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If the above strategy is not adjusted, the crown situation threatens to quickly spiral out of control again after the November lockdown. Virologist Drosten explains how you can avoid this and why you can’t learn to live with the virus.
Christian Drosten no longer likes to show himself in public, avoiding television shows, among other things. Unfortunately it is being exploited and attacked by other means, he explains. During a visit to his parents in Emsland, he took the opportunity on a live broadcast to lecture at Windthorst evening in Meppen and to answer questions from the audience. Charité’s virologist explained the seriousness of the corona situation, why current measures are necessary and how Germany could keep the pandemic under control in the long term after the partial closure.
Triage threat
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First, Drosten used an obvious example to show how important it is to act now. As the largest university clinic in Europe, the Charité has about 400 intensive care beds, Drosten said, and hardly any other hospital has that many. Of these, about 160 beds are currently occupied with Covid 19 patients. “Last week that was 80 and the week before about 40. Next week, if things continue like this, we will be in the range of 300 patients.” . Currently, the number of Covid 19 cases in intensive care units is doubling roughly every ten days.
The Charité only has 400 intensive care beds and the patients who are in the remaining beds will be there next week, Drosten said. Not just Covid 19 patients, other serious illnesses would have to be treated further. The clinic is clearing a few more beds, postponing operations. At the Charité, however, the Berlin virologist warned that all intensive care beds were already about to be occupied. In other hospitals this is only a matter of two or three weeks.
“So we have to get into a triage situation.” In an intensive care unit, for example, that would mean considering whether to save the 35-year-old father and “deal” with an elderly patient with a lower chance of survival. For this reason, the federal government has decided on the current measures.
Change of strategy necessary
Christian Drosten assumes, however, that what was done in Germany before the November blockade against the spread of the coronavirus will not be enough in December and the following cold months to avoid a new loss of control. Improvements are needed.
Therefore, the Berliner calls for a change in the strategy of the health authorities. Currently they can no longer track all chains of infection. Rather than looking for people who have had contact with an infected person, as was the case previously, he advocates tracing the source of the infection. The point is to find possible clusters, to drop nests. Drosten assumes that about 20 percent of those infected in so-called super-spread events are responsible for 80 percent of the spread. All others do not infect anyone or only a few people.
Tracking not efficient
If the test result was positive, the infection was about 10 days ago, according to Drosten. Since one is particularly contagious shortly before the first symptoms and a few days after, it is sufficient to briefly isolate a patient because he is hardly infectious. You can find one or another infected person in your contacts, but these are not relevant to the infection process.
It is important to locate the cluster, Drosten explained. And then you should immediately quarantine everyone involved without wasting time on testing. Starting from a certain group size, it is very likely that not only several infection chains will start, but also new super-propagator events. Young people in a group are rarely sick and therefore do not go to the doctor, but they are still highly infectious.
To locate nests of cases, the virologist wants people to keep a contact diary in which they can enter critical situations. Because who could still remember where he was ten days ago? He explained.
There are no legal bases
However, Drosten is aware that a paradigm shift in public health is “extremely difficult”, “because there are legal obstacles at work.” There is currently no legal basis for sending an entire group to home quarantine on suspicion.
Ute Teichert, director of the Public Health Service Physicians Association, agrees. Therefore, at the ZDF Tagesthemen on October 23, he asked to maintain the follow-up strategy. However, he did not acknowledge any loss of control by health authorities at this time. However, “all the political headwinds must be overcome,” Drosten said.
Rapid tests make a lot possible
Drosten has high hopes for rapid antigen tests. Besides the persecution of the groups, these are the second main issue that he and other scientists who advise governments are currently “hatching”. The tests were only positive when the viral load is so high that a patient is also infectious. In the case of a negative result, an infected person is no longer contagious.
If all opinion leaders in politics boldly participate and translate this into guidelines, in the future two types of diagnoses could be made, according to the virologist: PCR tests clarify whether a person is infected and rapid antigen tests if they are. contagious. This can be used, for example, to protect nursing homes and nursing homes, to test directly on those affected by group monitoring, or to allow people to return to work quickly after an infection.
The virus is not a health problem for the majority of the population, especially among the youth, the core of our workforce, Drosten said. However, they were absent for a long time due to isolation at home. “And that’s where business and health are. That’s where we have to go.” They are even considering allowing rapid tests like home tests soon, which would normally take a year. Until now, the tests can only be carried out by qualified personnel.
If necessary, ministerial decrees
Germany must come out of the short-term blockade in a different way than it did. “That is, with better methods and a different strategy.” Also, regulations would have to be opened in some places. “And if it is only temporarily and if the brutal instrument of a ministerial decree is needed here and there. That may have to happen.”
You don’t want a repeat lock, but you can’t rule it out either. It also goes without saying that everything will remain as it is until the end of November, Drosten said. Politicians have set a mid-term evaluation for the middle of the month. The AHA rules alone would probably not be enough, additional action is likely needed. But the Berlin scientist hopes that particularly drastic rules such as bans on visits to nursing homes are not necessary.
It doesn’t work without a vaccine
Another pillar of the strategy is the prospect of the early availability of a vaccine. He even has to trust that “he has no other choice,” Drosten stressed. It is sometimes suggested in public that no one can know if vaccines will ever work and that one must learn to live with the virus. This is complete nonsense as long as you don’t think of specific numbers behind.
Learning to live with the virus would ultimately mean allowing infections, says Drosten. But you can only do this until the health authorities are no longer managing case tracking. “If it’s out of control, we go back into the exponentially rising range. And then we have a few weeks until the intensive care units are full and we reconsider sorting.”
This inevitably means that something needs to be done when the limit of the ability to effectively pursue cases is reached. “Talking is no longer enough, just learning to live with the virus is no longer enough.”
Achieve controlled herd immunity
You will learn to live with the virus when herd immunity is achieved. With this, Drosten does not want to infect society in an uncontrolled way. This can only be done in a tolerable way by vaccinating particularly threatened groups, he said. Then one can gradually tolerate a greater number of infections.
But even then, too many infections should not be allowed. Because this would inevitably lead to more serious illnesses in the very young, who would then fill up the intensive care units and also die. For this reason, among other things, antiviral drugs are essential to overcome the pandemic.
When it comes to schools, Drosten continues to assume that children are basically as contagious as teenagers or adults. Studies to the contrary arose, among other things, due to incorrect observations during the first confinement or during the holidays. Furthermore, the virus barely spread in summer. And finally, infections in children would be detected less frequently because they hardly present symptoms, explained the virologist.
Schools have priority
Other virologists “rooted in the laboratory” like him would see it in exactly the same way. In this case, too, district administrators are called in, who ultimately have to decide on school closings. It “stays there” because it is transmitted in the federal system.
You have to set priorities, so Drosten. Everything is dangerous where many people are, but schools are particularly important. “That’s why they have to stay awake and other things stay closed.” The political decision was correct, he emphasized.
Now we must openly observe how schools develop in this second wave and in the temporary closure. “We just don’t know.” One can only hope that the widespread use of masks and hygiene measures in schools will prevent infections. It also helps reduce free time after school.
