University Hospital Cologne Situation in IC units: "Russian roulette would be safer"

Cologne · The situation in hospitals continues to worsen. For doctors and nursing staff, the burden is barely manageable. A visit to the intensive care unit at Cologne University Hospital.

 An intensive care nurse cares for a patient suffering from Covid-19 in the intensive care unit. (Symbolic image)

An intensive care nurse cares for a patient suffering from Covid-19 in the intensive care unit. (Symbolic image)

Foto: dpa/Ole Spata

The number of patients requiring intensive care continues to rise every day. On Monday, the register of the Interdisciplinary Association of Intensive Care and Emergency Medicine (Divi) recorded 5122 occupied intensive care beds nationwide. That is 68 more than on Friday. The situation in NRW is also regionally very serious. In Cologne, the situation is "very, very tense," says Professor Bernd Böttiger, who heads the Department of Anesthesiology and Operative Intensive Care Medicine at the University Hospital of Cologne. "The situation has never been as tense as it is now, ever since the virus has been on our minds," he says. Across the city of Cologne, 135 of 300 intensive care beds are occupied by Covid patients.

Covid patients are currently being cared for in three intensive care units at the university hospital. 30 patients are currently there, 27 of whom require ventilation. This corresponds to about one-third of the in-house capacity for adults - which does not mean that the remaining beds are empty. Other seriously ill patients are being cared for in them, and the occupancy rate is 100 percent, Böttiger explains.

"We're gearing up to open an additional intensive care unit for Covid patients," he says. However, the joint approach with the other hospitals also aims to prevent this from happening. The OR program at University Hospital has already been cut by 30 percent, and ten operating rooms are currently not running. An additional opening of an intensive care unit for Covid patients would have the consequence that even fewer non-Covid patients could be cared for. Last weekend alone, twelve non-Covid patients had to be taken to other cities by the ambulance service because Cologne hospitals were unable to admit them, Böttiger describes. In addition, four Covid patients were transferred from the University Hospital to other intensive care units in other cities. Citywide, this occurred with seven patients.

We met doctors and nursing staff from the intensive care unit at the University Hospital in Cologne and asked them how they had fared in recent months, how had they coped with the enormous stresses and strains, and what worried them most. They are unanimously disappointed with the way politicians are dealing with the crisis and criticize the hesitant and inconsistent approach. But many people's cavalier approach to the rules also leads to frustration. Whereas, Böttiger says, he still has the impression that citizens are more likely to have grasped the seriousness of the situation than politicians.

■ Wolfgang Wetsch (40), senior physician in intensive care medicine: "You can compare the situation in the intensive care units in Cologne to a sponge that absorbs a lot, but at some point it is full and spills over. That's the point that everyone is afraid of, including me. But the point at which triage becomes necessary is something we never want to get to, nor should we. It's just that we're in a wave that we all hoped wouldn't happen, just as we hope a fourth wave won't happen. But that can't work if the measures don't work. What is also annoying is the lack of threat awareness, especially among young people. Last Sunday, after the intensive care visit, I was really depressed about how bad and how protracted courses of the disease in Covid patients are. On the way home I saw young people sitting in groups drinking beer in the park. I would actually like to give these people a tour of the ward. The average age of our patients has leveled off at around 50, and we currently have two 30-year-olds in treatment. That gets under my skin, too."

■ Michael Groß (51), team leader of the intensive care unit: "For me as team leader, the question constantly arises as to how long my colleagues on the unit will be able to keep up with the high demands. Everyone is extremely overworked. Then it's always on my mind how will we have to set ourselves up if even more Covid patients arrive. There is also the pressure of no longer being able to meet our own standards. We already can't, because we don't have the time to take care of the patients in the way we should. And the more patients we admit, the more people an intensive care nurse has to look after. In this respect, I didn't feel any relaxation after the second wave, because the knowledge that a third wave was coming never let me relax. In addition, it makes me stunned to see how hesitant politicians are to react, even though everyone should know where this is headed. That worries me, as do the many inconsistent rules regarding behavior in schools or retail stores. Because in my daily work, I see the consequences of this inconsistency."

■ Bernd Böttiger (62), Director of the Cologne Clinic for Intensive Care Medicine: "It can't be said often enough, but what we are experiencing right now is a new pandemic. This is accompanied by a different epidemiological dynamic that cannot be broken with the previous measures. We just saw a slight Easter effect in ICU occupancy, a minimal reduction in the continuous increase. Nevertheless, we already have significantly more patients than in the second wave. And it continues to increase rapidly throughout Cologne. From my point of view, it was a big political mistake to let the incidences run away. Action was taken far too late, and instead, as in the market, incidence values were negotiated that were far too high. This is all very difficult to bear. What we need is a hard lockdown of two or three weeks that is worthy of its name. Otherwise, we will not be able to cope with the new virus variant. Otherwise, we'll just be lapping around for a long time, and a lot of people will have to be cared for in intensive care units every day, one-third to one-half of whom will die. Russian roulette is safer."

■ Susann Böttger (38), intensive care nurse: "I have become very thin-skinned in the meantime and have lost faith that the situation will ease for a long time. With each wave, the fears have grown as to how can we handle this in terms of nursing on the ward. But while the ignorance robbed me of sleep at the beginning, today I just fall into bed knocked out after work. My personal impression is that the ward filled up much more rapidly with Covid patients in the third wave than before, and the patients also developed a severe reaction more quickly. That's what scares me. Also the question of where this is all going to go. In addition, it's frustrating to see that you're trying hard to see a patient, but you go home after the shift and think it didn't do anything. On the contrary, it's gotten worse. Then you ask yourself what you could have done better. Me and my colleagues, we all work at the limit; the faces and body posture after duty speak a clear language; everyone is just exhausted. Despite everything, I would choose this profession again."

Original text: Jörg Isringhaus

Translation: Mareike Graepel

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