Interview by Sarah Polzer

Dr. Löffler, how did you get in touch with COVIDSurg?
Twitter was definitively the main hub. I came across COVIDSurg through a tweet by my colleague Hans Lederhuber. I can still exactly remember the beginning, it was March 15th 2020 - my birthday. I only celebrated shortly in a very small circle with coffee and cake. It was just before the first lockdown and there was a lot of uncertainty about what to expect. Afterwards, I called Hans and we asked ourselves what we could do. We decided to create a template for institutional review board review, so that everyone could use it for submission to one of the many German ethics committees. On about twenty pages we outlined our request, presenting numerous relevant aspects. On March 20th, we submitted a respective application to the ethics committee in Tübingen and received a positive response after only six days. Never before have I witnessed an application of this kind being reviewed so quickly.

Which role did Tübingen play?
Tübingen was a trailblazer and paved the way for the collection of important data from COVID-19 patients throughout surgical departments in Germany.  About one month after the positive Tübingen ethics vote, we submitted a manuscript to the medical journal The Lancet. The study was published at the end of May. 1243 colleagues worldwide had contributed to this.

What is the main topic of those studies?
Everyone in the COVIDSurg network has been pursuing the same goal, namely to make surgery safe again. The first study had shown that the mortality of COVID-19 patients who needed surgery had massively increased.  During the study, 23.8% of the included patients have died within 30 days. Among the operations assessed, 24.8% were elective procedures, i.e. planned operations. About three quarters was emergency surgery. In a later study, we investigated when resuming planned surgery is safe following a SARS-CoV-2 infection. To do this, we collected and analysed data from more than 140 000 patients all over the world.

How was informed consent obtained from those patients who participated in this study?
All data is anonymous and does not reference any individual patients. In Germany, every patient who was considered for the study had to be informed beforehand. In part, this was done on the basis of dissent after appropriate information, but partly also explicit oral or written consent had to be obtained. The responsible local ethics committee reviewed the documentation before in each case and provided a vote; accordingly, there were differences at hospital level. After many individual reviews, we had the "go" for the study at various locations throughout Germany.

How did it feel when the study was published in the journal The Lancet?
Logistically, it has been very difficult. The joy was all the greater when the publication was announced. Science really took place in real time here. For example, we had a WhatsApp group for questions, so that we could support each other in case of problems. There was also a hotline to help with specific questions. The article has now been cited over a thousand times and is referenced in the guidelines of the World Health Organisation (WHO). Further, the mortality rate among infected surgical patients has most probably decreased as we have moved forward. This has motivated many of us to continue.

You are one of the national leads of COVIDSurg in Germany. How did you manage to assemble and structure a team so quickly?
At the very beginning, it was about getting people on board. That was very focussed on email in Germany. I wrote to a great many people and also followed up with personal contacts. I still take my hat off to everyone who has worked with me during that time. Particularly noteworthy are Hans Lederhuber and Markus Albertsmeier, who worked closely with me as national leads. COVIDSurg grew out of the GlobalSurg research network. The headquarters are therefore in Birmingham. However, Tübingen was involved in the COVIDSurg studies from the very beginning.

What do you personally take away from your work with this network?
I have made enormous progress in different areas. It was an incredible experience to work with so many scientists from countries from A to Z, for example, to be on international conference calls and discuss a topic that moved us all. The network showed me that we think by far too little out the box.

In the summer semester of 2021, you taught the practical seminar Visual Science Communication in Medicine: COVIDSurg at the University of Tübingen together with Michael Pelzer from the Department of General Rhetoric. How did that happen?
The idea evolved from serendipity. I took part in an online seminar by Michael Pelzer on science communication offered by the iFIT* Cluster of Excellence at Tübingen University. That is how we got in touch. I told Michael what I was doing and what my research was. He was very excited and asked me to explain the COVIDSurg studies that we were conducting at the time in more detail. He then suggested we might start a pilot project with students on visual science communication together. Subsequently, we jointly worked on this idea and looked for experts from COVIDSurg who could provide further expertise to our course participants. On one day, we had experts from all over the world digitally visiting our seminar. This experience of having the world as our guests for one evening was incredible. Planning the seminar was very laborious and intensive work. At the same time, it was very exciting, because we didn't know what would become of it. I particularly liked the mix of students with different professional backgrounds. This enables stepping out of one's own bubble to get a different perspective on things.

*The Cluster of Excellence 2180 "Individualisation of Tumour Therapies by Molecular Imaging and Functional Identification of Therapeutic Targets" (iFIT) is the only oncology Cluster of Excellence in Germany. Within this consortium, scientists work together in a unique cooperation reuniting three different research areas to develop new, individualised cancer therapies.

Will there be further seminars of this kind that you will carry out together with students?
Yes. This winter semester we are offering an interdisciplinary practical seminar again. This time it is about vaccine development in Tübingen. The whole seminar is taking place as a hybrid event. The first kick-off meeting took place in presence. The next sessions are then planned in an online format.

How did you find your way into medicine?
Actually, I never really wanted to go into medicine at first. Initially I felt much closer to the humanities. At that time, I was doing community service and working as a paramedic. I realised that medicine can directly improve people's lives. Therefore, I wanted to acquire more skills, so that I could help actively. As a result, I decided to sign up for medicine. Fortunately, I got into University. During my studies, stays abroad have also had substantial impact on me. I was in Central America and South Africa. After that, I learned a lot more about research. At the beginning of my studies, I couldn't even imagine a career in science. Sometimes it still feels a bit strange to be standing where I am at right now.

Do you have any tips for prospective scientists?
Successful science takes a lot of perseverance. Something that must never be underestimated is that science is not a sprint, although it may sometimes look like it from the outside. On the contrary, it is often a marathon. There are always new questions. The most important things to bring along is open-mindedness and curiosity towards new things. It is therefore absolutely worthwhile to work together with other researchers. This can also be very helpful on an international level. COVIDSurg is the best example for this. You should also be able to think outside the box. Dare to venture into a field that is completely unknown to you. Every researcher should strive to become a real expert in their own specific scientific field. To find the appropriate area of research for you, it is important to ask the right questions.