funded projects which contribute to a better understanding of COVID-19, secures the best possible care of COVID-19 patients, and is also intended to prepare Germany for other pandemics.
UKDH is part of NUM and involved in eight of the 13 projects.
In this unique network, the competencies from a large spectrum of specialties are bundled, so that this and future pandemics can be coped with the cumulative knowledge. The network of university medicine is funded with 150 million euros from April 2020 to the end of 2021. An extension until the end of 2024 with an annual funding volume of 80 million euros, has been promised meanwhile.
Healthcare research in real time (AKTIN-EZV)
How many patients go to the emergency room daily with which complaints? How urgent is their treatment? How does this reflect the heath situation throughout Germany? With the AKTIN-Emergency Register this information can be collected in a decentralized manner in the participating hospitals and evaluated. AKTIN stands for “Action Alliance for Information and Communications Technology in Intensive and Emergency Medicine” and makes it possible for the first time to monitor what is happening in the emergency rooms of hospitals during the pandemic, in future pandemics, or for other events relevant for healthcare in real time.
The Robert Koch Institute (RKI) has been receiving this real-time data on the situation in German emergency rooms during the COVID-19 pandemic since March of 2020. The automatic supply of data to the RKI and to local health authorities as well as the utilization of the data are to be further developed during the project.
Contact: PD Dr. Lars Kihm, Clinic for Endocrinology, Diabetology, Metabolism and Clinical Chemistry
Effective, but also commensurate testing and monitoring strategies (surveillance) for various population groups are indispensable for the containment of a pandemic. They provide data on the emergence and spread of COVID-19 infections, which can then be used to plan, take. and evaluate measures. Without such strategies, no scientifically based recommendations can be given to regional and national decision-makers from the public healthcare system, society, and politicians.
In the B-FAST research network, teams from 26 university clinics work together. The overriding goal is to develop a sustainably deployable surveillance and testing strategy that can be transferred to future pandemics. On the B-FAST platform, the necessary testing and surveillance systems are networked into one overall system and the relevant information and recommendations of all university hospitals, the Robert Koch Institute (RKI) and other parties involved are made available through the network.
Contact: Dr. Claudia Denkinger, Center for Infectiology, Section Clinical Tropical Medicine
Since the beginning of the pandemic in the spring of 2020, large quantities of research-relevant data, materials and insights have accrued in the IT systems and electronic patient records from the care of patients with COVID-19, which must be collected in standardized ways, if possible, in a timely manner, and then merged centrally, and evaluated. Teams from various sites are building up a joint research data platform called CODEX to make these collected data related to COVID-19 available for research purposes. These data are recorded according to uniform requirements and thus offer a broad and scientifically high-quality basis for various evaluations and complex research issues.
Deutsches Forschungsnetzwork Autopsien bei Pandemien (DEFEAT PANDEMIcs)
Autopsies make an important contribution to understanding COVID-19, because they deliver important insights into the severe course of the infectious disease and its impact on the organism at an early stage. The objective of the network DEFEAT PANDEMIcs is to standardize the legal and organizational prerequisites and the pathological-virological diagnostics for autopsies throughout Germany during a pandemic. With the buildup of this platform, data, bio samples, and insights can be gathered and merged in a standardized form. Therefore, they are retrievable and evaluable to cope with the ongoing COVID-19 pandemic and at the same time as preparation for possible future pandemics. Most pathological, neuropathological, and forensic institutes at German university hospitals as well as non-university partners have joined this unique network.
Documentation of COVID disease progressions (NAPKON)
The “Nationale Pandemie Kohorten Netz (NAPKON)” is a platform for the comprehensive documentation of clinical data from the areas of prevention, diagnostics, and therapy, of bio samples and imaging as well as information about risk factors and possible biomarkers for COVID disease progressions. Hence NAPKON creates the fundamental infrastructure for a better understanding, resistance to and combatting pandemics using COVID-19 as an example.
Due to central coordination and access possibilities, scientific and care-relevant projects can be implemented comprehensively and quickly. With the extensive quality-assured data researchers can investigate issues related to the risk factors of the pandemic, disease progressions, and late sequalae and to obtain representative results. In this way, short-term treatment recommendations can be developed or measures to combat the pandemic can be evaluated and refined.
COVID-19 can directly and indirectly affect organs in addition to the lungs and the respiratory tract, especially during severe disease progressions. The severity of this organ involvement has a direct influence on the individual prognosis and treatment. The “Nationale Kompetenznetz Organo-Strat” will make a key contribution to understanding COVID-19 and the organ involvement related to this disease. This network of university hospitals and high-security laboratories intends to develop and implement standards for organ models and the data management to research COVID-19 and other diseases. In particular, the organ models are intended to allow more meaningful studies on organ involvement than previously.
At the same time, the structure that has been established serves to prepare for future pandemics, as information on its impact on the various organs can be provided immediately as of the emergences of a new pathogen.
Radiologic data, e.g., from computer tomographic studies, play a key role in the diagnose and disease progression of a COVID-19 disease with lung involvement. Therefore, radiologic imaging is an important instrument for monitoring treatment and as a decision-making tool and measuring instrument of pandemic lung diseases.
An obstacle to the systematic collection and evaluation of radiologic data to date was the input of the findings in free texts that are not easily machine-readable. A structured and uniform collection, archiving and processing of medical data will remedy this situation.
As the first network of this size, RACOON will build up a nationwide infrastructure for the structured gathering of radiologic data from COVID-19 patients. In the future, this uniform data collection will offer the possibility of joining epidemiological early warning systems or medical assistance systems based on artificial intelligence and a quality-assured basis for research studies.
Analysis of individual and collective immunity (COVIM)
The development of protective immunity can prevent infections and have a critical impact on the COVID-19 pandemic. Therefore, it is particularly important to identify and assess immunity characteristics at both the individual and population levels: Who is immunologically protected from SARS-CoV-2 infection, by what means, and for how long? How can immunological protection be transferred from a few immune individuals to many non-immune individuals?
Studies on this are already underway at many sites in Germany. The main goal is therefore to network and harmonize these research approaches and to establish central platforms. The project combines the expertise and data of many researchers from different disciplines, such as immunology, virology, clinical infectiology, pneumology, nephrology and microbiology from all over Germany. In the collaborative project COVIM, parameters are defined that enable the determination of immunity against COVID-19 in a standardized manner. In addition, therapies and drugs are being developed that aim to transfer immunological protective mechanisms to diseased individuals or to individuals at high risk of contracting the disease. At Heidelberg University Hospital, the immune response of immunosuppressed patients after organ transplantation and dialysis patients to COVID-19 vaccination is being investigated as part of COVIM.
