5 years of the Sars-CoV-2 pandemic

Experts from LMU and LMU Klinikum outline their key findings from this period. Everyone agrees that the push for digitalization, interdisciplinary and interprofessional collaboration and modern and transparent communication were of great importance and still are today. At the same time, however, the doctors and researchers also saw which topics should be evaluated and shaped differently in the future.

Our years of regular infectiology training, early warning systems and crisis simulations, international networking in infection and tropical medicine and the expertise of employees experienced in outbreaks have enabled us to quickly set up a COVID-19 Response Unit. This enabled us, for example, to respond directly to the outbreak with our first COVID-19 Testing Unit in Germany after the first COVID-19 case, vaccination campaigns, training in retirement homes, etc. We were also able to draw on existing research projects (e.g. wastewater monitoring, epidemiological studies, vaccination studies). This rapid response capability and cooperation within the network have proven their worth. The great support, funding and finding quick, pragmatic solutions in the acute situation from politicians, authorities and partners were also key. We have further expanded these structures for pandemic preparedness, and new projects, internationally recognized studies (e.g. prospective COVID-19 cohort Munich) and research infrastructures (e.g. cooperation with Fraunhofer ITMP-IIP) have emerged.

We recognized each other less well (mask), but got to know each other better - both interdisciplinary and interprofessional. We also learned that basic research can also be life-saving (vaccination), that fax machines are no longer a modern means of communication, that the efficiency of and solidarity within the system (when it matters) is surprisingly high, but also that we are extremely slow (because over-regulated) in the organization of clinical research in Germany and have a lot of room for improvement. Therefore, the establishment of the University Medicine Network with the projects that have now been announced will positively change the clinical research landscape in Germany.

The pandemic has made it clear how critical it is to have sufficient staffing levels in order to cope with crises. The pandemic has raised public awareness of the systemic importance of nursing staff. Recognition and respect for the work of nursing staff have increased.
Nursing staff have demonstrated their ability to adapt quickly to new situations, e.g. by learning new processes and dealing with COVID-19 patients. This demonstrated the high level of competence and adaptability of the staff. The pandemic required quick, often unconventional decisions. Among other things, they learned to act flexibly in uncertain situations and set clear priorities.

The idea and possibility of an interdisciplinary center of infectiology at the LMU Clinic, now known as KLIK, arose from the collaboration of various medical clinics and brings infectiological expertise under one roof. We have learned to see clinical infectiology as a specialty and a new specialist title has been approved for it during the pandemic. What we have not managed to achieve is a law that is able to put an end to the petty federalism in the event of a pandemic.

New, interdisciplinary networks between epidemiology, clinical medicine, informatics, public health and many other disciplines, including the humanities, have formed with astonishing speed, pursuing and achieving common goals on an equal footing. Even though there was always a need for social discussion, public acceptance of scientific results was high. However, we have also learned that the pandemic has not been a great equalizer, but has reinforced social differences and upheavals, whether it was about the use of the corona warning app, care for the elderly or vaccination readiness.
Epidemiology has become much more visible as a discipline. However, it remains an interesting task to make the public aware that the methods of epidemiology form the foundation for all aspects of public health and do not exclusively model infection events.

Thanks to close cooperation between various departments at the LMU Hospital, various services have been created to provide psychosocial support for the seriously ill, the dying, relatives and employees. The care and support of dying people is even more challenging in the pandemic situation and is not at the forefront of planning and crisis teams.
Dying in isolation and without the presence of relatives should also be avoided in a pandemic situation, as it leaves the bereaved with great burdens and makes grieving more difficult.

Modern biomedicine can overcome such a major challenge. Supply chains for masks and medicines, among other things, should not be based solely on economic parameters, but should also take into account the security of supply for the population in the event of a pandemic. Surveillance networks for newly emerging pandemic pathogens should remain active nationally and internationally.
The Bay-VOC monitoring network (https://www.bay-voc.lmu.de/), which was created during the COVID-19 pandemic, now combines weekly pathogen testing of patient swabs in around 200 sentinel practices and up to 30 wastewater collection points in Bavaria. In addition to SARS-CoV-2, the focus is currently also on influenza viruses and RSV. The constant methodological and conceptual development in this network between the LGL and the virologies at universities and university hospitals in Bavaria has created an important structure with a promising future.

Corona has shown the extent to which changing living conditions have a detrimental effect on the mental health of children and young people. The closure of kindergartens and schools should have been avoided and homeschooling should have been much better supported. Children and young people with learning and behavioral difficulties need special help, especially in such life situations, instead of being left to fend for themselves and their families.
The pandemic and its aftermath have further increased the need for child and adolescent psychiatric and psychotherapeutic treatment. In addition to the need for more inpatient and day-care treatment, the importance of prevention to strengthen the resilience of children and adolescents has increased. This should be scientifically sound and as low-threshold as possible. With digital prevention services, such aswww.ich-bin-alles.de we address young people directly in order to strengthen them and help them find their own resources and cope better with future stressful situations.

The close cooperation and coordination within the respective specialist areas (pediatrics, infectiology) as well as communication with the public health system and the media was certainly positive. At the Hauner Children's Hospital, we have consistently introduced point-of-care diagnostics and now have much better options for the rapid detection of other infections (influenza, RSV, but also gastrointestinal infections).
As an infectiologist and pediatrician, the pandemic has made me even more aware of how important the social environment is for children's development. In future, we must ensure that we avoid impairments in school performance due to school closures, an increase in mental health problems and suicidal tendencies in children and adolescents, as well as changes in the immune response ("Immunity Dept") with an increase and in some cases significantly more severe courses of infections (such as group A streptococci, parvo B19 virus and many others).

We have learned and experienced that it is extremely important to set up structures and processes for patient care and staff training quickly and across all clinics. The same applies to the need for interdisciplinary and interprofessional cooperation - in nursing as well as in the exchange between nursing and doctors and all other parties involved in the hospital.

Basic hygiene always works and protects against any type of pathogen, it just needs to be implemented consistently. It is essential to make clear decisions, often in initially unclear situations, and to communicate and explain them. Online training courses and hybrid events have become indispensable.
Rapid diagnostics and daily information on patients with respiratory tract infections have significantly shortened the response time to outbreaks. The permanent application of basic hygiene rules must be improved even further: the wearing of face masks during ALL contact with people with respiratory infection symptoms and hand hygiene.

"The coronavirus pandemic has presented us with many problems. In addition to the acute waves with numerous people falling ill and dying, long-term effects on physical and emotional health have also become increasingly apparent in recent years. Dealing with these colossal challenges has encouraged new approaches and solution-oriented approaches. These include intensive collaboration between different specialist areas, such as in the post-COVID LMU project, national and international networking with other practitioners and researchers, as well as important milestones in the digitalization of medicine. Even though the number of post-COVID cases has recently declined, a relevant proportion of the population is still affected. We therefore attach great importance to the interdisciplinary and scientifically sound treatment of our patients. We are also investigating the disease in regional, national and international cooperation projects. We are therefore better positioned today to meet future challenges."