Management of the Covid-19-Pandemic in Germany

  • In March 2020, the pandemic "plans" of the federal government of Germany as well as Hessen seemed to provide for a diffuse treatment of CoVID-2019 patients in any hospital. These plans were vague. Terms were indefinite. They did not provide specific instructions for action.
  • Background: The authorities had simply failed to create a real management plan for such a pandemic.
  • Italy had the same problem. In March 2020, everyone treated everyone everywhere. The entire health system failed after three weeks.

  • The content of this page is a proposal from our research team. It does not correspond to any of the treatment instructions currently used in Germany. It is based on the adaptation of the highly positive experiences gathered in China to the German situation. It is meant as a contribution to the discussion. Please help to improve this proposal.

What do we have to do in Germany?

  • Not every hospital is allowed to accept CoVID 2019 patients. We need specialized treatment centers with:
    • Acquisition units for clinical diagnostics and medical history
    • Computed tomography (CT) scanners
    • Immediate laboratories
    • CoVID-2019 special clinics
    • Isolation centers

  • We need better case definitions.
  • We need a clear, nationwide schedule.

Treatment centers

  • Every district and independent city needs:
    • a diagnostic center: this can be an administrative or office building.
      • per suspected case: 1 single room, in which clinical diagnostics and anamnesis take place
      • a short distance away: 2-3 CT scanners in the immediate neighborhood (any makeshift dwelling will do)
      • a rapid laboratory for PCR tests
      • clear path markings
      • doctors, nurses, documentation assistants, cleaning staff
      • decontamination locks for the staff
    • a CoVID-2019 special clinic: this can be one of the district hospitals or one of the city clinics.
      • It should be close to the diagnostic center.
      • The intensive care beds for CoVID 2019 cases must be centered here.
      • This is where to treat all risk patients and every serious or critical case.
    • a primary isolation center: this can be a sports or event hall.
      • All CoVID patients in the "mild" and "moderate" case groups are admitted here.
    • a secondary isolation center: This can also be a sports or event hall.
      • Here you can gather all patients and all suspected cases that have opposed the directive of stationary or domestic isolation.
    • a tertiary isolation center: This can be a hotel.
      • Here you include all those who are obliged to isolate themselves, who should/cannot be isolated voluntarily or on order together with unaffected family members, as their relatives belong to infrastructure-important occupational groups (examples: healthcare, power plant employees, drivers in the utility service, prosecutors, police officers).

Mobile CoVID-Teams

  • Every county or city has to have diagnostic teams for:
    • smear drive-throughs that run on certain roads
    • examine occupants of each car (double testing is even useful).
    • home visits, on which all residents are tested by throat / nose swab and fever measurements.

  • Each district and city has therapeutic teams for:
    • the care of suspect patients in domestic isolation who need to be followed up on their illnesses, but not admitted to special hospitals or isolation centers.

How?

Based on the very good experience in Hubei in February 2020, we suggest the following treatment route for Germany:
  • If you think you are infected, stay at home for at least 14 days.
    • Measures fever every day.
    • Those who live with others (family, friends, shared living) stay in isolation with their entire household.
  • If you get a cough or fever (Body temperature > 37°C ; any measuring method) or if your general condition deteriorates, further examinations are initially carried out in the diagnostic center only. The patient therefore never visits his family doctor or an emergency room in this situation!
    • Everything will be done in the diagnostic center.
    • Clinical examination of suspected cases is carried out.
    • The medical/social history is taken.
    • Contact tracking is initiated.
    • Blood is drawn.
  • Anyone who is NOT termed a CoVID 2019 patient in the assessment of the diagnostic center will go home.
    • Now, he (always used instead of "he/she" etc.) contacts his family doctor.
    • However, because he has visited the diagnostic center, he is forced to stay at home for 14 days.
    • or: depending on the patient's overall clinical situation is forwarded to a NON-CoVID-2019 clinic, which has been specially trained for CoVID-2019.
      • isolated for 14 days
      • treated by fully protected medics
  • Anyone who remains a suspected case after the initial examination will receive a thorax CT
    • If the thorax CT does not show findings suspicious/suggestive for COVID-19, a PCR exclusion test is carried out.
      • The result must be available within 4 hours.
      • Waiting for the result, the suspect patient remains in the diagnostic center in a single room.
    • If CT and PCR are negative, the patient returns home.
      • However, because he has visited the diagnostic center, he is forced to stay at home for 14 days.
      • He is cared for by a specially trained team of general practitioners.
      • According to this procedure, the following applies in the case of a positive PCR test: suspicion confirmed, the patient is termed "definitely ill".
    • If the thorax CT shows findings suspicious for COVID-19, a first PCR exclusion test is carried out.
      • The patient is considered to be "with high probability" ill.
  • Anyone who is "with high probability" or "definitely ill",
    • but neither "seriously" nor "critically" ill
    • or who is not older than 70 years old, and without defined previous illnesses,
    • will be sent into the primary isolation center. There, he gets examined every day.
  • Voluntary entry to a tertiary isolation center is permitted under certain circumstances (see above), to whom domestic isolation has been imposed.
  • All other patients come to the dedicated CoVID 2019 hospital.
  • The CoVID-2019 hospital, the isolation center, or the home isolation leaves as "cured", who:

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Other important measures

  • Fever measurements
    • Transmission of SARS-CoV-2 is rare in infected persons without symptoms.
    • most common undetected symptom: temperature increase (cut-off level: 37°C/98,6°F)
    • measurement at wrist or forehead, 2 cm (0,8 inches) distance to the skin
    • general occasions for measurements
      • airports, railway stations etc.: every passenger
      • hospitals, doctors' surgeries, retirement homes, parliaments, authorities: everyone, when entering, when leaving
      • further treatment at the CoVID-2019 centre or by a mobile CoVID-2019 team in case of suspicious findings
  • swabs for direct SARS-CoV-2 detection (PCR)
    • all people important for the infrastructure during the crisis
      • every 3 days
      • not performed by themselves or by laymen
      • deep pharyngeal, 15 seconds long

  • If we take this path,
    • we can master the pandemic.
    • we will handle resources carefully.
    • we will also have the much needed capacities for the continuous or new treatment of illnesses/ trauma independent of SARS-CoV-2.

What should not be kept secret

  • Those, who are not found at home by the diagnosis or therapy team, even though they have been prescribed domestic isolation, are directed to a secondary isolation center.
  • Protection by the police is required for
    • mobile diagnostic teams.
    • diagnostic centers.
    • secondary isolation centers.

  • Every location in every district needs a sufficient number of body bags and cooling capacities (4% of the population).
  • Every district and every independent city needs a full-protection team of coroners. With CoVID-2019, the body examination is particularly dangerous. Nevertheless, it is also important for maintaining public order. Every dead person must be tested for SARS-CoV-2 using a PCR test, in addition to the regular physical examination.
  • Burials cannot take place in the presence of mourning communities.
  • Individual burials might not be possible throughout.