Annemarie Sigle on the Baltic seashore.
Photo: Berliner Zeitung/Markus Wächter

HeiligendammTwelve steps and then another twelve. An almost insurmountable obstacle. How is he supposed to get up there? Half the stairs, then a break, then the other half. Fifteen minutes for one floor. Tamer Arslan shakes his head. He wants to take the elevator.

The world has been turned on its head for Tamer Arslan, a senior physician from Berlin. The surgeon normally operates on people's stomachs and intestines. Right now, he can't even make it up a flight of stairs without help. Breathing is difficult. His speech is sluggish. He’s barely surviving. He's learning to breathe properly again. He has no idea when he'll be able to work again.

Tamer Arslan fell sick with covid-19 and is still far from healthy. He's been at the Median Clinic in Heiligendamm, a rehab facility for lung diseases, for a week now. A small walk in the garden is an ordeal.

Public debate in Germany has focused on the lockdown, masks, the economic fallout and travel restrictions. Only sporadically do we hear about people – among them a lot medical staff – who have actually contracted covid-19. 

The Median building is vast. During the day, corridors are filled with patients heading to the dining hall or rushing to their next treatment: breathing exercises, strength and endurance training, water treading. The fitter ones stroll along the beach, ride bikes and take in the sea air.

Tamer Arslan.
Photo: Berliner Zeitung/Markus Wächter

Tamer Arslan is 44 years old, was physically fit and had never suffered from a serious illness. He probably caught covid-19 from a patient, as did five of his colleagues. While the others recovered quickly, Arslan fought for his life for weeks. It’s still not known why some get very ill and others not at all.

"Why me of all people? I have no idea," says Arslan, who was in hospital from late June to the end of August.

He must have caught the disease on his last working day before his holiday in Turkey, Arslan believes. His wrists already hurt during the flight. When it got worse, he called the clinic in Berlin and heard that one of his patients in the intensive care unit had tested positive for covid-19, as had two doctors and three nurses. Tamer Arslan self-isolated.

This virus says, I'm here. Then it eats you up. I feel as if I've been consumed inside.

Tamer Arslan, patient at Heiligendamm

"I didn’t have typical Covid symptoms: no cough, no loss of taste, just pain," he says. Pills would help for a few hours, but then the pain returned. When his temperature rose, he was given flu meds and antibiotics. One corona test was negative. But it kept getting worse.

He persuaded a doctor to take an X-ray of his lungs. A typical image of Covid emerged: cloudy, milky, not what the lungs are supposed to look like. From then on it went downhill. He was moved to intensive care, then transferred to the university hospital in Izmir.

"That was when I knew that my life was at stake." Arslan talks about how oxygen saturation in his blood was only 70 per cent. He talks about a doctor who said: "We have to intubate you now." That means general anaesthetic, being placed in an artificial coma. Tube in your windpipe, a ventilator.

"On 14 July I fell asleep," he says. The casual tone with which he recounts events doesn’t reflect the drama. It’s as if it had happened to someone else.

Learning to breathe again

As Arslan slept in the intensive care unit in Izmir, his kidneys failed. He was given blood plasma with antibodies. That is what the doctors told him later. He almost died. Fourteen days later, when he woke up, oxygen was forced into him. Arslan tore the tubes from body and wanted to die.

"The worst thing was the feeling of suffocation. It takes so long until someone comes. It's like diving when you go down too deep and think I have to breathe now. But I can't," says Arslan – a nightmare.

And now? "I have a lung like a ladybird," says Arslan. "This virus says 'here I am ', and then it eats you up. I feel like eaten up inside," says Arslan. In Heiligendamm he does breathing exercises, gets lung massages. He can't remember anything. He writes down the dates of treatments. His heart beats too fast. He takes beta-blockers, does fitness training, wants to get back to work, but it will probably take time. "As a surgeon, I can't say, 'Oh, I'm not feeling well right now, let's take a break."

To date, just over 100 former Covid patients have come to Heiligendamm. 61-year-old Annemarie Sigle arrived a fortnight ago from Swabia in southern Germany.

When she walks in the door of a small lounge, it’s immediately clear that she is better off than Tamer Arslan. She seems exhilarated, wide awake, and yet her case is particularly worrying. She was never seriously ill. At least compared to Tamer Arslan. She wasn’t in hospital, she wasn’t ventilated. She suffered a fever for 12 days in March. But she’s not healthy.

Sigle is a medical technician. In mid-March her daughter asked her why she kept working: what about her age, her asthma? But Sigle felt well-protected. She wore a protective suit at work, an FFP2 mask, doubled gloves. Her colleagues sometimes laughed at her because they thought she was overdoing it.

In March skiers returned from Ischgl to her home region. Every day two to three patients required a thorax CT scan in their hospital and it was Sigle's job to perform the scans. At the time, she didn't know the virus could stick around for long period indoors via aerosols.

She thinks it must have been a patient with a severe cough. It was a Thursday when she felt the first symptoms. On Friday, her lungs were affected. Next came a high fever and a severe cough. She wrote her last will and testament and went to bed in the attic while her husband stayed in the bedroom downstairs. He was never infected.

Annemarie Sigle returned to work 13 weeks later. And yet she had to sit on a radiator in the hallway to her department. Her next stopover was on a chair at the registration desk. She spoke two sentences and was out of breath. Riding my bike 12 kilometres to work? Impossible.

"I was happy if I didn't have to take the lift for one floor," she says. That's how July and August went for her. 

Simply a lack of air

When she talks, she sometimes has to stop mid-sentence. Suddenly her chest feels as if it is tied up. She coughs. Only after a while does she continue. "At first I panicked when this happened. There is simply a lack of air. Breathing and talking do not work together. I have to wait a while until it passes," she says.

She's now trying to climb stairs and ride her bike. "At first you think, 'Oh, I survived it.' But as soon as you get up you have to go back to bed because you're so tired. It can't stay like that," she says. She's exhausted. She mixes up letters while writing. When writing down the train connection to Heiligendamm, she writes Gleiß , Gleiz and then Gleis (platform), without realising what she's doing.

Sigle fears a second wave and that the virus might mutate. She regularly checks whether she still has antibodies in her blood. She hopes that people won't go to demonstrations or celebrate close together. "They think, oh, it's just like the flu, but it's not."

Dr Jördis Frommhold.
Photo: Berliner Zeitung/Markus Wächter

"230,000 people have gone through Covid in Germany so far. They're called convalescents, but that's the wrong word. They're not healthy," says Dr Jördis Frommhold, chief physician at the department for respiratory diseases in Heiligendamm. She's open to talking to the press. She goes on chat shows, because she wants to warn that covid will permanently harm a lot people if we don't do something about it now.

"I can only appeal to politicians to deal with this. Otherwise, we will have a large number of people with reduced earning capacity, disability - and permanent disability," she says.

Soldiers, firemen and triathletes get sick, as do 86-year-old people who survive the intensive care unit and are fit again after 14 days

Dr Jördis Frommhold

The average age of covid patients in her clinic is between 35 and 65, and they come from all over Germany. Many of them are trained athletes.

"To be honest, no risk profile can be identified. Forty-year-old German soldiers, firemen and triathletes get sick, as do 86-year-old people who survive the intensive care unit and are fit again after 14 days, while the 40-year-old won't regain his normal fitness again after five weeks," she says.

Also just as unclear is who develops which post-Covid symptoms. In addition to breathing problems and reduced levels of fitness, sudden pain, numbness, paralysis and hair loss can occur. Some people have memory problems, problems remembering words, spelling difficulties. Some can't walk. Others have psychological problems because they can't cope with life-threatening situations and loss of control. Traumatic experiences come up. Sudden panic attacks make normal life impossible.

From Dr Frommhold's point of view, rehabilitation and outpatient therapy is crucial. First of all, the lungs need to be used again properly. Most people would have gotten used to breathing gently. Not only those who were ventilated. Not enough oxygen gets into the bloodstream. Then it's impossible to climb stairs. After learning to breathe again, you build up your fitness.

She says that people with permanent disabilities who didn't even notice that they had Covid-19 were also struggling.

"I've received dozens of e-mails, handwritten letters, cries for help. I get calls from people who feel that they have fallen through the cracks because they have no diagnosis. The high number of people who are affected worries me," she says.

Frommhold has a problem with the repression of reality. She thinks the desire to return to life before corona is unrealistic. "Normal life is now. It will never be the same again." Whether there's a vaccine or not is irrelevant for her. She has to deal with the situation now. Keep your distance. Put your mask on.

Annemarie Sigle thinks differently. She doesn't want to put anything on hold anymore. The first thing she is going to do is buy an e-bike. "I'd been thinking about it for some time, but now I don't want to wait any longer. You have to live now. It can be over at any time."