What is your current state of mind? 

Dr Emile Bock: We expected and feared such an evolution, the arrival of a second wave. Its size, greater than the first, and its duration, longer, will obviously present a huge challenge to the health sector. We are currently in the upward phase of this wave and we do not know when we will reach the peak. We are also waiting to see what effect the latest measures announced by the government will have.

Are you ready to face this second wave? 

The first wave in March-April has enabled us to strengthen our logistic and infrastructural organisation. We are now practically self-sufficient in equipment since the Robert Schuman hospitals--through their sister company Santé Services–-produce surgical masks and will soon be able to manufacture FFP2 masks as well. Additionally, Luxembourg is able to relaunch the production of Tyvek protective clothing.

The flows initially developed during the emergency situation have been integrated into sustainable infrastructures pertaining to the hospital. In light of the recent increase in covid-19 patients, we have, for instance, expanded the covid area indoors and set up five new examining areas to isolate patients. The healthcare organisation is reevaluated on a daily basis, according to the flow of covid and non-covid patients. 

So in a way the experience in March has helped you… 

Yes, in terms of logistics, emergency organisation and separation of covid and non-covid flows. At the moment, we also have limited internal administrative tasks by postponing everything that is not essential. The challenge will be to manage both, covid care and urgent non-covid care. Planned non-covid interventions are already impacted at this point due to staff shortages caused by quarantine and positive cases within the teams as well as the surge of infected patients in hospitals. 

How do you feel about the statements of elected officials from the Grand Est or the Belgian province of Luxembourg, who have said that Luxembourg is “savagely poaching” hospital staff? 

All of Europe is in a crisis, and this is partly understandable. I think that some regions--including Luxembourg--are now paying for years of fiscal restraint and non-formal training in these challenging, undervalued careers that are no longer chosen by young people. I want to emphasize that the departure of hospital staff from neighbouring regions is less due to to wage aspects than to the better working conditions that we offer in Luxembourg, as three emergency physicians from the Grand Est that moved abroad--one to Switzerland, one to Belgium and one to Luxembourg--stated in Le Républicain Lorrain. 

How many Covid patients would you be able to take in? 

The Robert Schuman hospitals have a total of 703 beds available; with the current spike in infections we are anticipating up to three covid floors while trying to preserve normal medicine. The limit is not so much to do with the number of normal care beds or respirators, but more with the number of healthcare staff to ensure quality management.

Is the idea of a healthcare reserve useful? 

To my knowledge it has never been used in hospitals and is currently quite limited. It would make sense to use it in nursing homes because the treatment is pretty codified to enable it with high quality for patients who do not need to stay in resuscitation and for whom a hospital stay represents an additional stress factor compared to their usual environment. We can also imagine home hospital solutions in collaboration with home care networks to take some of the pressure off of hospital facilities and even take care of operated patients whose stay is limited. In such a case, general practitioners could play a central role. There are no limits to the imagination when it comes to finding solutions in a crisis situation. 

Should more drastic measures be put in place to curb this second wave? A second lockdown? 

Reflections should always be made with regards to three focal points: health, society and the economy. The latter also has to continue to turn as much as possible in order to avoid a disaster at the economic level; the effects on our societal behaviour are already palpable. It is therefore necessary to keep an eye on the health sector to make sure that it can absorb the flow of patients, whatever their pathology, and guarantee them high quality care. As for schools, nothing can justify sacrificing the education of a whole generation. After all, it is young people who represent the future of the three pillars I just mentioned. 

So the lockdown as we experienced it in March is not necessary anymore today? 

Right now, no. If, however, hospitals and resuscitation teams found themselves saturated, we would have no other choice. That said, regardless of the measures, people have to realize that they are the solution to the problem by adhering to the rules: staying at home, limiting contacts, wearing a mask also in public spaces, respecting distances, washing hands…It is extremely important in the current situation to follow these rules meticulously. 

Will there be a pre and post-covid in hospitals? 

“I hope so, and not just for hospitals, but for the entire health sector. However, we are still managing this crisis rather than anticipating. We’re chasing the virus, when we should be ahead of it. I regret that the CNS has not yet grasped the issue surrounding lack of staff and the financial effort necessary to deal with this situation. The additional healthcare positions we were given this summer are only filling a chronic deficit. Human resources are the key element. The healthcare staff will be at the heart of the fight taking place in this phase of the crisis, but also beyond that. 

How are the teams holding up? 

“Everyone went back to “combat” mode when the second wave hit. We were prepared. Fatigue is there, but morale is good. We will have to keep going. The profession of caregiver is a vocation rather than just a job. I am not worried about the teams motivation towards treating patients, even if it will get tough. 

Are there psychological supports planned? 

“We had already set up a support programme during the first wave, which was barely used given its relatively short duration. Teams of psychologists and psychiatrists continue to proactively reach out to people to prepare for difficult situations as much as possible. 

How do you experience the situation personally? 

“This is our job, but the scale and duration of the crisis is unprecedented. The nights are short, the days are long. We know that we are only at the beginning of this second wave. We are off to a marathon. 

This article was originally published in French on Paperjam.lu  and has been translated and edited for Delano.