Matthias Schrappe, Hedwig François-Kettner, Matthias Gruhl, Dieter Hart, Franz Knieps, Philipp Manow, Holger Pfaff, Klaus Püschel, Gerd Glaeske: Thesenpapier 4.0 Die Pandemie durch SARS-CoV-2/Covid-19 – der Übergang zur chronischen Phase – Verbesserung der Outcomes in Sicht Stabile Kontrolle: Würde und Humanität wahren Diskursverengung vermeiden: Corona nicht politisieren [Thesis Paper 4.0 The Pandemic through SARS-CoV-2/Covid-19 – the Transition to the Chronic Phase – Improving Outcomes in Sight Stable Control. Maintaining dignity and humanity. Avoid narrowing of discourse. Do not politicize Corona], Köln, Berlin, Bremen, Hamburg (30. August 2020).
The most important messages at a glance
(1) After the herd-shaped spread (clusters), sporadic dynamics now dominate: Increase in daily newly reported infections with SARS-CoV-2/Covid-19 from approx. 300 cases/day to currently approx. 1,350 cases/day (calendar week 34), expansion of the weekly test scope from 400,000 to 900,000, decrease in the rate of positive test results 9% to approx. 1% – in addition to the “herds”, homogeneous (sporadic) spread has now moved to the forefront. This dynamic cannot be controlled by testing and tracking alone, but requires stable control through cleverly planned, target group-oriented prevention measures.
(2) Parallel to the increase in reported infections, the clinical consequences are weakening: The increase in the daily number of newly reported infections in the last five to six weeks has not been followed by an increase in disease and complications. Instead, the hospitalization rate has fallen from over 20% to 9%, the number of patients receiving intensive care has dropped from 3,000 to 230 and the mortality rate of infected persons has fallen from 7% to 0.4% (the figures for the last few weeks are even lower, but cannot yet be conclusively assessed). This tendency is confirmed by the patient collective represented by infected health care workers (n = 14,977 on 26.8.2020), where the number of unreported cases should not play a role: here the mortality rate is between 0.12 and 0.16%. The increasing testing of non-infected persons, a younger average age and the improvement of organizational processes in health care facilities and nursing homes are to be discussed as the reasons for this favorable development. It is unclear whether there is also a change in the type of virus.
(3) The sporadic spread will continue to increase to a limited extent, but can be contained: In a rough model, further spread is determined by four compartments: the “background noise”, the travel returnees, the school or kindergarten openings and the increased indoor use in winter. A further, even significant increase in daily new infections cannot therefore be ruled out. This situation can be overcome if (1) specific prevention programs are developed that protect vulnerable groups (while actively maintaining individual dignity and humanity), and if (2) the resources of the health care system (organization, bed capacity) are maintained in their present form. Therapy and vaccine development are conceivable solutions, but the epidemic must be stably controlled even if there are delays in this respect.
(4) If the scope of testing is massively expanded to low-prevalence collectives (frequency 1-3%), uncontrollable problems with false-positive results are to be expected, which cannot be managed by the institutions charged with follow-up. The testing strategy must therefore be aligned with the Stable Control strategy, i.e. primarily collectives with higher prevalence, collectives with a higher or unknown risk of infection (e.g. teachers, kindergarten staff) and collectives with a high individual risk of complications (e.g. residents of nursing homes and their relatives, outpatient care) must be tested.
(5) The definition of the “second wave” should not be based on rigid limits, but should refer to the criterion of the lack of delimitation of herds and sporadic spread (supplemented by a regional component – more than 5 local authorities in at least two federal states – and an officially established loss of control).
(6) The primary goal is “stable control” of the epidemic; eradication is ruled out, as is the strategy of herd immunity. Target group-oriented prevention measures for the particularly vulnerable groups in the population are essential. These protection concepts must take into account the goals of infection control as well as the humanity and dignity of the individual person.
(7) At the beginning of the epidemic, staff and patients/residents/cared persons in health care institutions, nursing homes and community facilities contributed a large proportion of the disease, with up to 1,000 new infections per day and almost 50% of deaths caused by Covid-19 in Germany.
(8) At present a slight increase in the number of employees and persons cared for in the community facilities according to §33 IfSG1 can be observed, which requires intensive monitoring.
(9) The recommendations on the wearing of masks must be adapted to the baseline risks. The relative risk reduction of 80% proven by studies means an absolute risk difference of 8% in a high-risk area (e.g. health care, assumed infection probability 10%), so that 2.5 persons must wear a mask to prevent infection, while in a low-risk area (1 hour stay in the supermarket, infection risk of 0.01%) 12,500 persons must wear a mask to prevent infection.
(10) Do not politicize Corona: The interpretation of the epidemiological situation and the debate over the best strategy for combating the pandemic should not be dominated by calculations of short-term political positional advantages and is not suitable as a subject for the upcoming election campaign.
(11) Rational decision-making, rational discourse: Even the pandemic does not justify departing from the basic norm of reasoned deliberative decision-making and relativizing the requirements of a transparent, fair and fact-based discourse between politics, science and the media. It is precisely in this situation that the respective role assignments must be clearly recognizable in order to be able to delimit the responsibilities in a democratic constitutional state. Only under these conditions is it possible to strengthen citizens’ trust in democratic communication under the rule of law.