According to reports, the RKI wants to rebalance the corona criteria and increasingly look at the number of people in the hospital. It has always been about many factors – and above all about things that cannot be measured.
He was happy that there were steps towards a different corona strategy, said FDP chairman Christian Lindner to the “Augsburger Allgemeine”: “The numbers indicate that we have achieved the status of controllability.” In fact, this impression can arise when the national and regional incidences on a weekly average are less than ten cases per 100,000 inhabitants, or at least not significantly higher. However, the quote from Christian Lindner comes from May last year and not from these days, since the question of “How next?” has become acute again.
How little we had achieved the “status of controllability” when not only Lindner was already hopefully assuming it should be clear today to everyone who has also brought the third wave of infections behind them after the second and who may already be worried that it could be in autumn a fourth will follow. The current impression of the infection process can in any case lead to a completely wrong judgment if the criteria are not correct. But which should it be? Which parameters should those who make political decisions, specify legal rules and thus tell us how we should behave, where and when, so that the damage caused by the corona virus remains as low as possible?
The moral of the pandemic
Whether incidences, R values, positive rates of the corona tests or the occupancy numbers of the registry of intensive care medicine – none of these numbers are in themselves suitable to map our way through the pandemic. Because where that leads long is not a medical or epidemiological decision, not even a political one, but an ethical one. What we want, what goal we set ourselves and what path we want to take to achieve this goal is first and foremost a question of morality. The fact that this virus causes considerable damage is undisputed as long as we do not go into detail. However, we should not be able to agree quite so quickly on the answer to the question of who should carry these burdens and which ones.
When vaccinations were months if not years in the future, drugs failed or simply weren’t available, when even in intensive care units there was still no experience of how to counter this completely new infectious disease, the question of the damage was as simple as it was brutal : How much death is inevitable? Where the funds were no longer sufficient, the “triage” came into the discussion, the allocation of limited medical resources only to those sick people for whom there is still the greatest hope of success, of salvation. However, it quickly became clear that Covid-19 hit the unprotected old and very old particularly hard. With the years of life, the risk of becoming seriously or even life-threatening with Sars-CoV-2 increases exponentially, if immunity does not already exist. But there wasn’t. And so it was decided early in this pandemic for Germany to give priority to saving as many human lives as possible over any other damage limitation.
This was not decided by doctors like Lothar Wieler from the Robert Koch Institute, not by virologists like Christian Drosten, not by epidemiologists and model computers like Viola Priesemann. It was decided by those who are responsible for making decisions in our democratically constituted society – and who have to answer for it at least in the next elections. Determining and then selecting criteria for such decisions is, however, not a trivial matter. Not scientifically, not ethically, not politically. No amount of brisk appearance on a talk show and no headline, however bold, can change that. Social action is always complex. All the more, however, in the case of a previously unknown existential threat, for the prevention of which there is no ready-made plan, cannot exist.
What does that mean for this summer?
The first, only seemingly banal answer: That this summer is at best like the past in terms of feeling. In any case, the infection situation is completely different, although the number of new infections is roughly back where it was twelve months ago: well below 10 if one takes the 7-day incidence as a basis. At that time, however, there were hardly any rapid tests. As a mask, many – if at all – used “mouth and nose covers” made of fabric or plastic. And as far as vaccination was concerned, there were hopes and large-scale studies for various vaccines, but no reliable results yet. Everything is different today. In particular, the vaccination against Covid-19 has made massive progress, at least in the affluent parts of the world, and has significantly reduced the danger situation for many. At least at the moment, new mutants of the virus do not change that. Complete vaccinations protect against all variants from serious or even fatal diseases. And the protection provided by medical masks is also reliable – whether against alpha, gamma, delta, lambda or whatever else may come up. You just have to wear them.
So if the elderly and those particularly at risk from previous illnesses are already protected to a large extent and younger and very young people, children, even in the case of an infection confirmed by a test, only very rarely become seriously ill, the incidence can then still be the criterion for that path, on which we steer through the pandemic? Short answer: it never was. Even at the time of the “Federal Emergency Brake”, this number alone did not determine the reality of our everyday life. There have always been regional differences, including those at country level. Different interpretations of the same number too. The “Federal Emergency Brake” was only introduced because the number of intensive care patients threatened to get out of hand. And at the beginning of the pandemic there was talk at least as often as of the incidence of the “R-value”, i.e. the number of reproductions. This indicates how many people an infected person infects on average. And this number also contains a whole bunch of parameters that describe the properties of the virus itself as well as the effectiveness of certain countermeasures of masks in everyday life via contact restrictions such as test strategies.
England as a role model?
And yet the incidence is not insignificant even today. Because it is a measure of the total number of infections and how the infection process develops. England is currently showing how to deal with it: Despite the rapidly increasing cases, “Freedom Day” is to be celebrated on July 19, the day of the liberation from almost all corona restrictions. The lively hustle and bustle around the European Football Championship showed what that probably means. Proponents of the openings such as Prime Minister Boris Johnson point to the low number of sicknesses and deaths despite the steep rise in the case curve. You just have to learn to live with the virus, they say. And for many – including us – that means saying goodbye to incidence. The number of sick people, the occupancy of intensive care units and ventilators is now the measure of all things.
From mid-May to mid-July, the 7-day incidence in the United Kingdom increased tenfold from a good 30 to around 320. The number of intensive care patients with Covid-19 tripled in this period, as did the number of daily Covid deaths. Currently that is around 30 additional deaths per day. Is that much? Will the number rise if the incidences continue to grow? How high can it go? And how many children will possibly suffer from the long-term effects of an initially completely inconspicuous infection, including “long covid”?
Medicine can say something about how one number relates to the other. It can also say something about how likely it is that each and every one of us, our children or parents, would become ill and what the overall medical or economic consequences of this would be. But whether an incidence, sickness or death rate “high” is “justifiable” or “too high”, and who will bear what burden in this pandemic and who will have to make what sacrifices, none of this can be done scientifically in clinics or universities can not be calculated with computer models, regardless of which parameters form the foundation. There is only one authority for such decisions: morality, conscience.
