Currently Germany is very successfully fighting the COVID-19 (Coronavirus disease 2019) pandemic. As of 16. April 2020 there were 130,450 confirmed infections resulting in 3,569 deaths. This is a very low fatality rate in comparison to other countries. Professor Dr. Robert Thimme, medical director of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases at the Medical Center - University of Freiburg, believes that quick and strict measures of social distancing as well as a robust and well functioning health care system contributed to this success.

What can you say about Freiburg?

We have made excellent preparations in Freiburg: rapidly founded a Task force, organized out-patient testing and counselling, separated the clinical pathways for infected patients and non-infected patients. Furthermore, a dynamic model based on stages has been implemented for the increase of care capacities in normal wards and intensive care units. These measures allowed us to care for the first 115 patients without any shortages. This is a great accomplishment for Freiburg and has only been possible thanks to the professional cooperation of all disciplines involved.

During the last weeks we have seen the full spectrum of coronavirus: from very mild forms to severe cases. For instance, last week we discharged a 96- year- old man and a 95- year- old women who were treated forCOVID-19. These amazing cases are hard to forget!

What is so different about coronavirus compared to Ebola or swine flu? Why did it spread all around the world, causing such dramatic consequences?

The new pandemic coronavirus SARS-CoV-2, causing COVID-19 (Coronavirus Disease 2019), is different because of its high contagiousness coefficient. The current data shows that one infected person normally infects at least two further people. This virus spreads extremely fast. Another difference is that SARS-CoV-2 reproduces in your throat at very high levels, making it much easier to pass the virus to others even without having any symptoms and knowing that you have it.

What are the typical symptoms of SARS-CoV-2? What symptoms have you seen with your patients?

Typical symptoms are fever, dry cough and joint pain. These are also the symptoms we see with our patients. However, in most cases (approx. 90%) the symptoms are mild. Additional symptoms could be: loss of smell, headache and diarrhea. In severe cases patients develop shortness of breath.

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

The majority of corona cases are mild. Only a small percentage of the infected patients develop life threatening symptoms and need intensive care. Specialists at the Medical Center – University of Freiburg are currently involved in research studies to develop new diagnostic tests, including antibody testing, to establish new therapies, and to better understand our immune response against the virus. The latter is very important for development of a future vaccination.

What are the best ways to protect oneself from the infection? Does it help to wear a face mask and gloves?

Yes, face masks and gloves help. If you are carrying the virus, a face mask protects the people around you from getting infected. You can use simple masks, also self-made. If you buy face masks in the pharmacy, you cannot wash them as they loose their protection

The most important is however to wash your hands!

Does it make sense to take vitamins to improve immune system?

In general, a balanced diet rich in vitamins improves the immune system. I would not recommend taking any additional vitamins because there is no scientific proof that they protect people from infection or even oncological disease.

 Is it true that alcohol can kill viruses or does alcohol weaken the immune system?

Unfortunately, alcohol only weakens the immune system. In high dosages alcohol harms your health. It is better to drink moderately.

Some articles have reported that patients who have received a tuberculosis vaccination in the past develop much milder symptoms. Is this true?

This is not yet proven and is being investigated in scientific studies. The main idea is that a tuberculosis vaccination might have unspecific effects to other infectious diseases by inducing the immune response (i.e. positive side effect) in our case to COVID-19.

Some corona patients develop shortness of breath and severe pneumonia. Who are those patients?

Mostly patients over 70 years old with accompanying diseases, often high blood pressure or diabetes. But as always there are exceptions. Some young patients can also develop a severe pneumonia. Unfortunately, we have no marker at the moment that could distinguishat an early stage of the disease whether a patient will have mild or severe symptoms.

Which pre-existing conditions make COVID-19 patients more vulnerable to severe symptoms? Is it true that patients with liver ailments are also at high-risk? What about patients who have undergone a gastric or bowel resection, a gall bladder removal, or had other illnesses of the gastric system in the past?

As mentioned, more vulnerable patients usually suffer from diabetes or high blood pressure. Neither patients with liver diseases nor patients who had gastric or bowel resection or other operations of the gastrointestinal tract are at a significant higher risk of experiencing severe symptoms.

What long- term effects remain after recovery or can occur at a later stage?

In the case of mild progression, most patients will not experience any discomfort. Patients with acute respiratory failure, who need long-term respiration, could develop long-term complications due to damage or remodelling of the lungs tissue. At this stage, however. it is still too early to make long-term predictions.

What does the test for coronavirus infection look like? Which tests are used at the Medical Center – University of Freiburg? How accurate are they?

At the moment the test for coronavirus is still being done via a polymerase chain reaction (PCR) using an oral swab. Soon antibody testing should be available and will tell us whether an infection with coronavirus has already taken place. It’s interesting though that there are cases whereby patients show absolutely no symptoms and therefore did not know that they have had infections. This can only been found out by antibody testing.

Can you become immune to coronavirus? If so, for how long?

Primarily we assume that after an infection heals, there will be immunity, mediated by the antibodies forming in the progress of an infection. At this point we cannot say for how long.

Is it possible to reliably identify whether an infection with coronavirus has already taken place and antibodies have been formed? Is it possible to help patients without antibodies, for example by donating blood?

This is one therapy approach that is currently being tested in different places, including Freiburg – antibodies are isolated from healed patients and injected in infected patients. We are awaiting the results.

What medication should people stock up on at home? Is it advisable to stock up at all?

It’s not advisable to stock virus medication at home. Virus medication should only be used if stronger symptoms appear. In such cases, it is recommended to go to a medical center experienced in the treatment of COVID. Paracetamol and Ibuprofen should always be available at home to treat fever or pain.

Is it true that children are rarely affected by the virus? What is the reason for that?

Yes, it’s true that children in general experience only mild symptoms. This is also the case despite distinct infiltrations of the lung having been resported in some cases. The cause for this mechanism has not been identified yet but the same milder degree of symptoms in children has been described for other viral infections, too. One of the reasons could be that the less trained and “used up” immune system reacts quicker to the virus. This question is being researched in current studies, too.

What is your advice to our patients?

Wash your hands as often as you can, keep social distancing and live a healthy life-style. Do not panic! In most instances, viral infection takes a very mild course. In case of a more severe course, especially with permanent fever and shortness of breath, go immediately to an experienced center.

In out next newsletter Prof. Dr. Burkle, the medical director of the intensive care unit, shares his insights on promising treatments and how coronavirus will effect our lives for years to come.

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• Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases