Hendrik Streeck: More pragmatism in dealing with Corona
We must finally stop just looking at the infection figures in a frightened way. Instead of panic, we need pragmatism and a forward-looking system.
by Hendrik Streek
[This article published on 10/8/2020 is translated from the German on the Internet, https://amp2.handelsblatt.com/meinung/gastbeitraege/gastkommentar-hendrik-streeck-mehr-pragmatismus-im-umgang-mit-corona/26258508.html ]
About 120 years ago the new corona virus OC43 came over mankind and probably triggered a pandemic. Some suspect that this was the then "Russian flu", and some data indeed suggest that it was.
If the pathogen was, an estimated one million people, mainly elderly people, died from this virus, which was to be taken quite seriously at the time: OC43 jumped from cow to man. Today, this virus has long since become native to our country. We call this endemic.
There are four corona viruses that are endemic in our country and which account for ten to 30 percent of the flu-like infections in autumn and winter. These quasi "usual" Corona‧viren, to which in the meantime also the OC43 virus belongs, are long since no longer as dangerous as they once were. Because we have become accustomed to them - and they have become accustomed to us.
Now comes the time of year when coronavirus infections occur more frequently again. This certainly also applies to the new coronavirus Sars-CoV-2, which again has many reasons: We now spend more time in warm indoor rooms. The air circulation there is worse, the mucous membranes are more susceptible, the temperature is better for respiratory diseases, and so on and so forth. So the number of infections will increase.
Concerns about temporary restrictions at local hotspots will flare up accordingly. In Berlin, tough measures have already been imposed again. Many cities will probably soon exceed the limit of 50 new infections per 100,000 inhabitants.
Seven districts have exceeded the threshold value; eight more are about to do so. To put it bluntly, no one knows how the infection rate will develop, but it is likely that the numbers will continue to rise. Despite the everyday mask. Despite distance. Despite hygiene and ventilation.
By the way, these factors help to control the infection and probably reduce the symptoms. We cannot completely stop it with these measures. Living with corona also means accepting that Sars-CoV-2 - like the other four endemic corona viruses before it - will become native to us.
It also means accepting that we cannot stop all infections, but must pursue the goal of avoiding deaths, severe courses and long-term consequences. It also means realizing that we will not always succeed in doing so. Here a look at the bare figures is enough, because despite the measures we have taken, we have also experienced deaths, severe cases and long-term consequences in the summer.
On the positive side, our health and laboratory system has developed extremely well in recent months. The number of tests has more than tripled. The tracking of infection chains has been optimized. And awareness has been raised of how important our health authorities are. In addition, we have collected data - a great deal of data.
All this means that 4000 new infections per day currently do not mean the same thing as they did in March and April. So, with many measures, we are all working together to reduce the number of people who become seriously or even fatally infected. Our behavior (keyword: AHA rules) contributes decisively to this, as does the better protection of risk groups.
Medical and intensive medical care has also improved enormously. A comparison with the figures and procedures in March and April is therefore no longer necessary. Instead, we should use our data to develop a more intelligent and forward-looking system. Our data already provide answers to questions about the number of sick notes and hospitalizations in connection with Covid-19 and also allow for forecasts.
A marathon, not a sprint
At present, we can see that only a small percentage of those infected really need medical care. The percentage will increase, but even that is calculable. The pure infection figures do not represent this and do not indicate what is important. The renowned head of the public health department in Frankfurt, Prof. René Gottschalk, recently made this clear in the analysis of the infection rate for Frankfurt am Main.
Infections with mild and asymptomatic courses are not the problem. The courses of events that require intensive care or inpatient treatment should be more in the focus of our attention. It is precisely because we are so good at testing and tracking that we are currently seeing many more infections in percentage terms, but these are less relevant to monitoring the pandemic in toto.
Due to the correlation between test and infection numbers, the infection number alone is only of limited significance. Just as important is the inpatient and intensive care occupancy rate. After all, this is the ultimate measure of where the limits of our healthcare system lie. Instead of one-dimensional, we must learn to think multi-dimensionally.
A traffic light system based on the interplay of infection rates, number of tests, inpatient and intensive care occupancy can help here. Threshold values can be defined for individual districts, taking into account the respective factors and hospitals, as well as at the federal level, in order to better assess the overall picture.
Who can really know whether an increase from 2000 to currently more than 4000 new infections per day is too much or even unmanageable? In Munich, the threshold values may lie elsewhere than in Friesland. In Göttingen elsewhere than in Bonn.
At the moment we are generally still in the green zone. A traffic light could clearly signal when this case is no longer given. Personally, I would be more worried if, instead of 50 celebrating young people with mild symptoms, 30 people had to be treated as inpatients. A traffic light can illustrate this. The pure infection figures cannot.
Our Plan A is the vaccine that should bring us relief in dealing with the virus. When it will come is unfortunately uncertain. Therefore it would be more sensible to think about plan B. Namely, how we make it possible to live with the virus. A life with conscious attentiveness towards ourselves and our fellow men.
Anyone who has ever run a marathon knows that after kilometer 5 at the latest, the cheering people at the side of the road are still happy, but that they are no longer the decisive factor for you to keep running. The motivation by the audience only works during a sprint. A marathon, on the other hand, can be passed by the will to take responsibility for oneself and to take care of each other.
So the question should not be "When will a vaccine be available?", but rather "How can we manage to deal with the virus in a sovereign manner and ensure that the pandemic unites rather than divides us? Because such a pandemic can only be managed together - and only globally.
It is indisputable that our focus in the further course of the pandemic must be on protecting risk groups. We know that the virus is particularly dangerous for older people and those from risk groups. Nevertheless, we must consider how we can prevent entire population groups from becoming isolated (often against their own will).
Life without the pause button
With regard to retirement homes, it is conceivable to admit visitors in a "sluice" model only after a negative rapid test. Nursing and medical personnel also require appropriate protection. However, it is also a reality that, despite the fact that nursing homes are adequately equipped with protective equipment for staff and all hygiene regulations are observed, it is not possible to completely prevent the virus from entering the homes. However, further spread in these facilities can already be effectively prevented today.
Between all the justified debate, the calls for sufficient protection and the efforts to prevent our medical care from leading to a fatal collapse, we as doctors, but also all politicians, have the responsibility to maintain a fact-based calm.
Not every increase in the number of infections should be a cause for concern. Not even the increase in case numbers in intensive care units should lead to a reflexive "See, I told you! It is undisputed that if infection rates rise, this will also have consequences for the inpatient and intensive care occupancy rates of hospitals. We will also see an increase in the death rates. But we cannot prevent this, we can only minimize and control it.
Just as OC43 raged around 120 years ago, Sars-CoV-2 is now putting us to the test. It is a serious virus, but it does not mean our downfall. It cannot be "demonstrated away". And lockdowns are not a panacea, but a kind of "pause button" of life, which must continue.
For me, living with the virus means mindfulness towards myself and my fellow human beings. It means developing intelligent systems to monitor the infection process and to best protect those people who are at risk of suffering a severe course of the disease.
More than ever, pragmatic approaches are needed to find solutions to allow life without breaks. Scientists must make their contribution. It is more important than ever that we are not only stubbornly clinging to concepts, but that we are prepared to break new ground. Also new ways of communication. A Corona traffic light would make both possible as first step.