Those who want to enter the Malteser Hospital fail at the main entrance. Nobody gets in without being checked anymore, instead of ten there is only one single entrance. Patients are categorised, large red signs show the way.

Methods that are otherwise known only from crisis regions. No wonder: This needle eye principle was conceived by emergency physician Tim Flasbeck, who regularly sets up emergency rooms in such regions. "This is the only way we can conserve our resources of hygiene products and protect all patients, employees and relatives," says Flasbeck.

He and his colleagues have been preparing for the worst-case scenario for weeks: In case there is an onslaught of patients who need treatment for coronavirus. "How the situation develops, we do not know. But we must be prepared," says Deputy Medical Director Joachim Schmidt. With an overburdened healthcare system, nobody can rely on the best possible care.

It is a narrow ridge on which Malteser International doctors are currently moving. On the one hand, they have to create capacities to be able to take in many coronavirus-infected people with severe disease conditions, according to the emergency plan of the German government. On the other hand, normal operations must continue; accident victims or cancer patients also need help. In order to organise this, there is a crisis management team that brings together doctors, management and hygienists. There are just under 400 beds, twelve of which are for intensive care cases.

In the Bonn University Hospital there are 1300, 120 of them are intensive care. To increase them is one thing. But the approach is also to use the existing beds for affected people instead of for patients whose treatment is not time-critical. "Whatever operations can be postponed, we postpone. But of course there are tumor patients who can't wait very long," says Schmidt. In order to reduce the risk of infection, expectant fathers are not allowed to be present at the University Hospital, neither during examinations nor at birth. The hospital also excludes a visit to the maternity ward on its homepage.

"The most difficult thing is to find trained staff," explains Flasbeck. Intensive care beds can be relatively easily upgraded with additional machines such as ventilators, which is what is happening at the moment. But they have to be operated. It would therefore be fatal if staff were to be lost to the new corona virus and have to be quarantined.

Efforts are already being made to find reserves, and nursing staff are being trained for use in other areas. Volunteers and pensioners are also being considered. "And in general, we are reducing the risk of infection for our employees." This includes the closure of the geriatric day clinic.

According to Flasbeck, the most effective method is the eye of the needle principle, which also protected Uganda from the spread of the Ebola virus. As a matter of principle, visitors are now only allowed to come by in exceptional situations, for example when a relative is dying or when the patient is a child. The pernicious thing about the coronavirus is the large number of patients without symptoms, which is basically a good thing. "But we can't catch them. That's why we try to keep the number of visitors to the hospital to a minimum.“

Those who have to go to the emergency room are examined around the clock before they are allowed to enter. There are two nurses sitting in the main entrance, questioning everyone about symptoms and possible coronavirus contact persons. Anyone who is conspicuous is examined more closely or sent away. This is done by the emergency room coordinator, who wears a protective mask with a plastic disk that covers the entire face. To prevent possible infected persons from entering the building in the first place, a tent is set up in front of the main entrance. Those who are not an emergency and, for example, only want to take a swab test for the new coronavirus are referred to the municipal diagnostics centre.

The emergency patients are divided into three categories. Category one includes people without flu-like symptoms who have a medical problem and have, for example, twisted their foot. Category two are patients with mild flu-like symptoms who have no reasonable suspicion of the coronavirus and can therefore leave the outpatient clinic.

Category three are patients with flu-like symptoms who must be removed and treated in any case. Either because the suspicion arises, for example staying in a risk area like Italy. Or patients who do not have a well-founded suspicion, but show very significant flu like symptoms. All category three patients are given a face mask and are taken to an isolation ward.

This whole emergency operation costs money. "The occupancy rate of our beds is normally more than 90 percent," says Dieter Birr, who is the commercial director of the Malteser Hospital. As a commercial enterprise, one has to cover costs, the highly qualified staff needs to be paid. Therefore, especially intensive care beds with their modern machines are expensive when they are empty. "We therefore need financial support from the country if we are to free up everything now." Without them, every hospital operation would be at risk. "Otherwise you can declare bankruptcy before the first coronavirus patient even gets here."

Original text: Nicolas Ottersbach, Translation: Mareike Graepel