next on d.w. . happiness is for everyone this is a very different from primates we have a totally ridiculous sized view of nature say that this is climate change spreads that sex how to dress in books you get smarter for free t.w. books. thousands of covert 1000 patients are fighting for their lives in german intensive care units you know it's fighting in germany half the patients who end up on respirators die and we have to remember these are human beings with families for some of these numbers are abstract maybe coronavirus tonight here's can't put themselves in someone else's shoes but each number stands for a person that size

a match. we've been filming the work of i.c.u. teams at fribourg university medical center since the start of the pandemic. but the cut you can't get any more air you can't speak you realize that you might die. how can we beat this virus what are the possible long term effects in germany 2nd wave many young and healthy people have caught the coronavirus unfortunately being young and healthy is no guarantee for getting a mild case. there was a young man 45 years old with a release of the x.x. this is a textbook case of how someone who is young and healthy and without significant preexisting conditions can almost end up dying.

the air ambulance arrives with a corona patient onboard he's enclosed in a special protective box to prevent others getting infected during the journey to the hospital a little later the patient in his late forty's arrives at the intensive care unit where dr vivian saltzman works the patient is already in an artificial coma and has been into baited that means he's connected to a ventilator. man who had said that patient came from a smaller hospital he had coughing at a temperature for a few days and then his condition suddenly deteriorated placed he developed severe breathing difficulties he was into abated and then transferred here. 6 medical workers carefully turn the patient so that he's lying face down prone positioning is proving to be one of the most important treatments to help many

people severely affected by the virus. patients have to be adequately cushion to avoid pressure sores on the face for example because they spend so many hours bed bound. off their work site there don't let that mistake if you lie on your back secretions collect and inflammation worsens the lungs can't heal properly our patients lie in bed for well said turning them face down allows the rear areas of the lungs to be ventilated and to heal the patients alternate between their back and the front so that all parts of the lungs can be equally ventilated that. every day the patients are turned on their stomachs and then back again it's very work intensive for the medical staff. of the ventilator is not enough for many of the seriously ill covert 900 patients they would die if they were not also attached to an artificial long. the catheter channels the blood out

of the body and then back into it with its twin tubes and i think that if you take him out after making a small incision the doctor pushes the catheter toward the heart using a guide wire that you know. to shut your eyes it appears. that. it's. got a pretty good this is the e.c.m. or the heart lung machine. it's attached by a plastic tubing and in this instance takes over the work of the lungs. what it worth my blood flows into the machine the carbon dioxide is removed and the blood is in rich with oxygen then it's pumped back into the patient. and. you know of course we also use it for far too long support we use it after

a heart attack after resuscitation they have a wide range of medical uses but the ones just on long support here are primarily coronavirus patients we don't have many options left for really sick patients that's the last card we have a carsley. they're going to go with the 5 we have 23 e.c.m. o's in fribourg university medical center 23 that's it and currently we only have 2 that are not in use so i hope the way won't be so severe and so disruptive because this is not just about intensive care beds as such are going to get you in the 1st wave of the pandemic one in 3 patients here are needed to be hooked up to an e.c.m. know to have a chance of survival. to question the therapeutic options are sobering of we supply oxygen we have the e.c.m. o. side it just buys time the body the lung. is have to heal themselves there is no

medication to treat coronavirus. almost half of the patients who ended up in intensive care in fribourg during the 1st wave died at the beginning of march few people suspected what the medics would soon be facing the 1st cases were only detected in germany in late january. this is barbara she was one of germany's 1st coded 1000 patients she is a pediatric specialist at the university medical center her colleague consultant johan a sculptor and has worked with her on many occasions. you. know it's 2 percent of the visitors who are when the patient arrived in intensive care she had severe breathing difficulties otherwise she was very ill lunch among some of the patients we encounter she was feverish but not at all disorientated that we were really struggling to get her breathing difficulties under control we gave her

a lot of medication to try to control and we had to give her an awful lot of oxygen and then given the rapid progression of the onus we decided to anita times and into paint on this amount as to supply her with a very rich concentration of oxygen but we saw she was suffering from severe lung failure. that's our. barbara spent more than a week fighting for her life. she made it her ventilation tube is gone in all likelihood she is no longer infectious today's 1st test was negative she has beat the virus but it was a close call. his situation was frightening at that moment. but you can't get any air anymore. you can't speak. you realize that you might be going to die or. then i began giving instructions

with my last remaining strength about my last wishes if i don't make it. the button would. have on whatsapp. it was a nightmare. in germany's 1st wave of the covert 900 figures rose rapidly in the south of the country fribourg university medical center switched to treating only medical emergencies and patients with a new coronavirus. this is clement's the sores on his face are from the long periods of time that he has spent lying face down before contracting the virus clements was a fit man in his mid sixty's a passionate mountaineer with no preexisting conditions. vivian saltsman has been treating him for weeks his lungs were so badly affected that she's been keeping him alive with an artificial long that supplies his blood with oxygen clemens has been

attached to the machine for almost 3 weeks but the intensive care team is confident he will make it. now after 20 days they have decided that he no longer needs the e.c.m. oma sheen. if you're going to remove the tubes from here growing it's a big step forward we're all really pleased. that . the e.c.u. mo is no longer needed but he still needs ventilation via the tube inserted in his trachea. that afternoon clemons gets visitors his wife but tina and his daughter have come to see him they're still not allowed to touch because of the danger of infection.

out of. there. his eyes are half open but not focused he's only semi conscious. barbara has just received her 2nd negative test the treatment was successful the virus can no longer be detected in her body she's not infectious she has survived kovac 19. she's still weak but she's no longer getting oxygen what she doesn't realize is that the nightmare is still far from over a little later she's back on a normal hospital ward where she gets some sobering news from a lung specialist. he puts her back on oxygen she's not getting enough air just hit means are not independent it's ok when i'm in the room. but it's

a bit tiresome if i'm quite honest. over the shoulders if i want to go outside i have to carry this heavy bottle. and i had really been hoping that i would get taken off it soon. but i think i'll just have to resign myself to my fate. is a long specialist cope at 19 has also confronted doctors in his discipline with a completely new range of challenges. the answer. for the inflammation triggered by the virus has also destroyed healthy tissue in the lawn and scars have formed. and the scars are a defect that hamper the normal functioning of the longer. they hinder the gaseous

exchange and we want to restrict that as far as possible by suppressing the inflammation that leads to these scars. into talking. with antiinflammatories like cortisone no one knows yet what the long term consequences will be of a severe case of coronavirus as a doctor barbara is only too aware of that you know. you can't but help thinking how will i cope with every day life will i be able to live and work more money after this. that's the $1000000.00 question. but if i'm left with lung damage it wouldn't be so great of course. but i can't do anything about it.

back in intensive care clemons condition has barely altered. his lungs are being ventilated via a tricky ostomy he hasn't received any sedatives for some time now but he still isn't properly conscious the doctor suspect coburg 19 also attacks the brain as indicators suggest. but yet the innocents in many cases we see the brain being severely affected many patients are agitated disoriented and the loss of sleep medication is that they become so disoriented during the course of the illness the brain has to be involved in the title. in the high security lab of the viral a-g. department they're studying the coronavirus there infecting cells with covert 19 so that they can examine it more closely all of the light colored dots are infections

that are spreading. under the microscope you can see alongside the blue cell nuclear lie that there are masses of red virus particles that are self replicating . such research is helping viral edges done yellow personally and helmet hangal to know what they're up against the sars coronavirus to which is causing the current covert $1000.00 pandemic is a much more successful and unpredictable opponent than the 1st sars virus. has a corner of your weaver all i just thought we knew about coronaviruses the sauce coronavirus tune is a science virus that's much more advanced than the sars virus that we were confronted with in 20022003 which had difficulties with effective transmission about the current virus manages it. exactly that it is efficiently transmitted via the air we breathe and of course that's really bad news for us from so far as if there is a fuse in my 25 year career as a viral

a just it's the nastiest virus i've come across because it's so unpredictable and it's becoming clear just how unpredictable when you get the flu you know you're going to get sick seriously ill if you're unlucky but there is a vaccine we can treat it sars c.o.v. to is quite different some people get it but don't get ill though they are infectious others die from it without it being clear why and of course it affects older people but also the audience person it's an absolutely unfair opponent. after being unconscious for around 6 weeks clements has come around. whether. he took a long time to really become conscious and communicate but now he is not at all disoriented and can join in he's mostly pretty cheerful he's

a fighter have he's a cyclist he wants to do all these things again he has goals i think that's very important to know what you are fighting for to stick with it. clemens has beaten the coronavirus but he keeps getting other infections mike ammonia each one is a new threat to his life. this is hope it's a roller coaster when he got an infection again he was just lying there again i began to despair and wonder what would happen here the next bad piece of news always seems to be around the corner so i'm afraid of being too optimistic you stop wanting to engage even with the positive stuff that. clemens has been. in intensive care for more than 2 months. his constant focus getting his own life back he has lost more than 15 kilos and most of his muscles have wasted away.

he's getting high energy nutrition via a feeding tube he is fighting to recover. files about once he is in a kind of rehabilitation phase at the moment with us he's doing a lot of physiotherapy he's using the pedal exercise or he's also able to get out of his chair already and can do that pretty well the situation with the artificial ventilation is getting better. slowly that. his wife but you know records every bit of progress that he makes. it is that in this is him going into his room he couldn't get up and sit down alone at that point and this was the 1st time more than 4 weeks ago that you even recognized as. a jury member that yes you can remember that i can remember. yes his

gaze looked human again through his pursuit of him and it is a huge difference if someone has light in their eyes or. it's really frightening when someone just looks completely blank at least i was really afraid. you wonder within his spirit he will be back to the way he was or not it's terrifying. barbara has been at a rehabilitation center in the black forest for almost 6 weeks now she doesn't need oxygen anymore and she's fighting her way back to normality. amazing if you saw me on the walker. here she is 7 weeks ago on

a walker at the intensive care unit in freiburg when she arrived there she was at the point of suffocation. as well not only that it was absolutely apparent to me that i would not have survived without artificial ventilation and so in principle they've given me a new lease of life and i experienced an amazing sense of gratitude the 1st 23 days i was really over the moon. it was a feeling of happiness that i think i have never experienced before it's. not me. in summer clemons 2 was on his way to a rehabilitation center in the black forest after more than 70 days in intensive care. before he got the coronavirus he could climb 4000 meter high mountains. now the

slightest incline taxes him. somebody for a moment yes i can feel that i've been active. going through super stop my legs that are the problem it's my lungs. at times i asked myself what made me so vulnerable. and that means i thought that i would definitely not be affected as badly as someone with respect for. her. so i don't have high blood pressure or diabetes no other chronic illnesses. who's not. i haven't found any answer to that.

it's easier if you bring up one leg next to the other. really get your thighs does or. the physical rehabilitation program has modest goals this isn't about climbing 4000 meter peaks but ensuring that clements can cope with daily life. a few weeks after completing her rehab barbara has a check up at the university medical center she has been training hard as a doctor she knows that your lungs don't recover on their own. take a big breath out breathe out out out out out breathe then quickly deeper deeper and quickly breathe it all out out out out out stay with it really press out over the air until there's nothing left gone gone gone great. what have the hours of training achieved disappointment. no seams if only

67 really. that's what that would mean that my lung capacity has only approved by 10 percent in 8 weeks 5 of them spend working like a dog to improve my lungs. i'm off. the doctors want to take a look inside her along us because i was in and hold your breath. are there still size of inflammation. can be anything. are there signs of pulmonary fibrosis scarring of the lungs to covert 19 leave lasting damage in severe cases. these cloudy areas here these very fine lines here these don't exist in normal lungs 1st so no hard data because there haven't

been any long cohort studies that would tell us whether or not these changes i'm likely to diminish over time or how they might develop but. there are types of pulmonary fibrosis that continue to develop even when a virus has gone i can't tell from your m.r.i. at the moment. the moment. barbara performs well on the following running test but will she remain so fit. as a doctor she knows how dreadful pulmonary fibrosis can be. just as the story. that you there is what you used to call it the apathic lung fibrosis that people can get after a severe case of influenza and at some point you end up needing a lung transplant. that's something that takes place after 10 years rather than one . but of course its progression can come to a halt with a bit of luck that's much too strong but you can also end up battling to get air.

it's a horrible way to die. from the school. in autumn the number of cases begins rising again. clemens has come to the medical center to thank the staff couldn't forgive the i'm glad i'm a visitor this time and not a patient. to suffer that really shook me up. i bet it did all your fears come flooding back don't they. clemens continues to convalesce meanwhile more and more. virus patients start arriving at the hospital in fribourg been freed karen's infectious diseases department is full again just like in spring and additional

normal wards have already been transformed into covert 19 more it. is either going are saying that several other hospitals in the area are already full so we have to brace ourselves for even more cases and the next $7.00 to $14.00 days. older age groups are now being affected and we know from our experience of the 1st wave that this will result in more hospital admissions. here at the normal code ward patients often require oxygen but they don't yet need artificial ventilation about all the staff can do is give oxygen inhalations and stop patients from getting additional infections. the winter weeks will be crucial ones for the hospitals the team led by. is responsible for forecasting for the hospital working out how many patients will likely need to be admitted if we don't stick to the restrictions. you have to see

things from the point of view of the virus. the virus has a semi parasitic relationship to us and exploits our needs. the iris explodes the need of people to be sociable to get together to celebrate with the family with the neighbors successful viruses take advantage of this in a perfidious way. in the 1st wave relatively few people were affected in germany now the virus is almost on the press and any family can be affected. you can even find. the far reaching social penetration of the virus also means that we are going to have to be more patient when it comes to fighting this fire is now that it is much. more widespread . i assume that a short lock down like the one that worked so well in april will not work again in that way and that we will have to come to terms with

a longer lockdown of. i'm sure. there are more difficult times ahead for the people working in intensive care vaccination is no quick fix to be covert 19 we're going to need greater staying power. i hope that we'll have the corona virus pandemic under control in the 3 years and by then we will have successfully vaccinated the entire population and know that the immunity conferred by the vaccines well last several years then we consider the question of when a booster vaccine might be needed in 3 years in 3 years many intensive care units are already at or over full capacity in fribourg they still fight to save every life in the intensive care ward so working at their limit we have to say that quite clearly we still have empty beds but every day the numbers are increasing and the patients remain in hospital for weeks or months the beds aren't freed up in just

a few days. i don't know how but we have to manage even if the numbers rise we have the beds that we have at our disposal. and we will do our best looking after everyone. we can't really do any more is that we have to look after the severe cases we have to count we can't say we can cope with any more here is the cutoff point this option does not exist you see. we have to carry on somehow that's quite clear. and with those words philip schmidt gets to work preparing a fresh intensive care bed in the next coronavirus patient is already on the way.

a job. susan is teaching. the psalms the response. to. the journey. to. go.

to. the state of the news line from berlin impeachment 2.0 and the u.s. lawmakers take action again to impeach u.s. president donald trump democrats formally accused trumped up and signing and suresh and last week the mob that overran the capital they say took cues from the president also coming up. a cold winter.