COVID pushes ICU to their limit and beyond

Every morning at six o'clock, Alexandra Heisterkamp arrives at the Intensive Care Unit (ICU) at the University Medical Center in the central German city of Münster. The first thing she sees: three empty beds. So-called intensive care beds. So, why aren't they in use?

"We can't use them,” Alexandra explains, "because we don't have enough qualified staff.” And, she adds: "It's the same story throughout the ward and I can't see any sign that things are going to improve. It certainly doesn't bode well for the challenges that are coming our way.”

Three unused beds sounds like a manageable problem. But across Germany as a whole, the total number of ICU beds is down by 6,300 compared to last year. Around 50 districts — COVID-19 hotspots — are already reporting that their intensive care capacities are exhausted. The worst affected are the southern states of Bavaria and Baden-Württemberg.

So, while there are still plenty of ICU beds ready to go in Germany's hospitals, the crucial problem remains an acute lack of specialized staff. At the beginning of the pandemic, the Münster University Medical Center had a capacity of 135 ICU beds. That figure has now fallen to 110 as highly-qualified nurses and caregivers burned out, stopped working or went part-time.

Respect for ICU staff: Too much talk, too little action

Alexandra Heisterkamp is not among those worst affected. She's been on the ICU staff at the University Medical Center for 17 years and now only works part-time, which helps to remove some of the pressure. But she, too, says that it's hard to understand how Germany managed to get so much so badly wrong in underestimating the peril posed by the fourth pandemic wave. "You can't help feeling pretty angry,” she says.

She's also angry that nearly two years into the crisis, her profession still isn't getting the recognition and appreciation that it deserves: "There's a very strange and widespread perception of what intensive care is all about. And just for once, people really need to ask themselves: 'What kind of treatment do I want for myself when I find myself in here at the end of my life?'”

Alexandra Heisterkamp is a member of DIVI, the German Interdisciplinary Association for Intensive Care and Emergency Medicine. In recent weeks and months, the doctors, nurses, caregivers, and therapists represented by the DIVI have said their early warnings went unheard. Time and again the organization had spoken out, pointing to the likelihood of a dramatic rise in infection rates and forecasting that it would inevitably leave ICUs desperately understaffed.

Fourth wave warnings: all in vain

Tensions are running high — as is clear from e-mails addressed to the DIVI. Like this one: "The politicians are letting us go to wrack and ruin. We're in the midst of a fourth wave, but nobody's interested in the problems facing ICU units.”

Three of Germany's political parties are currently working to forge a new coalition government following the autumn election. The DIVI has been doing what it can to get its voice heard at the negotiating table. That includes putting forward concrete proposals on how to prevent so many colleagues from abandoning their careers as nurses and carers. However, says the DIVI, the response has not been encouraging.

"We urgently need a clear and unambiguous signal that people appreciate what we do. It needs to be loud and clear so that those who are committed to our profession stay on board. And I don't just mean ICU staff, but all nurses and caregivers. These are people who in tough times have made their contribution, helped others, done their bit,” says DIVI President Professor Gernot Marx.

His concrete demand: "For at least six months salaries should be tax-free. Or, at the very least, night shifts. That would be a sign that the political decision-makers are finally getting onside with ICU workers."

Do politicians know too little about ICUs?

There has been criticism of politicians who don't seem to properly understand the workings of intensive care units. Wolfgang Kubicki of the liberal Free Democrats, for instance, sparked controversy when he came up with the idea of activating an emergency contingency of 10,000 intensive care beds.

But it's not that easy: "Dear Wolfgang Kubicki: let me tell you that a bed alone can't bring a person back to good health. You also need highly-qualified professionals. And it's not the kind of thing you can pick up on a 24-hour crash course," says Kathrin Hüster: "It's just populist grandstanding. No real understanding. No real expertise."

It can still send Hüster into a fury when politicians come up with unhelpful proposals like Kubicki's. This is despite the fact that she's no longer on the front line. A year ago, she stopped working as a carer following 20 years on the job, the last eight working in ICUs in the populous state of North Rhine-Westphalia. If you really want to know just how bad things are, this is the go-to woman.

Overstretching careworkers

"It's what anybody in the profession will tell you. We're just numbers. A faceless mass of health service providers," says Hüster. "Sooner or later, it catches up with even the hardiest colleagues. And when they talk about solving the problem by bringing in thousands of medical students? Well, that too is questionable."

It's taken a while, says Kathrin Hüster. Now, though, she's finally getting a full night's sleep. Mostly, that is. Still, three or four times a week she dreams of her work in the ICUs. Kathrin spent her last summer holiday at a campsite. And during that stay, she suddenly heard a respirator alarm tone that somebody had programmed into their cellphone as a ringtone. "I immediately told myself: quick, up, run — somebody's in trouble. There I was: back on the ward again.”

Some 1.7 million people in Germany are currently employed as nurses and caregivers for others who are ill or elderly. That's about the same number as the population of the country's second-largest city, Hamburg. But it remains a sector that has no really effective lobby. In recent times, there's been plenty of applause and heartfelt praise. And even a promised coronavirus cash bonus (which many, however, didn't actually ever get).

Hüster says it's high time for an official care industry commission to meet weekly with health ministry representatives. "An advisory body that would include frontline personnel."

One thing is for sure: Things can't go on as they are. Germany simply can't afford to see people drifting away in droves. But, says Kathrin Hüster, maybe we need to be confronted with the worst-case scenario before the politicians finally wake up: "And that would be when so many people quit their caregiver jobs that care for the ill, the infirm and the elderly would become a luxury that only the rich can afford.”

This article has been translated from German.

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