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Interview with the Medical Director of Anesthesiology and Critical Care Prof. Dr. Hartmut Bürkle

Germany is slowly easing its coronavirus lockdown. Starting from  20.04.2020 small stores (under 800 m2), car and bicycles dealers as well as bookstores re-opened their doors. Schools and universities are preparing for students to come back. Prof. Dr. Hartmut Bürkle, the medical director of the Anesthesiology and Critical Care Department of the Medical Center - University of Freiburg, suggests that we will not be able to return to our “normal” life before spring 2021.

How dangerous is coronavirus? What new information have Freiburg specialists gathered in the last weeks?

Fortunately the new infectious disease caused by Corona Virus SARS Corona 2  -  COVID – 19 (according to the year of its appearance) - is not dangerous and goes unnoticed for about 80 people out of 100 who contract it.

The progression of the disease is unspecific and can vary from no symptoms up to severe pneumonia with lung failure and death. It is difficult to describe the “typical” progression. We define a “mild” progression of the disease when there are no signs of pneumonia; “moderate” when a patient has slight pneumonia with radiological confirmation that less than 50% of lungs is involved, no shortness of breath and the oxygen saturation of the blood  more than 93%.

COVID-19 disease will develop in 20 out of 100 infected people. These patients normally have fever, dry cough, running nose, hoarseness, fatigue, muscle pain, diarrhea or loss of sense of smell and taste.

Only a small percentage of COVID -19 patients (around 4-5 %) develop strong shortness of breath and significant breathing problems. These symptoms usually occur 4-7 days after the infection. COVID -19 pneumonia causes shortness of breath. In addition, 20-30% of these patients develop myocarditis (inflammation of the heart muscle).

In case of such symptoms, you should go to a clinic or a doctor because the disease can progress very rapidly. We, as specialists, test via throat swab and check whether a patient is COVID positive. Attention: a lot of testing methods, including the so-called rapid tests, are unfortunately very unreliable, with some partially fake tests on the market. You should always go to a qualified lab for such a test.

We have gathered new information regarding medicine used up until now and therapy methods for treating severe lung failure (ARDS ) caused by COVID-19 disease. So far, our experience has shown that most medicines do not satisfy the expectations. Only Hydroxychloroquine (Plaquenil) under strict doctors control can perhaps improve and alleviate the symptoms. However, this medicine causes a lot of heart problems. Remdesivir could be a treatment option for COVID patients but current studies are still too small to honestly declare Remdesivir as a therapy success.

Magazine Focus reported about the high mortality rate of the ventilated patients and the new therapy methods in the USA. How many patients are currently being ventilated at the Medical Center – University of Freiburg? Why is the mortality rate in Freiburg and in Germany so low?

The article reports on new therapy suggestions in the USA  to replace ventilation therapy with therapeutic treatment methods, an approach that seems to result from a dire situation instead of being based on sound medical expertise and infrastructure. If you lack good critical care ventilation equipment, an intensive care unit and well trained intensive care staff, while facing a sudden surge of patients, you certainly start to think about alternative therapies. This may be understandable, but it is misguided.

Ventilation therapy should only to be used when warranted and carried out by trained specialists; the same holds true for COVID -19 patients. Initially, in cases of  slight pneumonia you need to try an oxygen supply, positioning therapy and the so-called high flow nasal cannula oxygen. If  shortness of breath persists, you need to start invasive ventilation. Otherwise a patient just suffocates from inside.  

We have treated more than 200 COVID-19 patients so far, more than 40 patients received invasive ventilation and we are one of the largest ARDS-ECMO centers in Germany with great competence and excellent equipment. That is why the mortality rate here is low.

Germany is generally  better equipped than many other countries, which definitely plays an important role.

Would it make sense to test broad levels of the population as South Korea did?

Yes, it would make sense but most countries lack sufficient testing capacities and personnel.

For some patients, the coronavirus can progress severely and lead to breathing problems and pneumonia. Who is particularly affected? What can you report about the affected patients in Freiburg:

Men are more affected than women, often smokers and patients with diabetes mellitus, obesity and high blood pressure. Severely affected patients come to our ARDS / ECMO intensive care units and are treated here for a long time.

How old are patients who get severe pneumonia? Are there children?

No, fortunately no children and usually no adolescents or young women. Mostly elderly patients.

How long do patients stay in an intensive care unit before returning to the normal ward?

3 weeks

Do patients develop other diseases such as vasculitis or neurological deficits?

Unfortunately, approx. 40-60% suffer from accompanying illnesses with the most severe COVID-19 pneumonia with lung failure (ARDS), mostly pulmonary artery embolism, kidney failure, bleeding in the brain.

In principle, can any hospital with intensive therapy beds help corona patients?

Yes and no, every hospital can help. In severe cases, patients in so-called ARDS and ECMO centers have about a 30% better survival rate. We have the greatest advantage in Freiburg, of course, thanks to our globally recognized expertise.

Australian doctors claim to have found a drug against the corona virus - "Ivermectin" - is this "fake news"?

It is not fake news, but the drug, which is used to treat scabies, has only been tested experimentally and not clinically. That means there is not a single patient with Covid 19 disease who has been successfully treated with it so far. So I wouldn't recommend it at the moment.

There have been too many best therapy recommendations that did not deliver what they promised. Let's wait for well-made clinical studies for these drugs and their "healing promise".

What is your prognosis: when can we return to a “normal” life?

Normal life can return once we have:

a.  developed an immunization (vaccination) (probably by spring 2021) which has been successfully tested until then.

b.  developed  a drug therapy that stops severe pneumonia (without simultaneously developing life-threatening side effects; probably in early 2021) and

c. allowed many people to contract the virus without becoming very sick (this is happening all over the world at the moment) Then we have a so-called herd immunity.

These infected people must then be identified early using mobile data apps and tests. They then have to be in home quarantine for 14 days. Then everything will be fine. Until we are below an infection rate of less than 0.8 in all countries, we will always see outbreaks of more Covid 19 cases with more victims.

Mouth - nose protection (to reduce the risk  of infecting others) will therefore have to be worn in different countries for quite a while. Nevertheless rest assured that you can remain a healthy and happy person. Covid- 19 is a common disease that fortunately is not associated with severe outcomes for most people.

Since Covid 19 is extremely contagious, this disease differs from many other serious diseases that we all know and rightly fear. Cancer or a heart attack are well-known examples, which when left untreated, are often fatal. Our university can offer very good therapies for  fatal diseases such as cancer and heart attack, ,  and usually either cure or at least alleviate the symptoms.

For Covid 19 we are on the right path even in the most difficult cases, but we need more knowledge and time.

Our ARDS ECMO intensive care medicine at the Medical Center – University of Freiburg is a  highly valued medical competence center, both nationally and internationally. With experts from numerous fields of our excellent university medicine, we will research the new Covid 19 disease to the best of our ability in order to contribute to the worldwide development of a successful drug for Covid 19 disease.

Until then, maintain a healthy and happy lifestyle, quit smoking and practice perfect hygiene (wash your hands often!)

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Department of Anesthesiology and Critical Care Department