Stefan Willich has been director of the Charité Institute for Social Medicine, Epidemiology and Health Economics since 1995. From 2012 to 2014, the doctor and conductor paused in this function and headed the Hanns Eisler University of Music in Berlin. The interview was conducted for the Tagesspiegel BACKGROUND Health & E-Health. Here you can subscribe to the decision-maker newsletter .
Mr. Willich, the German Society of Epidemiologists published a paper on Thursday , in who advocates a rapid reduction in infection rates. Politicians would have to bring this down significantly within the next two weeks in order to avoid overloading the intensive care units in Germany. Do you share this forecast?
Die current forecasts have the restriction that they work with many statistical uncertainties and unknown quantities. So it is not yet clear exactly how many of those infected in Germany need inpatient treatment – the current figures point to about five percent – and how many even need intensive care care, current estimates are one percent. The undisclosed number of those actually infected is likely to be very high in Germany as well as in other countries.
More precise numbers would be important in order to be able to reliably answer the question of whether and when our health system can reach its limits. So far, the clinics have hardly been affected, and I don’t think that will change this week. But the number of infected people could continue to increase rapidly in the next few weeks, and health policy and clinics will have to plan in this case. We should prepare for the worst case scenario. But it is not said that it will occur .
But all the data point to it, right?
There is as yet no data on the extent to which the measures taken to date in Germany affect the number of infections. We can only assess that at the end of this week at the earliest. I firmly believe that the measures taken so far will be effective and I expect a significant slowdown in the increase to date. That’s why I don’t think it makes sense to take the next step now, for example in the form of nationwide curfews.
So you think the current pandemic is not dangerous?
Measured in terms of lethality, i.e. the number of cases leading to death, it is slightly higher than influenza flu: In Germany, around 0.3 to 0.4 percent of all infected people die according to current trends Patient. SARS or even Ebola move in completely different dimensions. And the Spanish flu around 1918, which was occasionally given for comparison, was much more threatening in terms of lethality and overall mortality among the population. With SARS-Cov-2, people under the age of 65 and without previous illnesses are apparently hardly at risk. The disease is particularly dangerous for older people with chronic medical conditions. This risk profile is different from that of influenza flu, which also endangers children and pregnant women.
“The pandemic can probably not be prevented.”
But in the There are still millions of people at risk who need to be protected.
Therefore, it makes sense and is necessary to provide the best possible protection for these vulnerable groups of people to develop. The pandemic cannot be prevented from spreading through the world and infecting large parts of humanity. The question is whether it will take months or years. And of course, when vaccines will be available.
In the current situation, it is important to keep an eye on the hospital capacities, so to ensure that all patients can receive the best possible care in the coming weeks and months. The increase curve of the infections must be flattened so that the capacity of the health system and specifically the intensive care treatment options are sufficient.
Background about the corona virus:
- Virologist Drosten: “Maybe we have to assume that we will spend a year in a state of emergency”
- The Covid 19 map of Germany: See all coronavirus infections by county and state
- With face masks against the corona virus? What really protects against the transmission of germs
- Follow the events for Corona virus in Berlin in its own live blog
Your colleague Christian Drosten, chief virologist of the Charité and one of the most important advisors to the federal government in the current pandemic , sounds a lot different. He warns of dramatic conditions. Is there a dissent between the virologist Drosten and you, the head of the Charité Institute for and Epidemiology?
If nothing had been done in the last few days, bottlenecks would be possible, of which Mr. Drosten rightly warned. But if the measures that came into force last week are consistently continued, then I expect a significant reduction in new cases. You saw that in South Korea, by the way without general curfews. Most citizens in Germany seem to behave sensibly and there is no reason in my view to send the whole country into domestic quarantine now. As a social medicine doctor, I also have to take social perspectives into account.
With a complete lockdown one directly or indirectly endangers the economic existence of many people, already negative effects can be seen. Unemployment could go up and precarious living conditions and, as a result, mental illness could increase. And there is strong evidence that poverty is the main societal risk factor for disease incidence and higher mortality. If individual deaths are now prevented, but overall mortality in the population increases in the next few years, the proportionality of the means would no longer be ensured.
Can you just offset this against each other?
In the next few weeks it must be ensured that patients are in the hospitals can be well cared for. An important basis for appropriate health policy decisions would include information about the capacities in the clinics and the patient history to date. How many Covid-19 patients are treated in hospital, how old are they, what previous illnesses are there, what is their length of hospital stay and how is the clinical course?
This data is urgently needed for both Germany and Europe, for realistic scenarios and forecasts as the basis for political regulation and clinical deployment planning. But health policy measures must also be weighed up in terms of their longer-term consequences. The current threat must not lead to reactions with which serious future health crises can be initiated.
“A consistent infection test is necessary.”
So you are calling for social life to come back up after the Easter holidays?
If the previously exponential growth of new diseases is broken, the gradual return to normal social life should take place. Of course, there will not be a normalization in all areas of life immediately, that would be blue-eyed and maybe risky if the process is not sufficiently evaluated.
Consistent infection testing at the population level is particularly important, such as in South Korea. This is the only way to reliably estimate the number of infections and immunity. If we don’t test broadly, we run the risk of quickly facing the same unclear hazard situation as now.
Why does South Korea manage to test in bulk, Germany not?
I ask myself the same thing. It would be a priority task for everyone involved to create capacities here. Good monitoring is the basic prerequisite for gradually normalizing social life. It will be a process of many months, not weeks, unfortunately that is already foreseeable.
What about the elderly, the pre-ill people? Shouldn’t they still be isolated during this time?
The special protection Risk groups will need to wait until there are vaccination measures and special medications, the entire population is sufficiently immunized, or until the risk of viruses is reduced, for example in the summer months. Concepts must now be drawn up for the phase of successive re-entry.
Here too, cost-benefit assessment is important. A longer quarantine of older and chronically ill people can in turn lead to health damage and serious danger. I urge you to consider the longer-term consequences of solution strategies in the current situation.
Public health has so far been a national matter, the EU Commission would like more rights of access. Shouldn’t measures like the one outlined in a densely populated and extremely high mobility continent like Europe need to be coordinated very closely?
I find it very disappointing how badly the European idea works in health care, you can see that, for example, from the lack of hospital information. There is an urgent need to coordinate at European level and beyond to be better prepared for future emergencies.
We should also use the current situation for necessary learning processes. Asian countries such as South Korea, Singapore, Japan and Taiwan had taken the SARS crisis in 2003 as an opportunity to develop and test extensive prevention plans and are well ahead of European countries in coping with epidemics.
At the same time, there is a very decentralized system in Germany at the lower levels, with the federal states and the local health authorities, who do not always coordinate their work. Isn’t a change of direction necessary in this area?
The Robert Koch -Institut has a high level of competence for emergencies. But the public health service in Germany as a whole is not considered to be particularly modern, at least compared to the Anglo-Saxon countries, which also do a lot more public health research than we do. More expertise, standardization, coordination and less patchwork would be important, especially in a dangerous situation like now.
The Anglo-Saxon countries USA and Great Britain are currently apparently completely overwhelmed to formulate a corona strategy. What do you think of the idea that was initially brought up there to rely on herd immunity?
The concept of herd immunity, that is, to let the virus run free and to focus on protecting the risk groups, seems too risky. England backed from this idea after advice from infection epidemiologists, and almost all western countries, including the United States, are now pursuing similar Asian-style containment and prevention measures. I think this is also the safer option.
Holland has opted for a middle ground: there they allow the spread of the virus, but isolate vulnerable population groups as far as possible . While in Brazil, as a counter model, at least from the President’s point of view, no countermeasures are necessary. We will only know in a few months which strategies work best in international comparison. The correct consequences should then also be drawn from this. Because health catastrophes caused by viral threats have occurred again and again and will continue to exist in the future.