Rapid Response Infrastructures for Pandemic Preparedness in Tertiary Care Hospitals: Lessons Learned from the COVID-19 Outbreak in Germany

Background: Germany is among the countries with the highest numbers of SARS-CoV-2 infections in Europe. To slow the spread of SARS-CoV-2 a combination of measures is essential: extensive testing and immediate isolation of SARS-CoV-2 positive cases, tracking and precautionary self-isolation of close contacts. Moreover, outbreak situations with contagious pathogens in densely populated areas cause tremendous pressure on local health care systems. In response to certain trigger events such as social media or press releases, large numbers of potentially infected patients seek consultation at hospital outpatient departments and emergency rooms (ER). To avoid malfunctioning of these critical services, patients need to be redirected and triaged at dedicated and promptly installed facilities. Methods: Here we provide a detailed description of a COVID-19 rapid response infrastructure (CRRI) which was successfully installed at the University Hospital Cologne (UHC) in response to the COVID-19 epidemic in Germany. Results: Within 24 hours, our setup led to pronounced reduction of patient load in the ER and enabled risk assessment of 1166 patients of which 746 (64%) received testing for SARS-CoV-2 during the first 2 weeks of operation (February 27th – March 12th, 2020). Timely on-site evaluation of positive test results informed on local transmission cycles, which in turn led to successful extension of test indications beyond national guidelines. In addition, the infrastructure was exploited for testing and contact tracing of hospital personnel as cases strongly increased in Germany. Interpretation: Our findings show that such infrastructure can and must be rapidly installed, equipped and maintained for the current COVID-19 epidemic and future highly dynamic outbreaks. However, as cases steadily rise, we also recommend that health authorities use time gained by hospital-based facilities to install additional infrastructure for community testing. Funding Statement: J.R. receives funding from the Thematic Translational Unit Tuberculosis (TTU TB, grant number TTU 02.806 and 02.905) of the German Center of Infection Research (DZIF). Financial support was also received from the German Research Foundation (DFG RY 159) and the Center for Molecular Medicine Cologne (ZMMK – CAP8). I.S. receives funding by the German Center for Infection Research (DZIF) (grant number TTU 02.806 and 02.905, grant number TI 07.001_SUAREZ_00). OAC receives funding from the German Center of Infection Research (DZIF), grant number TI, and the German Research Foundation/German Excellence Strategy (grant EXC 2030 – 390661388). C.L. receives funding by the German Center of Infection Research (DZIF) TTU HIV (grant number TTU 04.820) and The German Federal Joint Committee (G-BA) (grant number 01VSF18036). Declaration of Interests: The authors declare no competing financial interest. Ethics Approval Statement: The use of anonymized clinical data was approved by the Institutional Review Board of the UHC, Germany.