The Euregio Meuse-Rhine (EMR), with a high population density, intense cross-border passage, and only an estimated 5-10% of inhabitants that ran through infection during this first pandemic wave, is likely struck hard again in a second COVID-19 wave. That is why, the Interreg Euregio Meuse-Rhine project CoDaP aims to study the heterogeneity differences in Intensive Care Unit (ICU) patients, improve clinical decision guidelines, and build IT-infrastructure for secure and efficient data-exchange and analysis. Ultimately, this will help to provide all available care, including admission to the ICU, to those patients that will benefit the most, while focussing on supportive care for both them and their families.
In the past few months, we have learned that COVID-19 infections present extremely heterogeneously. This heterogeneity is amplified since no specific treatment for COVID-19 exists. A cross-border prospectively collected ICU COVID-19 cohort does not exist, but is urgently needed. A large well-characterised Euregio Meuse-Rhine COVID-19 cohort that incorporates the "natural" variation between countries can reveal best practice throughout our region to benefit future COVID-19 patients, at least, throughout our region and countries.
Conversely, while taking different settings (including health care systems) into account, Euregio data can be used to predict outcomes. Established prediction scores for general ICU populations appear inappropriate for the COVID-19 population, which differ clinically. Fortunately, many COVID-19 prediction scores become available. Euregio data has major advantages to investigate their external validity cross-border, and, particularly, could establish whether certain scores perform better in one hospital or country over the other. Development of new, or adaptation of existing models for the Euregio Meuse-Rhine specifically will help to inform physicians better.
It is very important to note that the cross-border perspective in learning lessons is likely to unravel additional ones: As inhabitants of the EMR are alike, differences in outcomes are primarily driven by system factors: Within the EMR, healthcare systems, hospital infrastructure, admission criteria, and treatment choices vary considerably. Scarce ICU resources should be optimally used during the pandemic, in agreement with regular care, which inevitably affects physician decisions.