Covid-19 Ways through the pandemic
COVID-19 not only poses huge challenges for intensive care.
One of the lessons Prof. Dr. med. Bernhard Greitemann, Medical Director at the German Münsterland Hospital and initiator of successful rehabilitation projects, has learned from the pandemic is that rehabilitation and acute care facilities must cooperate more closely. And: the provision of medical aids must unequivocally be maintained.
life: How has the crisis been in your rehabilitation clinic?
Prof. Greitemann: The occupancy rate of the hospital really varied. As you know, scheduled surgeries were canceled during the first wave, which meant that we got less follow-up treatments from acute care hospitals. The German statutory pension insurance also canceled all kinds of therapy, like reconvalescence treatment. Of course, this caused a huge drop in occupancy, not only for us. In early June 2020, we started to ramp up work in the hospital again, applying a structural approach with a clear hygiene and pandemic concept. We measured the temperature of anyone entering the premises and obtained a short-term medical history. If anything stood out, a PCR test was performed. From August, we started to carry out rapid testing – this currently includes patients, employees and external healthcare providers twice a week. We even test suppliers who visit – all at our expense. They are also included in our vaccination concept. We have implemented specific visitor and dining room rules, reduced the group size for treatment sessions and provided comprehensive disinfection options. We even managed to set up an isolation ward with a clean-room airlock, despite the high demand for staff and costs involved. This meant that we could continue to treat patients appropriately who had tested positive for COVID-19. And we remained rigorous by discharging patients who repeatedly breached hygiene rules. As of June last year, the occupancy rate has almost been back to normal. This worked well in the Orthopedics Department, but I do know that associated hospitals have had extended problems with occupancy.
What specific considerations need to be accounted for in orthopedic rehabilitation?
Prof. Greitemann: There have been reports stating that COVID-19 patients who have spent a lot of time in intensive care on a ventilator develop calcification in the skeletal muscles. This seems to be similar to the condition we see after severe traumatic brain injuries. This muscle ossification leads to secondary functional impairments that require treatment. We now also have the first patients suffering from loss of limb as a result of a COVID infection. As rehabilitation measures were canceled or postponed, we are now also addressing the associated consequences. Even in severe neuro-orthopedic cases, outpatient treatment could not be provided. Physiotherapy practices were closed, as were social care centers, albeit temporarily. This led to severe functional impairments in those patients. And all of a sudden, we see a lot of patients with pronounced gait abnormalities, reduced strength, a poor joint situation and extremely limited mobility.
“We shouldn’t only look for consequences from the pandemic in acute care.
The need for rehabilitation has increased significantly, too.”Prof. Dr. med. Bernhard Greitemann
How can medical products help in this situation?
Prof. Greitemann: That’s quite obvious: just think of a patient with severe osteoarthritis of the knee. There isn’t much that can be done about the pain. Because the patient wanted to delay joint replacement, he has tried to avoid surgery for years. At some point, there was no way around it. He was eventually offered a date for surgery. But then, everything was canceled. At this point, I can use a knee support to help with the pain management and joint function. I could also prescribe an osteoarthritis brace to relieve the intra-articular space. That will provide the affected joint with a pressure reduction of up to 30 percent, which can be crucial for the patient’s mobility. Plus, this will also reduce symptoms. This patient still has to go to work, go shopping – despite surgery being postponed. And even after successful surgery, rehabilitation often doesn’t start immediately. Given the lack of follow-up care, the treatment with braces is indispensable in my opinion.
What difficulties arise from this for everyday treatment?
Prof. Greitemann: We mustn’t forget: at the beginning of the pandemic, suppliers of medical products weren’t even let into hospitals in some places. Some companies also stopped their field sales teams from working, or short-time working arrangements were introduced. That was devastating for certain groups of patients. What does that do to a child with spastic quadriplegia, for example? That’s why the German Association for Orthopedic Technology pointed out that manufacturers of medical products are relevant to the system and must be included in opening strategies. It is now all the more important to learn from the pandemic to strengthen the system.
Which insights did you gain from the crisis?
Prof. Greitemann: We shouldn’t be so short-sighted and only look for consequences from the pandemic in acute care. Rehabilitation is essential, especially for COVID-19. The need for rehabilitation has increased significantly. There are many patients who need long-term pneumological rehabilitation because of their lung involvement, many of those affected have impaired circulation, many show psychological problems processing the situation. Problems with the locomotor system have to be resolved using the appropriate medical products and training during rehabilitation. For a while, rehabilitation clinics were discussed an option to deal with the “overflow” from acute care for patients affected less severely by COVID-19. That’s a possibility. Modern rehabilitation can certainly get involved. We would just have to check which rehabilitation clinics can help with that. What are the local processes like? It’s also a question of costs. Closer cooperation between acute care and rehabilitation is the clear lesson we have to learn from the pandemic. It’s unlikely that this will be the last one.
Images: Andreas Wetzel, istockphoto.com/tatianazaets
The Vein Center at the Ruhr University Departments of Dermatology and Vascular Surgery at
St. Maria Hilf Hospital in Bochum is characterized by a treatment range that meets patient needs. How has the hospital, its director and the patients made it through the pandemic so far? For Prof. Dr. med. Markus Stücker, Managing Director of the Hospital and President of the German Society of Phlebology, one thing is clear: the most effective way to address patients’ concerns and fears is with the entire spectrum of treatment options.
life: What is a typical treatment day like in your outpatient clinic under COVID-19 conditions?
Prof. Stücker: We measure the temperature of all patients, and we ask questions about COVID symptoms and relevant contacts. If all is clear, patients are strategically positioned in the waiting area under the strictest hygiene measures. The number of permitted patients in that area has been reduced. Examinations and treatments are continuing without change. Even though everything has become more complicated, phlebological diagnostics and treatment still work like before. We haven’t had any infections since the start of the pandemic. Patients come to their outpatient treatment sessions as usual. But they’re more cautious about surgery involving general anesthesia. Multimorbid patients with extensive conditions that should really be treated by inpatient care, ask: hand on heart, is that really urgent or can I wait until I’ve been vaccinated? In some cases, my answer is: if you wear a compression stocking over the summer, you can come back in the fall. In this respect, things have changed. But one aspect that has clearly reduced is inpatient varicose vein surgery. We’re at 30 percent compared with previous years.
Which particular challenges does phlebology face?
Prof. Stücker: Patients suffering from venous leg ulcers are a problem. Before the COVID-19, they came to us at a relatively early stage of their condition. During the first six months of the pandemic, the number decreased dramatically. We see more extensive lower leg ulcerations and more frequent wound infections. All of a sudden, huge thromboses are occurring again. Many patients often simply wait too long. This observation is also shared by GPs. This frustrates us as healthcare providers, but it’s the patient who suffers the set-back. If patients come to us after six months instead of after four weeks, we’ve lost five months. This not only prolongs the time the patient suffers from an open leg wound, usually the ulcer has also increased in size. Compression therapy isn’t carried out sufficiently, and the support is often put on without first undergoing decongestive therapy. Treatment of varicose veins is postponed, and we lose valuable time. Patients often make an emotional risk assessment: a protracted phlebological condition versus catching COVID. The fear of dying from COVID-19 is weighed against the venous leg ulcer. But the risk of sepsis and thrombosis must also be considered. It’s a difficult decision, for me too.
“We see more frequent wound infections. All of a sudden, huge thromboses are occurring again. Many patients often simply wait too long.”
Prof. Dr. med. Markus Stücker
How can medical products help in this situation?
Prof. Stücker: Some good studies have been conducted which show that products for compression therapy are very effective in preventing or treating thromboses. The healing of venous leg ulcers is accelerated, and the symptoms of varicose veins improve, which include swelling, feelings of heaviness or skin abnormalities with eczema. Compression is not a temporary solution but a non-surgical alternative that is employed until the varicose veins can be treated surgically. I can see that patients increasingly understand this. They’re relieved that they have a practicable solution for the next five, six months. Some even say that they would have started wearing compression stockings much earlier, if they had known how comfortable they can feel.
Does a lack of exercise caused by the pandemic pose an increased risk of thrombosis?
Prof. Stücker: We don’t have figures for that yet. It’s well-known that extended sitting and a lack of exercise – such as when working from home – leads to an increased risk of thrombosis. Over the past year, we’ve seen many older patients who have put on a lot of weight. 20 kilograms were not uncommon. Social distancing was often named as the reason. But going running, for a walk or cycling would have been possible. Giving up activities altogether is the wrong consequence of the restrictions, of course.
Which professional insights have you gained from the crisis?
Prof. Stücker: Vein problems can be treated with a whole host of therapy measures these days. That’s well-established. If you’re able to effectively care for patients in a crisis like this, from compression therapy and sclerotherapy to antithrombotics, laser treatment and surgery, you can address their concerns and fears and even bridge longer time frames. The value of
non-surgical treatment has changed. You have to see it like this: non-surgical, interventional and outpatient vein treatment overall have gained in significance during the crisis.
Images: Kliniken der Ruhr-Universität, shutterstock.com/Evgeniy Kalinovskiy, istockphoto.com/tatianazaets
Action instead of reaction. This is Pudel Orthopädie-Schuhtechnik’s business concept in a nutshell. Proactive concepts have helped the family-run business from Ludwigsburg grow for more than 30 years – and allowed them to successfully navigate the COVID-19 crisis.
When the virus sent Germany into lockdown in March 2020, André Schikora only paused briefly. Then he really went for it. “In the beginning, we had to learn how to deal with the situation, of course,” says the Managing Director of Pudel Orthopädie-Schuhtechnik in Ludwigsburg. The retail sector had to shut, so he cordoned off the sales area from the orthopedics part. He notified his customers. He developed a hygiene concept. And: he opened a new branch in Freiberg.
In the company’s head office about a year later: the customer coming into the shop this afternoon quite naturally holds her hands under the disinfectant dispenser next to the entrance. Protected by a perspex screen, receptionist Margret Burk asks her how she can help – with a welcoming smile, despite the mask. Running shoes? No problem! A member of the sales team takes the customer upstairs to the sports department. To ensure a safe distance on the narrow stairs, André Schikora, who is currently rushing through the building, waits at the top until they have passed. Disinfectant, droplet screen, mask, distancing. These things have become completely normal by now. They are the result of good organization. And: “From the beginning, our employees have helped to make sure that our customers feel safe and protected from infection,” the agile managing director explains who quickly worked on creating a COVID-compliant environment.
When it comes to new concepts, André Schikora is in his element. He pursues the philosophy for which his father-in-law, orthopedic shoemaker Helmut Pudel, laid the foundation more than 30 years ago. An “innovator and visionary“, as André Schikora calls him.
“In the beginning, we had to learn how to deal with the pandemic.
Our employees helped to make sure that our customers felt safe.”
André himself undertook to expand the professional sports sector when he joined the company and opened a branch at the VfB-Reha-Welt rehabilitation center in Stuttgart in 2007. “The cooperation with VfB was my brain child in those days,” says the graduate economist, who then trained to become a sports orthopedist and movement analyst. “We started with a camera and a treadmill,” the 47-year-old sports enthusiast remembers. Today, Reha-Welt’s running laboratory features state-of-the-art diagnostics and movement analyses, an orthopedics area for the provision of foot orthoses and supports, as well as many meters of shelves with sports shoes. Amateur and professional athletes are regulars – in addition to the VfB Stuttgart soccer club, Pudel works with several other sports teams.
André Schikora is now one of three managing directors, alongside his father-in-law and his son Tim. They rely on healthy growth, quality and comprehensive consultation. And successfully so: customers send enthusiastic thank-you notes by email, and physicians recommend Pudel Orthopädie-Schuhtechnik to their patients. That encourages the three managing directors: when a major building site caused diverted traffic, making it harder for customers to get to their store last year, they decided to open a new branch at the market in Freiberg.
And then COVID-19 struck. But that couldn’t faze André Schikora. First, sales were reinforced via the online shop that Pudel cooperates with. “We also took orders over the phone and sent out shoes with free delivery. Measurements in our store were still possible with an appointment to avoid waiting times.” At the same time, the team continues to focus on customers: in April 2020, the employees of the small, modern branch in Freiberg welcomed their first visitors – strictly complying with the hygiene concept, of course. André Schikora’s experiment paid off: previous customers are returning because of the good transport connection and parking situation.
In these circumstances, Bauerfeind’s contact-free digital Bodytronic 610 measurement system provides an invaluable service in both locations. While a customer stands on the self-rotating platform, BT 610 uses infrared light to measure the customer’s entire body – completely without any physical contact. Based on the imaging data, the software creates a 3D model calculation – the foundation for selecting the perfect size and product. “In this way, we were able to guarantee the quality of our products in times of COVID-19 as well,” explains André Schikora, whose company has relied on the products and all-out service offered by Bauerfeind for 13 years. The Pudel team is happy to make use of the online support that was expanded during the pandemic and the digital training options, for example. The Ludwigsburg management is proud of the outstanding qualification and commitment of its 38 employees. This includes three sports scientists and experts in phlebology and lymphology. The principle of a family-run business still works: not only André Schikora’s wife, Nadine, is active in Marketing, Purchasing and Sales, other employees, too, have the family name Pudel – all others are described as “extended family” by the boss.
Shopping experience the safe way
When the second lockdown paralyzed the country at the end of 2020, the Pudel Orthopädie-Schuhtechnik team relied on experience. As opposed to the first wave, this time the rule was: if more than half of a specialist retailer’s sales come from the area of orthopedics, the associated retail section is allowed to remain open. This was a relief because the company also lives from cross-sales. Customers who come to the shop with a prescription may also browse the sports department. Foot orthoses or a knee support may also be recommended to those whose running style is being analyzed. “Even my father-in-law recognized the opportunities offered by combining orthopedics and sports,” André Schikora says.
Another line of business the enthusiastic amateur runner tapped into was occupational health management (OHM). “We give talks, for example, or maintain partnerships to provide regular foot and shoe workshops as well as training sessions,” André Schikora reports. “You just have to stick with it and offer follow-up appointments and consultations.” When it comes to OHM, he sometimes works with partners, such as manufacturers of safety boots. OHM consultations take place on-site or online, depending on the distance – an experience that has proven itself during the COVID-19 crisis.
Digitalization as an addition
Much like digitalization in general. “You simply can’t do without it these days, but you have to check carefully what can be presented digitally,” André Schikora explains. All data transfers in the company and between the branches are digital, of course. But he believes there can be more. Nevertheless, he wants to get those customers back to his store who switched to digital visits during the pandemic. This is not the only area where the Pudel teams benefits from having employees of all ages. While the experienced company founders convince customers with solid craftsmanship, the youngest employees use Instagram stories to present the delivery of new sports shoes. A symbiosis of sound craftsmanship and spontaneous media presence. Refining what is tried-and-tested, investing in innovations. Action instead of reaction: the Pudel philosophy. Even COVID couldn’t change this. Quite the opposite: this exceptional situation confirmed André Schikora’s strategies and motivated him: “You have to adapt to the circumstances and go where the masses are.” He believes that it’s a mistake to stop during a crisis. “You have to be innovative in hard times, too!”
This approach means it is time for change again – despite or especially because of the pandemic. The father of two is now investing in an ambitious sports concept and wants to reach new target groups by developing “bike fitting”. Another idea is to set up an attractive lounge area to make waiting times more pleasant if the number of customers in the store exceeds COVID regulations. This will result in a whole new shopping experience in Pudel’s main location in Ludwigsburg over the next months. Just like his father-in-law Helmut Pudel, André is a true visionary. “We want customers to feel good when they arrive. And we want them to experience an advice explosion,” he says, happily noticing that the customer from the sports department has already been asked into the running laboratory for her foot measurement. ?
Images: Udo Schönewald, istockphoto.com/tatianazaets
The COVID-19 pandemic not only posed a huge challenge for intensive care.
- One lesson Prof. Dr. med. Bernhard Greitemann, Medical Director at Münsterland Hospital, has learned from the pandemic is that rehabilitation centers and acute care clinics have to work together more closely.
- Prof. Dr. med. Markus Stücker, Director at Ruhr University Bochum’s Vein Center, has noticed that many patients are waiting too long during the pandemic before visiting a physician.
- With consistently new concepts and partners such as Bauerfeind by his side, André Schikora, Managing Director at “Pudel Orthopädie-Technik”, relies on top quality and healthy growth. During the COVID-19 pandemic, too.