The intensive care doctor Uwe Janssens was "very happy" when he heard that the next openings should only be made at an incidence of 35. The previously targeted mark of 50 was "firstly chosen completely arbitrarily and secondly a completely wrong signal," he says in an interview with ntv.de.
Switching to 35 is a problem for communication. "We shimmy from branch to branch without a clear goal. In intensive care medicine, the aim at the end of treatment is that the patient can leave the intensive care unit with a sensible perspective. We also have short-term therapy goals that sometimes only range from hour to hour . But we always have a long-term, patient-centered therapy goal that we communicate transparently and comprehensibly with the patient and their relatives. Why on earth should that not be possible in politics? "
ntv.de: The number of corona cases is declining, the R value is declining, the seven-day incidence is 62 – is this the right time to start opening schools and daycare centers?
Uwe Janssens: We as intensive care physicians are not the ones who can judge how high the risk of openings in primary schools is. But it is clear that the recently introduced guideline of the Working Group of Scientific Medical Societies must be observed when the schools open. I missed this reference in the decision of the Prime Minister's Conference.
Strangely enough, tests are not mentioned in this guideline.
After all, the federal-state conference has now initiated that teachers should be vaccinated earlier than previously planned. From my point of view, everything makes sense that serves to get the children back into regular school operations. However, I already predict that there will be loud criticism from other groups in society who will then feel neglected.
I don't want to comment on the fact that there are still not enough tests for schools – schools are not the only facilities where tests are missing. And nobody is preventing the federal states from providing schools with tests. In general, it would be nice if the countries would finally do it. The suggestions from the guideline are not new. Keyword: air conditioning systems.
The next opening steps should only take place at a seven-day incidence of 35, although 50 had always been targeted so far. Do you think that's right?
In the first months of the pandemic in Germany, 50 was still the critical upper limit from which it would get really bad. It was only after we had incidences well above that 50 was declared the target. Well-known virologists and scientists from other disciplines have been pointing out for months that this mark of 50 was firstly chosen completely arbitrarily and secondly is a completely wrong signal. It is by no means the case that with an incidence of 50 cases per 100,000 inhabitants in seven days, the health authorities would all be able to carry out consistent contact follow-up. When I heard that it was now 35, I was actually very surprised, I hadn't expected it.
They were pleasantly surprised.
I was very happy. The Chancellor has always said that, or at least that is what she meant, but the Prime Ministers apparently only had an understanding under the great pressure created by the mutations. If there are health authorities in Germany that, with an incidence of 50, manage to initiate a consistent follow-up of contacts and above all to isolate the affected persons, then these are individual cases. Most of the health authorities get out at this point. That is why the next federal-state conference will have to deal with significantly lower incidences, around 25 or 10. However, this is a problem for communication. Formulating, justifying and communicating long-term goals – that would certainly be appropriate.
Why? What is wrong with the communication between the federal government and the prime ministers?
This communication makes us weary. We had the November lockdown, then the extension into December, into January, February, now into March. We shimmy from branch to branch without a clear goal. In intensive care medicine, the goal at the end of treatment is that the patient can leave the intensive care unit with a reasonable perspective. We also have short-term therapy goals that sometimes only range from hour to hour. But we always have a long-term, patient-centered therapy goal that we communicate in a transparent and understandable way with the patient and their relatives. Why on earth shouldn't that be possible in politics?
The Bavarian Prime Minister Markus Söder has shown sympathy for the no-Covid strategy. This concept is about reducing the seven-day incidence with a mix of measures – for example with "green zones", with tests, if necessary with border closings – to 10 and then to 0. Do you think that is feasible ?
I also have great sympathy for this strategy, even if I do not yet see exactly how the current structure can prevent the virus from being carried from a "red zone" to a "green zone". Here, too, you will have to test above all. The new no-covid paper contains four "toolboxes" with possible measures. There are a lot of clever ideas. From my point of view, the charming thing about this strategy is that it contains clear goals that can and must be communicated very clearly. So far it is not clear enough where we want to go. The no-covid concept contains positive goals and thus reward strategies. I think people are willing to accept limitations when they see they are being rewarded. Take areas where it works well, Münster, Rostock or Tübingen. There are clear concepts that obviously work. It does seem possible to reduce the incidences – mostly through testing, testing, testing.
That brings us back to the tests.
If the federal government is able to put many, many billions into the economy, then I wonder why the money for mass tests shouldn't be there. Another problem is, of course, that the Corona app cannot fulfill its purpose, since the mandatory data protection still prevents the practical use and the resulting benefits of such a system in Germany. Countries like South Korea can actually use such an app sensibly and profitably due to the regulations in force there. It's like with the health authorities: We are not making sufficient use of digital technologies.
It is sometimes argued that the incidence values are not the correct unit of measurement to assess the pandemic. The virologist Hendrik Streeck, for example, has called for a stress test for hospitals to find out where the limit is.
I have to tell you in all honesty: Intensive care medicine should not be used as a yardstick for how much we can burden our health system. It's true, our health system has not collapsed – but we also have very good intensive care in Germany. At the end of the year we groaned a lot, we are still not in the green, but there has never been a situation where, as we have seen in other countries, ambulances with untreated patients were queuing in front of the hospitals . At the beginning of January, at the peak of our occupancy rate, we had 5700 Covid-19 patients in intensive care units in Germany, with a total of almost 29,000 available intensive care beds. In comparison, France has only 5600 intensive care beds for a total of 67 million inhabitants. That is of course a completely different house number. But that doesn't mean that everything is fine when thousands of Covid 19 patients are in the intensive care units!
What would the correct unit of measurement be?
These are the incidence values. Think about the summer: back then we had single-digit incidences. We gave it up through negligence. Think how long it took us to go into soft lockdown – which didn't work, which actually only made things worse. The same discussions will take place again at the next Prime Minister's Conference in early March. Then if suddenly it is said that the destination is 25, then people will get out.
The day before yesterday you were with the Mayor of Tübingen Boris Palmer at "Maischberger". Palmer has argued that the incidence values should not be the sole measure of openings, but the availability of intensive care beds.
I understood him to mean that the suspension of fundamental rights is only appropriate if we get into a triage situation, that is, only if we have to decouple patients from ventilators in order to save others. This is of course absolutely insane. That is also what Streeck meant: only when intensive care medicine comes under stress, all measures are justified. No! It mustn't come to that in the first place! If intensive care physicians were to be forced, as a result of political decisions, to make so-called triage decisions, which are even punishable by law, that would be a disaster and unacceptable. If you have any idea, turn your eyes upwards at 50 as a signal for relaxation.
There are virologists who consider the mutations, which were first detected in South Africa, Great Britain and Brazil, to be less dangerous because the number of cases in Great Britain and Ireland is decreasing.
To achieve this, Great Britain and Ireland also had to go into a tough lockdown, a harder one than we currently have. Of course, the incidences then decrease. But you can't justify a demand for relaxation with that! On the contrary: it shows that you can also the mutated ones Can fight viruses successfully – but with a hard lockdown!
Hubertus Volmer spoke to Uwe Janssens
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