Enlarge image
Nurses in a corridor in the intensive care unit at the University Medical Center Schleswig-Holstein
Photo:
Frank Molter / dpa
There had been criticism of the incidence from the start. It is too general, it and does not show the values that really matter. Nevertheless, it is the parameter of the pandemic: the seven-day incidence value indicates how many people per 100,000 inhabitants have been newly infected with the coronavirus. And it has become the number among the numbers, a kind of pulse of the nation that shows where the country is currently in crisis; whether it goes through a wave or whether one can dare tentative openings of shops and theaters.
Now, however, the incidence should no longer apply alone. According to the plans of the Ministry of Health, another parameter is used, the hospitalization. According to the ministry, Federal Health Minister Jens Spahn signed a new ordinance on Monday that obliges the clinics to provide more details about Covid patients. Not only the occupancy of the intensive care units should be recorded, as has already been done, but all hospital admissions due to Corona. The age, type of treatment and vaccination status of the patient should be reported for each patient.
The background to the measure is clear: In the vulnerable groups, in which particularly severe courses are to be expected, which lead to more hospital admissions, higher intensive care bed occupancy and ultimately to more deaths, more and more people are vaccinated.
Therefore, the clinics will probably not fill up comparatively quickly even if the incidence values rise, because the age groups that are now unprotected usually survive infections better, and there are fewer severe courses and hospital admissions.
Therefore, in the future, a closer look at the numbers in the clinics should provide information on how burdened the health system is.
"From my point of view, this is a further differentiating view and a shift in focus that makes sense," said the Bremen epidemiologist Hajo Zeeb to SPIEGEL.
In large clinics, Covid-19 cases have been recorded every 24 hours since the beginning of the pandemic. "It is now also important to determine whether the Covid-19 disease was the primary reason for admission for the patient or whether, for example, an accident victim happened to test positive for Sars-CoV-2 in the admission screening in the emergency room of the clinic," says Clemens Wendtner, chief physician at the Schwabing Clinic in Munich, who advised the Federal Ministry of Health on the current decision about the Science Media Center. However, the recording of the vaccination status of the admitted Covid-19 patient is even more crucial.
When the vaccination rate in the population was not that high and the risk groups were less well protected, the incidence acted as a harbinger for the situation in the hospitals: if it rose, the occupancy of intensive care beds rose with some delay, and an increase even later the number of deaths from Corona. This is different today, as is currently the case in some neighboring European countries, for example, in which high incidences do not necessarily mean increases in hospital patients with Covid-19. In Spain, the incidence values have been rising for weeks, but not the number of Covid-19 patients in hospitals.
Even in the Netherlands, where the corona measures were relaxed early and there was a sharp increase in the number of cases due to the spread of the delta variant, relatively few hospital admissions have so far been observed.
With a seven-day incidence of around 270 most recently, younger people are affected by the spread of the disease, and there, too, the elderly are largely protected by the vaccination - the second vaccination rate is just a little behind the German rate of just under 40 percent.
"We still need incidence data"
The situation is similar for hospital admissions in the UK, where the country was hit early by Delta and currently has incidences well over 300. The government argues that the link between infections, hospital admissions and deaths is sufficiently weakened thanks to the successful vaccination program, so expect They don't put too much pressure on the country's health system and want to hold on to Freedom Day, the end of the Corona measures on July 19. It remains to be seen whether those responsible are right. Because autumn is also likely to bring more infections due to increased seasonality with more favorable weather conditions for the spread of viruses.
Nevertheless, some people now see the importance of the incidence value waning in Germany, including politicians and lobbyists. Since the beginning of the pandemic, the relevance of the value has been criticized, in part from the scientific side. The epidemiologist Gérard Krause from the Helmholtz Center for Infection Research in Braunschweig is one of the critics. The expert had long warned that too much importance was attached to incidence when deciding on restrictive measures. Case numbers alone are only of limited significance: whether a school class or an old people's home is affected by an increase in incidence makes a difference that the value does not say.
As a reminder: the incidence value, which has even been anchored in the Infection Protection Act for some time and thus the basis for many corona restrictions, was not based on any scientific data when the limit value of 50 was introduced, from which stricter measures applied. The only basis was the capacity limit for tracking the health authorities. At that time there was an average of five people per 20,000 inhabitants who were supposed to trace the chains of infection. According to the calculations with these administrative structures, this was possible for up to 50 acutely infected people per day.
However, the incidence will not be dispensed with for the time being. "We still need incidence data, especially those that describe specific age groups," says Zeeb, referring to the processing of the numbers, as the Robert Koch Institute offers updated weekly. And the federal government does not want the introduction of the new guideline for hospitalization to be understood as a change of course. There is also no change in political strategy associated with it.
A high rate of spread of Sars-CoV-2 among young people, as is currently experienced in Spain or the Netherlands, is not without its risks. Because you risk contamination of these age groups, i.e. a very high degree of spread. And that should not be without consequences for some. In contrast to the time before the vaccination programs began, it is no longer the elderly who bear the burden of the pandemic, but the young - the bill has shifted. »Here, slight gradients are clearly predominant. Nevertheless, with very high incidences, more cases of long-term effects are to be expected in these age groups, ”says Zeeb.
This refers to people who suffer from long covid, which also affects younger people more.
According to estimates by the World Health Organization (WHO), one in ten could suffer from long-term effects, the majority of them women.
It is also known that in very rare cases children can recognize Pims (Pediatric Inflammatory Multisystem Syndrome) after they have contracted the coronavirus.
"We still know little about the exact frequency and importance of long-term processes," says Zeeb.
The expert therefore sees with a critical eye that the virus is spreading more rapidly among younger citizens in some places.
"High numbers of infections among younger people are problematic, especially in autumn and winter, also because we could then have problems with schools and possible closings again," he says.
In addition, one should also watch very closely which people have to go to hospitals because of Covid-19 and whether they may be so-called vaccination breakthroughs, diseases with Covid-19 despite a double vaccination.
"It would be alarming if, in view of the impending delta wave, more patients who had already been fully vaccinated would come to the clinics in the next few weeks and months," says medical doctor Wendtner.
That would be an indication that speaks in favor of the introduction of third-party vaccinations, so-called booster vaccinations.
Another risk factor
When turning away from the containment strategy: If the virus continues to have many opportunities to reproduce in human host organisms with a high incidence, then there is an increased risk of mutations.
So the virus can become even more dangerous.
The only way to prevent a widespread increase in the number of infections at the moment is to prevent young people from infecting each other during excessive leisure activities.
At least such restrictions and the maintenance of measures such as masks and keeping your distance should apply until the younger age groups have not made significant progress with the main strategy against the pandemic: vaccination.
The Dutch Prime Minister Mark Rutte apologized on Monday for his poor judgment. The corona restrictions were relaxed too early, he said.