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Nurses in an intensive care unit in Ulm (archive picture): Most of the Covid patients are not vaccinated.
Photo: Felix Kästle / DPA
Almost 3.8 million people live in Berlin.
And there are currently 91 intensive care beds available throughout the city.
"You can see that it has become very, very tight overall." That is what Steffen Weber-Carstens said at a digital press conference of the Divi intensive register.
He is one of two medical-scientific directors of the platform, which records the occupancy of intensive care units in Germany on a daily basis.
According to the Divi, 960 intensive care beds are currently occupied in the capital.
In 198 of these beds there are patients with Covid 19 disease - a share of slightly more than 20 percent.
In a nationwide comparison, this is still a rather good value: In Bavaria, 965 corona patients were reported for Monday, November 22nd, occupying 34 percent of all available intensive care beds.
In Thuringia, Covid sufferers make up 36 percent, in Saxony 37 percent.
More and more clinics are reporting operating restrictions
Throughout Germany, 3845 corona patients are currently being cared for in intensive care units.
A week ago it was 3,177. More than half of the people are ventilated invasively, said Gernot Marx, President of the Divi.
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More and more clinics reported operational restrictions.
The highest level of utilization of the intensive care unit to date was reached during the second wave - in January of this year.
Around 5700 Covid patients were treated in German intensive care units at the time.
But compared to the situation in January, there is one major change: For many months now, everyone has had a vaccination available - a good vaccination, one of the best and most effective vaccinations that have ever been developed to date.
The vaccination has been shown to provide very good protection against a severe course of Covid 19 disease.
So how can it be that the intensive care units again reach the limits of their capacity utilization?
Three factors contribute to this.
The first: lack of staff.
The number of available intensive care beds is based on the available staff.
But a large number of nurses have reduced their workforce in recent months, Marx said at the press conference.
Many have also left their jobs entirely because of exhaustion.
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How many this actually affects can only be determined indirectly.
Because: According to Christian Karagiannidis, how many nurses there are in German hospitals is not recorded centrally at any point.
Karagiannidis is also the scientific director of the intensive care registry.
And says: Just from querying the intensive care beds that can be operated, conclusions can be drawn about the number of intensive care staff - because a nurse should not look after more than two intensive care patients during the day and not more than three at night.
The personnel key, which has been in effect since February, provides for this.
In December, around 12,000 ventilation beds were available in Germany, says Karagiannidis.
There are now 9,000 of these beds.
Not because there is a lack of technical equipment, but because of the lack of personnel.
This deficiency existed even before the pandemic, says the doctor, but it has grown again due to Corona.
Divi President Marx therefore advocates “clear financial incentives” in the nursing profession and demands a “plan to create perspectives for nursing” from those in charge of politics.
The "key to successfully coping with the pandemic" is ready
The second factor: Coronavirus patients are on average significantly longer in intensive care units than "normal" patients. As a rule, the length of stay in the intensive care unit is four days. For Covid patients, however, the data from the first three waves shows an average length of stay of 14 days. This reduces the frequency with which beds can be re-allocated. The length of stay is usually slightly shorter for patients who do not survive the disease - whoever dies, dies after an average of ten days in the intensive care unit.
Experts give the probability of death for Covid patients in the intensive care unit as between 30 and 50 percent.
Those who are ventilated with what is known as ECMO lung replacement therapy have even worse prospects.
ECMO is the abbreviation for the process of "extracorporeal membrane oxygenation".
The blood outside the body is enriched with oxygen and reintroduced into the body.
The third factor: the low vaccination rate.
"Vaccination is still the key to successfully coping with the pandemic," said the Divi President.
The number of first vaccinations should be increased significantly, the booster vaccinations should be administered quickly.
To do this, the country needs vaccination centers and mobile vaccination teams.
The Divi continues to reject a compulsory vaccination for individual professional groups.
But there is a "moral and ethical obligation of health workers," says Marx.
The data from the intensive care units alone should give all vaccination skeptics something to think about: “Whoever you talk to: The severe courses are unvaccinated patients.
Those who end up at ECMOS are unvaccinated patients, «says the Divi boss.
So-called vaccination breakthroughs - i.e. Covid disease in people who are fully vaccinated against the virus - are observed in the intensive care units almost exclusively in older people who have a previous illness or other special health risk.
Marx sums up: "Anyone who is fully vaccinated is very certain to be protected from severe courses."
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The mathematician Andreas Schuppert is also connected to the conference, who creates modeling for Divi with a forecast of the occupancy in the next few weeks.
He says, “We can afford higher incidences today.
The higher the vaccination quota, the higher the incidence can go. «But: At around 68 percent, the quota in Germany is not high enough to avoid the need for further protective measures.
"In fact, we ate the vaccination bonus for breakfast," says Schuppert.
Vaccination alone is the reason the health system hasn't collapsed yet.
This is what Steffen Weber-Carstens says: "If we didn't have the vaccination, we would have astronomically high intensive occupancy rates."
All can still be taken care of
In order to alleviate the acute shortage of available beds, nurses from other wards of the hospitals have to step in in the intensive care units.
Weber-Carstens says that some hospitals are currently even using students.
Operations that can be postponed must be postponed.
And patients from full wards have to be transferred to less full ones.
To this end, the COVRIIN specialist group at the RKI, in collaboration with the federal and state governments, has developed the concept of the "clover leaves": Germany is divided into five regions, the clover leaves: Bavaria and North Rhine-Westphalia each form a clover leaf - "South" and "West" .
Baden-Württemberg, Saarland, Rhineland-Palatinate and Hesse are grouped together to form the clover leaf »Southwest«.
The "Ost" clover leaf consists of the federal states of Thuringia, Saxony, Saxony-Anhalt, Brandenburg and Berlin.
Lower Saxony, Bremen, Hamburg, Schleswig-Holstein and Mecklenburg-Western Pomerania are bundled together as the “North” clover leaf.
Each of these shamrocks is coordinated by a central point - a so-called SPoC, a single point of contact.
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If it becomes apparent that hospitals in a region can no longer admit intensive care patients, a transfer within the clover leaf will be planned - in the course of 24 hours. If it is no longer possible to relocate intensive care patients to neighboring regions, according to the RKI, they will be relocated to other locations.
Jan-Thorsten Gräsner is a member of the COVRIIN steering group. He says: In order for the regional distribution of patients to work, strategic planning must be done. Wherever there were bottlenecks, it was necessary to react early. Emergency transfers, which pose a great risk for patients in critical condition, could thus be avoided. Which patients are transferred is always an individual decision, as is the choice of means of transport: ambulance, helicopter or Bundeswehr aircraft, in which six patients can be transported at the same time.
Corona sufferers in particular are relocated - but usually not if they are already being ventilated via an artificial lung: "An ECMO patient is in good hands at his place." It is not excluded that people who are not being treated for Covid-19, said Gräsner, but that is not the rule.
Because: The financing is currently only regulated for Covid patients.
The German health system can still provide general basic medical care, emphasizes Marx: "Everyone is cared for." Possibly just not at the same high level.