The Divi Intensive Care Registry reported about 8,600 free intensive care beds on Friday, plus an emergency reserve of 12,260 beds. The situation in intensive care in Germany is relatively good, but in France it is already looking more dramatic. There, the contamination situation is serious in the regions of Marseille, Bordeaux and Paris, and beds for intensive care are also becoming scarce in the south. Is Germany now threatening to delay a similar development?
What are the advantages?
If you compare the reported numbers of infections and the trends, it is likely that Germany is currently only in an earlier phase of the same development. That was also the case in the spring.
However, in Germany it was possible to influence the development in such a way that an overload of the supply systems as in some cases in France, Italy and Spain could be avoided. The national lockdown has probably made an important contribution to this by drastically reducing the number of contacts and thus the transfer options.
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At this point, however, large sections of the population were behind the measures and, because of the dramatic reports and images from those countries, were willing – and motivated by self-interest – to protect themselves and others as best they could.
A new countrywide lockdown is currently out of the question, mainly because of its negative economic and social consequences. It is largely unclear whether and to what extent local or regional lockdowns will occur in areas with particularly high numbers of new infections and how enforceable, transmissible and effective they will be.
The picture is mixed with regard to the willingness of the population to limit itself and to consistently reduce the risk of virus transmission. According to surveys, the acceptance of new, very restrictive measures would be significantly lower than in the spring.
One factor that develops in the exact opposite direction of spring is the weather-related possibility of being outside. According to studies, infections “from the outside” are at least 20 times less likely than “from the inside”. However, at lower temperatures, people spend more time indoors. Here Germany is even at a disadvantage compared to countries with a milder climate.
Virologist Christian Drosten sees a risk in the likely much greater spatial distribution of the virus than in spring. It is therefore plausible that considerably more infection clusters are currently developing as a result of transmission within Germany, still unnoticed, than before. This new starting point for the further spread of the virus is probably comparable to the situation in the other European countries that are currently more severely affected.
How many children contribute to the infection process is the subject of constant debate and studies. In Germany they are now being taught again under circumstances that only slightly reduce the risk of infection from each other. This is also done without a system of preventive testing that could be used to find early developing clusters and take containment measures.
Children with symptoms of respiratory disease are also not routinely tested and may continue to school if the symptoms are not severe or indicate very clearly Covid-19. This is a marked difference from spring, when schools were closed as a precaution – with negative consequences for education and the situation in families. However, this could also have contributed to the containment of the epidemic.
The virologist Christian Drosten sees a danger in the probably much greater spatial distribution of the … Photo: dpa / Christophe Gateau
What contradicts it?
In Germany, many precautions have become routine and integrated into the everyday life of the vast majority of the population: keep your distance, wash your hands and wear mouth and nose protection. Masks are also recognized as effective protection by the Robert Koch Institute, which had long described them as largely ineffective. And they are available.
Working in the home office for people who do not necessarily have to be in the workplace is now well established. The extent to which there are relevant differences in these factors for further development in Germany compared to the countries where the case numbers are significantly higher again has not been quantified. Virologists and medical professionals are also discussing the possibility that wearing masks and possibly social aloofness could help immunize the population.
The reasoning is based on the assumption that the protective measures can reduce the amount of virus that people ingest when infected and that this is conducive to an easier course of the disease. However, these can still cause people to build up immunity to Sars-CoV-2. This reduces their own risk of infection and the risk of them spreading the virus.
What can be improved?
Detecting infected people through testing at an early stage and limiting their contact with healthy people remains at the heart of infection protection. Quick tests that give a result in minutes can help if they are used extensively. The methods detect molecular traces of the virus, antigens, for example in saliva.
However, they are criticized for their high error rate. They recognize infected people less reliably than the most commonly used PCR tests on throat swabs today. False negative results from rapid tests that say “no infection” when there is one are more common in people with a low viral load.
Antigen-based tests could more reliably identify people with a high viral load “most likely to be contagious,” Marion Koopmans, virologist at the University of Rotterdam in the Netherlands, told nature.com. Until another test result is available, they can be isolated as a precaution and prevent possible infections.
So far it has not been clarified at which viral load the boundary between “infectious” and “non-infectious” is, but rapid and inexpensive tests could be a useful addition to the arsenal of infection protection, especially in times of rapidly increasing number of cases.