Expertise in critical care and innovative solutions for multi-organ support – these are key strengths that Fresenius Medical Care leverages to provide critically ill patients with the best possible care. This approach has proved effective in the coronavirus crisis: When the pandemic caused demand for acute dialysis machines and disposables to soar, the Company secured supplies for its clinics, saving the lives of patients who were seriously affected by COVID-19.
Carsten Vatter, Director Global Replenishment at the Biebesheim distribution center, was one of the first to realize what great demands the global coronavirus pandemic would place on Fresenius Medical Care. At a time when Germany‘s attention was still mainly focused on China and clinics in northern Italy were starting to fill up with COVID-19 patients, Vatter suddenly saw unusual requests from his Italian colleagues on his monitor: The normal stocks of materials for acute dialysis were no longer sufficient, they wrote. Italy desperately needed further supplies.
Shortly after that, Bernard Puigblanque also noticed unusual developments. The 57-year-old is head of the Intensive Care business unit for the whole of France. From his office near Paris, he is responsible for 14 employees who distribute and install acute dialysis products throughout the country and train hospital staff to use them. “In mid-March 2020, we suddenly received unusually high numbers of orders for acute dialysis machines and the associated disposables,” Puigblanque recalls. They all came from the first pandemic hot spots in France.
By this time, the virus had also started to spread within Germany. “I was one of the first at the Schweinfurt site to start working from home,” says Lisa Bausewein. Her husband had been in contact with an infected person and was self-isolating at home. “March 13, 2020, was my last day at the plant for the time being,” recalls the 29-year-old, who works in the customer service center at the Schweinfurt plant and is in charge of production scheduling for the multiFiltratePRO, Fresenius Medical Care’s latest acute dialysis machine. Bausewein had only just set up a provisional workstation at home, when most of her colleagues had to follow suit for safety reasons.
In mid-March 2020, we suddenly received unusually high numbers of orders for acute dialysis machines and the associated disposables.
This was in the third week of March 2020 – exactly at the same time as demand for the multiFiltratePRO machine and all acute dialysis disposables skyrocketed. Production had to be ramped up significantly, right in the middle of an exceptional crisis-induced situation: Germany was entering lockdown, neighboring countries were closing their borders, and half of Europe seemed to be in a state of shock. This raised a host of questions: How much additional demand would there be? Where would the components come from? Where would we find the staff to produce the additional machines and disposables? How would they get the products across the closed borders? Where are they needed most urgently?
COVID-19 and acute renal failure
The novel coronavirus SARS-CoV-2 not only attacks the lungs, but also the kidneys: These have an abundance of ACE2 receptors, via which the virus is able to penetrate the cells. Around a quarter of patients admitted to intensive care with COVID-19 develop acute renal failure that requires treatment. In these cases of renal failure, the organ‘s function must be replaced by acute dialysis therapy.
Acute peaks in demand
Acute dialysis is mainly performed in the form of continuous renal replacement therapy in intensive care units to replace vital kidney functions in severe cases of acute renal failure. It is a key element of critical care solutions, which constitute an increasingly important business area for Fresenius Medical Care. This is because the number of patients who receive continuous renal replacement therapy to treat acute kidney failure is set to rise to around 1.6 million per year by 2030.
For this reason, enhancing existing technologies and finding new, innovative solutions for the challenges involved in critical care are a key part of Fresenius Medical Care‘s strategy. The Company intends to expand its expertise in treating acute renal failure to include further extracorporeal critical care therapy areas, such as the treatment of acute heart, lung, and multi-organ failure. Our vision here is to provide patients in critical care with optimum treatment and better chances of survival using the best machines and therapies.
As well as respiratory problems, COVID-19 can cause acute renal failure in severe cases. Consequently, acute dialysis became the focus of attention almost overnight: Around one in four patients admitted to intensive care with COVID-19 develops acute renal failure, which has to be treated with acute dialysis. All of a sudden, intensive care units not only required extra ventilators, but also many more machines for acute dialysis. Eventually, the filters, solutions, and tubes required for these machines ran short, too, as the virus also significantly increases the blood‘s tendency to clot. With some COVID-19 patients, filters that usually last up to 72 hours became clogged after just a short time and had to be replaced – causing material consumption to rise at an equal rate. The latter situation has since improved, after initial scientific findings on COVID-19 became available and treatment was adapted accordingly.
What my team achieved while working from home was phenomenal.
Strong commitment to patients
When it became clear that the coronavirus pandemic would also exacerbate the situation in acute dialysis, Fresenius Medical Care set up a task force. Angelika Kneppel, Marketing Director Acute Dialysis, was part of the team: “All orders and information that reached Fresenius Medical Care through various channels were sent on to us.” Other groups, for instance at the Schweinfurt and St. Wendel plants, dealt with replenishing supplies of components, materials, and resources required to produce the machines, filters, and disposables. Within the space of a few days, a network had emerged in this widely spread company with the aim of getting the dramatic situation under control – after all, human lives were at stake.
Acute dialysis presents particular requirements, and is quite different from methods used to treat chronic renal failure, such as hemodialysis: Whereas patients with chronic renal failure have to make multiple visits to a dialysis clinic each week to receive treatment for several hours at a time, acute renal failure is treated in an intensive care unit over the course of several days, usually 24 hours a day. After a while, the kidneys generally regain their function to such an extent that acute dialysis is no longer required. To be able to respond as flexibly as possible when treating patients, acute dialysis machines are operated with solution bags and are independent of the existing infrastructure. In addition, to prevent blood clotting, patients receiving critical care need other therapeutic approaches, as there is often an increased risk of bleeding, for instance after an operation or in the case of an accident.
In France, Puigblanque received 70 orders for the multiFiltratePRO within a very short time. By way of comparison, this is equivalent to a month‘s worth of demand in normal times – worldwide! There were also orders for vast quantities of disposables. “We were in constant touch with the task force,” the head of the business unit recalls. “And at the same time, we were talking with the hospitals so that we always knew exactly what was most urgently needed.” Because supplies from Germany were not sufficient to cover all requests at once, Puigblanque started to split deliveries and divide them between the hospitals as best he could.
He received support from the distribution center in Biebesheim. “Normally, we send 30 truckloads to France each week, but in those weeks when the crisis was at its peak, it was 50,” Vatter explains. Italy and other countries were also supplied from Biebesheim and other distribution warehouses. “What my team achieved while working from home was phenomenal.”
truckloads were sent by Fresenius Medical Care from its distribution center in Biebesheim to France every week, when the crisis was at its peak.
Beating the crisis with team spirit
Until the first wave of the pandemic began to level off in Europe at the end of May, Fresenius Medical Care made a tremendous effort to meet the huge demand in the acute dialysis sector. Production of the multiFiltrate- PRO was gradually tripled, and other plants also increased their production volumes to a similar extent.
“My team did everything humanly possible to meet the demand,” says Vatter, which is putting it mildly given the enormous amount of work involved. From Biebesheim, all the goods were navigated through Europe, which was largely sealed off. Labeled as “life-sustaining supplies”, the deliveries from Fresenius Medical Care were waved past the lines of trucks at the border crossings and reached their destinations on time.
Puigblanque also managed to respond to every request eventually – even if not always on the same day or in one consignment. “That was definitely the most challenging time in my career,” he says today. In July, he received special recognition for his hard work in a letter from a hospital in the greater Paris area. “Thanks to your efforts to supply us with medical equipment regularly and on time, we were able to guarantee the required quality and safety of our treatments,” the letter said. “We would never have been able to meet this challenge without you.” The experienced sales expert was delighted by this: “It was the first time anything like that had happened to me in my working life.”