Our most important advisor in the coronavirus crisis: "I am extremely impressed by our people"

What Daniel Koch for the nation, is Julia Bielicki currently the face of the coronavirus crisis for UKBB employees. The infectiologist heads the Children's Hospital's hygiene committee and is therefore the most important advisor to the management during the pandemic. She was also the first to make staff aware that this virus could paralyse an entire healthcare system. And this was weeks before Basel began to wonder whether or not to cancel the carnival.

Since then, Dr Julia Bielicki has stood in front of the assembled workforce several times a week and presented the latest findings and measures. She made recommendations to the «Corona Task Force» practically every day, which led to decisions for further operations. And her phone was already ringing again before she had even hung it up. In short, her expertise was in demand like never before.

We meet the busy woman in the sun for a chat. We sit at a garden table in the courtyard of the children's hospital and talk the way people talk to each other in times of corona: across the long table top from one corner to the other. Even before the first question has been asked and the recorder is running, we are already in the middle of the conversation, realising how difficult it is to understand the drastic Measures of the Federal Office of Public Health (FOPH) in everyday life with family and children. «Our nanny is suffering a lot because she is not allowed to see our two children at the moment,» says Julia Bielicki. Her children are four and one and a half years old.

«Stay at home, don't meet friends and relatives» - Julia Bielicki, the FOPH's rules of behaviour are as clear as they are drastic. Do you still go to the playground with your children?

Oh yes. I don't think there's any other way. Anything else would be torture - for them, but also for the parents. We've been reading a lot about domestic violence in connection with the pandemic recently. That's also a reality. That's why I think: of course you have to comply with the current measures, keep your distance and only have contact with a small, stable circle of people. But you also have to get out with the children. What's more, we can slowly assume that the measures that have been taken are actually taking effect.

They have been working very hard for weeks, the nanny has been cancelled...

... luckily my husband has turned out to be an excellent househusband! (laughs) Seriously, we do take our son to kindergarten after all. This is still possible for parents in system-relevant professions. A great privilege, also for our children.

How are your children dealing with the situation?

Even if they don't really understand it all, it's a very special time for them and often confusing. So my son keeps talking about the «virus» and what you can't do now. He washes his hands well and even sneezes into his elbows when he thinks about it. Quite amazing behaviour for a four-year-old, isn't it?

«In a situation like this, you tend to think that you always have to maximise what is theoretically possible. However, this is neither practicable nor sensible.»

The situation is sometimes confusing for us adults too, even in hospital. This became tangible, for example, when we introduced compulsory masks at the UKBB and were suddenly told that they could be worn for an entire shift.

Yes, such things are not easy to communicate. The crux of the matter is that in an outbreak like this, where little is known about the pathogen, you always start with maximum safety measures. You can't start too early, otherwise there will be a lack of acceptance. But if you are too late, you will end up with avoidable transmissions. So you expect the worst and do everything you can to prevent it. And then you come along and say: We now know more and realise that these and those measures are no longer sensible. This can sometimes be difficult for staff to understand.

The question is: Is everything being done to ensure that we are optimally protected?

In a situation like this, there is a tendency to think that you always have to maximise what is theoretically possible. However, this is neither practicable nor sensible. You have to live with the fact that - as everywhere else - resources are limited in hospital hygiene. In order to develop recommendations in such a situation, you always have to weigh up what you are using and what effect you can achieve with it. You see, if you halve a risk, that sounds like a lot. But when you look at it soberly: What do you gain if you reduce a risk from just 0.2 per cent to 0.1 per cent under high wear and tear, for example?

The aim is therefore to get the maximum out of what is available.

Of course. As far as resources are concerned, we are in a very fortunate position in Basel. Not only in terms of material. Several people in Basel work very directly with the FOPH. In particular via the national expert group for infection control, the Prof Andreas Widmer of the University Hospital, which I am also a member of. As part of this network, we knew first-hand from our colleagues in Ticino, for example, what could be in store for our region. I think this constellation has already had a major influence on our actions.

How exactly?

We were able to make our own decisions. In the beginning, we were always two or three steps ahead. We were always able to do a little more than the FOPH would have demanded at the time. I think the benefits of this can be seen, for example, in the fact that there were no more transfers among hospital staff at the Basel site very early on.

The novel coronavirus still does not appear to pose a major threat to children. Even those who are infected hardly show any symptoms. Can you briefly explain why the virus is still a crisis for the UKBB?

A pandemic like this simply affects all institutions in a healthcare system. The federal government's directive, for example, to only treat «urgent cases» in order to keep capacities free: This affects UKBB just as much - with all the consequences. We also have to ensure that, given the available space, there is as little mixing of potentially infected and non-infected patients as possible. And imagine what would happen if most of the staff were suddenly unable to work because of the virus. After all, the staff don't just live in the hospital and could be infected somewhere and then carry the virus into the hospital.

«Everyone is extremely willing to maintain a situation in which the UKBB can continue to provide care for everyone who needs it.»

It was also debated whether paediatric staff would have to help out with the adults. 

This would theoretically be possible due to our public mandate. In other countries, this has actually happened. In England, for example, all paediatric senior physicians were transferred to the adult side, while retired paediatricians filled the vacancies that arose at the children's hospitals. This would of course also be a major challenge for the UKBB.

Your recommendations carry a lot of weight in the current crisis management, which means you have a lot of responsibility in a very difficult time. How well are you still sleeping?

Especially in the beginning, I was preoccupied with that. There was a lot you just couldn't know yet. I also learnt very directly from international partners how things worked in Italy, for example. It makes you feel a bit different. You want the staff and patients here to be protected in the best possible way. And that gives you the feeling: Your measures can make a huge difference! Whether the system can continue to function, whether individuals will be affected, in the worst case even in a life-threatening way. Fortunately, nobody has to bear the responsibility alone, because you always make such important decisions together with others. That's also what my husband always said to me when I was having second thoughts at home.

How do you feel about the atmosphere at UKBB?

I am extremely impressed by our people. Also of all the civilians and students who support us. Everyone is extremely willing to maintain a situation that ensures that the UKBB continues to provide care for everyone who needs it. We in Hospital Hygiene always feel a little uncomfortable. We are always the ones who say: «But we also have to think about this and that, and please don't forget that...» - That can be annoying for our colleagues. And they are also experts who think for themselves. That's why timing and comprehensibility are the be-all and end-all when we make recommendations. Then everyone pulls together. And the recommendations must be as simple and realistic as possible. Only then can it work.

Her phone rang continuously at times. Who was actually on the other end? And what did they want from you?

In the beginning, it was mainly people from UKBB. It was mostly about tangible things.

For example?

You may remember the case of one in the region, a daycare centre carer. There were several children who had contact with her, and of course their families came to us. It was very emotional in some cases. We didn't yet have an outpost in front of the building, where the emergency department now handles suspected cases. We had to work with what we had. And then you just stand on the emergency ward and help.

And all the other calls, what about them?

In a second phase, these tended to be the doctors from the practices. Our communication with them was intensive right from the start. And because the doctors in the Infolines of the BAG As some of them could hardly get through and the cantonal doctor was also very busy with phone calls at times, I gave them the number of my business mobile phone.

«I'm actually much more of a bacteria person. I think viruses are terrible pathogens!»

Did you manage an entire hotline on your own?

Well, there aren't that many of them, that was okay. (laughs) I still make a lot of phone calls to the Basel Department of Health, the university hospital's staff medical service, which also looks after our staff, and the USB's infection prevention department. Fortunately, my phone is no longer ringing off the hook. We are organised and know how things are going.

The infection curve is currently levelling off in Switzerland. How surprised were you that we found ourselves in such an unusual situation in the first place?

What has surprised me so far is how lightly we seem to have got off. On the one hand, that's very positive. On the other hand, this is precisely why we are now in a delicate phase. We could lose awareness of the fact that the risk is still there. Not only the population, but also hospital staff are longing for a certain normality in everyday life. That's why we now need to motivate our people to remain as committed as ever. I mean, in Geneva, the number of intensive care patients has shot up from five to eighty in just two days. We simply have to keep up the pace we're on now.

The coronavirus crisis is very drastic for everyone. Is there something fascinating about it for you as an infectiologist?

I really didn't need that! I already had enough to do before. (laughs) Fascinating? No. But it is certainly an opportunity to learn an incredible amount. Like many others in the company, I am suddenly confronted with processes and decisions that I would otherwise never have to make. The official channels are suddenly extremely short and you interact with people who would otherwise not have been on your radar as important partners. I'm grateful for that and would almost find it a shame if it changed again later. But from a professional point of view? I'm actually much more of a bacteria person. I think viruses are terrible pathogens!