Report from the front lines by professor-general practitioner Jochen Cals

25 March 2020

Many colleagues are currently busy organising online education or combining scientific research with the care of small children, but some employees of Maastricht University are literally operating on the front lines these days. Professor of General Practice Medicine Jochen Cals, for example, is also a practicing general practitioner in Sittard, a city that is suffering from a relatively high number of coronavirus infections. What is his experience during these unique times?

“What we are currently experiencing is unprecedented. I’ve never seen it before, and not a single colleague I talk to about it has ever experienced it before. Sittard is unfortunately a dark purple spot on the RIVM map that shows daily how many confirmed COVID-19 cases have been diagnosed in the Netherlands. Given the outbreak in the German region of Heinsberg—just across the border near Sittard—that's not surprising, I think. Many of our patients go shopping there, eat out and also celebrate carnival there. In Sittard, the first patients were seen in one of the nursing homes. After that, things developed very quickly in terms of the number of infections. The measures we take differ almost every day. For instance, we stopped all chronic care, such as blood pressure and blood sugar checks. All initial consults with patients are done by phone, then we evaluate whether someone really needs to be seen. If someone needs to be assessed for respiratory complaints or fever, we see them at the end of the day—in a special room, with the full package of personal protection measures. That means face mask on, goggles and covered up from head to toe. We check the clinical parameters, such as temperature and oxygen levels, if necessary run diagnostic tests. Patients who become too short of breath go to the hospital. I can’t provide any details, but my practice already has patients with confirmed COVID-19 diagnoses who are now in Intensive Care (IC). We are also gradually finding ourselves in new situations. For example, patients who, due to age and underlying suffering, no longer want to be admitted to hospital. In that case, however, you want to provide good end-of-life care, but in the meantime you can only do so if you, as a doctor and home care worker, can always follow all personal protective measures. So in that way we're actually already working on coronavirus-related palliative care".

How much time can you, as a practising general practitioner, spend on your work as a professor?
“As general practitioners, we have agreed with each other and with our staff that everyone should spend their normal days in the practice. Because, despite the great teamwork and everyone's offer to come and work more, we also have to take care of each other. This could last a long time, and we shouldn’t burn out our energy right away. We also need to be prepared to deal with illness among colleagues. So during these weeks, I’m working from home on Tuesdays and Fridays, and the other days in the practice, as always. I do notice that my ‘coronavirus working memory’ spins in the background all day long. Starting this week, we will scale up even more and we won’t be seeing patients who are suspected of having the coronavirus in our own practices during the day, either. This will happen at a separate location in the region. Then there will be additional services for all general practitioners. Nobody is complaining about that. There's a lot of talk about keeping social distance, but it would be better if we called it physical distance because, fortunately, there is a lot of social cohesion these days, also in our profession.”

Can all the studies being done by your research group continue?
“You notice that a lot of things have come to a standstill in terms of meeting and planning. My group mainly conducts applied clinical research. For example, I think that the preparation of a clinical study into chlamydia diagnostics in GP offices will be delayed because, for that, we need the general practitioners and microbiologists. They are now working on completely different things, and that's okay. We also do quite a bit of research into infectious diseases. Together with a fellow professor from Nijmegen, we were working on a research plan concerning the coronavirus, but application and rollout in such a short period of time unfortunately turned out not to be feasible. However, I’m really moved by the commitment of our students. One of the students doing her scientific internship with us is now helping out at the general practitioner's post. That's really great! Furthermore, the internships have of course been discontinued. Some of those medical students have set up a fantastic initiative to link students with doctors or UM employees. The students want to help by taking care of the children, for example, so that you can continue doing your work (see https://studentenoppas.wordpress.com). We met with one of the students last Friday. It’s a great initiative, and you’re seeing more of these ...".

Based on what you see happening so far, how do you expect this situation to develop further in South Limburg over the coming weeks?
"I’m deliberately not answering this question. My colleague Joost Zaat wrote a poingnant column in De Volkskrant about the information overload around the pandemic in the media and on social media. His final sentences: "Advice for doctors: forget Twitter and Facebook and check the NHG site. Good advice for patients: forget Facebook and check thuisarts.nl. Even better advice from me to inexpert experts: go do something else. As far as I’m concerned, that could be playing games, working on puzzles or watching porn. In Italy, the latter is free nowadays."

Written by Mark van der Linde for Maastricht University