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DThe director of the health department, Nicoletta Wischnewski, gets right to the point. “You know, an incidence of 35 can be a big problem or completely harmless, that depends mainly on who is infected and how high the risk of contracting a disease is,” says the medical officer by phone.
Wischnewski heads the health department in Berlin’s Charlottenburg-Wilmersdorf district and is the spokesperson for the twelve doctors in the capital. Together they have written a statement to the Berlin Senate calling for a move away from the general orientation towards advocacy values.
Fundamentally, it is not convenient to link the containment measures “with incidents of 20, 35, 50 positive cases per 100,000 inhabitants”, says the newspaper, that WELT is available and that the “Tagesspiegel” reported for the first time.
The incidents do not reflect the actual infection process as they depend, among other things, on testing capabilities and the willingness of the public to test. Health authorities “long ago” prioritized their measures based on the possible consequences of those affected.
The existing system is inadequate
It makes a difference whether it is asymptomatic individual cases or, for example, outbreaks in nursing homes and hospitals with an increased risk of mortality. Wischnewski, office manager, illustrates the development with an example from his district: “Due to vaccines, we now have significantly fewer outbreaks in nursing homes and nursing homes and have entered relatively calm waters.” This could facilitate the steps in the city, even if the incidence remains 55 lies.
According to Wischnewski, Berlin’s already existing traffic light system is insufficient as a guide. It is important to include the age structure, symptoms, and number of tests, in each district or district individually. “We have to do the work of evaluating this locally.” Compared to the first wave, more asymptomatic people are currently included in the statistics, who have tested positive for Covid but do not become seriously ill and are therefore not a burden on the medical system. . “If you look broadly, you will find many.”
But is the idea of Berlin a possible path for the whole republic? Ute Teichert, president of the Federal Association of Public Health Service Physicians, is skeptical. “I can understand the wishes of my colleagues in Berlin from a technical point of view, but I don’t think they can be used throughout Germany,” said Teichert WELT.
At the beginning of the pandemic, she herself criticized the 1950s incidence as a target, but has now turned away from it. “A clear point of reference for dealing with pandemics is very important for social interaction.”
“Unfortunately, health authority employees are not always part of the crisis team of district administrators,” says Teichert.
Source: pa / Eventpress / Eventpress Stauffenberg
The strategy proposed by Berlin also assumes that the health authorities in each district work closely with policy makers. However, in many places this does not work as in the capital, according to Teichert. “Unfortunately, employees of the health authorities are not always part of the crisis team of the district administrators and are technically involved.”
Their conclusion: Only when the public health service participates more in political decisions can other categories be considered in addition to advocacy. Two points would be decisive for Teichert: The proportion of cases that belong to a cluster – for example, an outbreak in a meat factory – versus the proportion of cases that are difficult to assign.
The second point could be the number of contacts to track. An example: an incident of 50 with two contact persons is sometimes less costly for health authorities than an incident of 30 with ten people to contact.
Meanwhile, there is support for Berliners from the main interest groups in the healthcare sector. The number of new infections per 100,000 inhabitants is an important criterion, “but it should not be the only one,” says Klaus Reinhardt, president of the German Medical Association WELT.
Also important are the number of infections broken down by age group and region, intensive care capacities, the number of fatal cases, as well as the spread of new variants of the virus and their potential risk. Therefore, a “much more differentiated” decision can be made about the withdrawal of the first containment measures than at present.
The German Hospital Association also speaks of a “narrow view” when it comes to directly linking possible relaxation with incidence values “of 35 and less”. The situation should be further assessed: “Above all, this includes the question of how far infected people can expect severe disease progression,” says Managing Director-designate Gerald Gass.
And there is also more support for Berliners from the forefront of the fight against pandemics. An accurate analysis of the number of infections is crucial to assess whether and what loosening can be performed, says the head of the department in Essen, Juliane Böttcher. In particular, it refers to the serious consequences of confinement for children and young people.
Frank Renken, director of the Dortmund office, also welcomes the move. “We shouldn’t just think about adapting the strategy to combat the pandemic, we should really start it.”
In order to proceed accordingly, local data would have to be available, from which it can be seen whether it is an increasingly diffuse spread of the virus or a smaller group. “It would certainly be good if the Robert Koch Institute adapted its recommendations in this direction to promote uniform decisions across the country.”
Other shades, however, come from the health department in the Offenbach district. Apart from outbreaks at individual hotspots, the number of unreported cases is correspondingly high if the incidence is high. That is why the incidence remains “an important indicator” to monitor the increasing risk of infection and is a basis for adopting protective measures, according to a spokeswoman. The crisis team of the Offenbach district crown analyzes daily the number of beds occupied and the evolution of the number of deaths.
However, many health authorities do not want to comment on the WELT request. This is mainly due to lack of capacity. But Friedrich Pürner learned what consequences criticism of the crown’s political strategy of control can sometimes have. The 54-year-old epidemiologist and public health specialist was appointed head of the health department in Aichach-Friedberg, a district near Augsburg, in February 2018.
Söder indicates careful openings
Corona’s current situation is once again of concern to the CSU board. The party leader, Markus Söder, defends the baseline of the pandemic and awaits the next federal and state conference on March 3.
But when he repeatedly criticized the Bavarian state government’s anti-crown course in the fall of last year, he first had to report to the Ministry of Health and then lost his post. Pürner was “attached” to a Bavarian authority 70 kilometers from his place of residence, so suddenly that there was not even a position available when he was supposed to start at the State Office for Health and Food Safety (LGL) in early November. .
The doctor himself sees the assignment as a “punitive transfer” and as a reaction to his repeated criticism. Among other things, Pürner had warned the Berlin doctor about the proportionality of the measures and rebuked the focus on incidence values.
