Bonn Even before the flu epidemic, it was difficult to reach the doctor’s surgeries in Bonn. Now coronavirus is making the problem worse. The differing rules for nurseries and schools are also coming under criticism from medical practitioners.
Anyone who feels ill should see a doctor. But this could be difficult this autumn and winter. Consultations are filled with infected and suspected coronavirus patients and phones lines are blocked. It is even difficult just to arrange an appointment, which is usually required in the case of infection. Several unsuccessful attempts have been made at various general practitioner and paediatrician practices in Bonn in the past week. Nobody answers the phone. "Unfortunately, Telekom is not able to give us a busy signal", complains Axel Gerschlauer, chairman of the professional association of paediatricians in Bonn. In fact, the line is constantly busy. "The rush is already huge," says Gerschlauer. Patient uncertainty in view of the rising number of infections and the constantly changing regulations concerning risk areas and testing is enormous, he explains. "This now affects every second patient contact" he adds.
A response that, following written enquiries, is eventually heard from other medical practices. Martin Mücke runs a general practice with five colleagues in Wilhelmstraße. He says: "We are dreading how we are going to organise the practice when the number of cases significantly increases". Basic measures include two large waiting rooms, hand disinfection for all patients, and blocks of appointments for infections at the end of consultation hours to avoid constantly putting on and taking off protective gowns and visors. Evidently infected patients are sometimes referred to the test centres to relieve the burden on their own practice, he admits.
Dieter Kraft is the chairman of the district office of the North Rhine General Practitioners' Association. He wants infectious patients to be admitted to the surgery on an individual basis only and by appointment. He says: "We will hand out umbrellas so that people can then wait outside for a short time". Axel Gerschlauer has had partitions installed between the individual chairs in the waiting room and is working on a plan for ventilation. Patients will only be "channelled" into and out of the treatment room when the doors are closed. "I don't know how this is going to work when there are more cases," says Gerschlauer.
Bonn doctors do not think much of the proposal from Federal Health Minister Jens Spahn to separate infected persons from other patients by setting up special outpatient clinics. "That would be the second-best solution at most," says Kraft. On the one hand, the doctors there would lack prior knowledge about patients’ allergies or previous illnesses, for example. On the other hand, the special outpatient clinics, unlike the test centres, would have to provide complete medical treatment, which would require a lot of staff and equipment. "This could be done in hospital. But the clinics would be grateful at having to do this on top," says Kraft.
"Using a stethoscope, feeling the lymph nodes, taking blood samples, if necessary also x-raying the lungs, then of course writing a sick note for the employer and monitoring the success of the treatment," Johannes Kruppenberger explains. The virologist runs a medical laboratory with an affiliated doctor's surgery at the Propsthof. "We are in the starting blocks for an infection outpatient clinic," he reveals. His team can treat 20 to 30 patients a day there and also reliably diagnose infections other than COVID-19. "However, if the flu epidemic brings large numbers of patients, this would probably not be sufficient for Bonn. In that case, the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) would have to fill in," says Kuppenberger. However, it would be difficult to find additional doctors. In an escalating situation, only specialist medical practices would be conceivable. But with the current rate of 2000 infections per day nationwide, it is much too early for that, he believes.
According to Martin Mücke, better educating the population is more important. There are significant problems with the corona warning app, for example. When contacting an infected person, information about whether it was a chance encounter on the street or a longer contact and what to do is not clearly communicated. Furthermore, not every patient with a cough can be tested immediately, he says.
For the paediatricians, Axel Gerschlauer complains of an imminent second "lockdown around the corner", "because according to the current rules in NRW, children and young people have to stay at home very quickly - and a parent has to look after them.” In addition, there are different political guidelines from the Ministry for Education and the Ministry for Family, he says. While kindergarten children with coughs, sore throats or raised temperatures are allowed to return after 48 hours without symptoms, school children must first take a test. "With the rising numbers of colds, this will not work in terms of testing capacities," says Gerschlauer. Alternatively, the doctor would have to decide. "Given that the disease of developed asymptomatically, especially in children, I cannot tell whether someone has COVID-19 without taking a test," argues Gerschlauer.
Gerschlauer has a clear prognosis for the flu season: "The availability of rapid tests will probably decide whether we will be breaking our necks here or not". From his daily experiences at the surgery Martin Mücke also confirms: "Many people with an infection want an antibody test for a quick result". However, this is not paid for prophylactically by the health insurance companies. For many patients this results in frustration, he says.
(Original text: Martin Wein, Translation: Caroline Kusch)