Intensive care medicine diagnosis: opening steps that could lead to more than 1,000 deaths a day – knowledge
From March 8, Germany will reopen with a major first step out of lockdown in the Coronavirus pandemic. Late Thursday evening, the federal and state governments decided to loosen communication restrictions. An “emergency brake” was also specified if the nationwide infection rate rose again to more than 100 cases per 100,000 inhabitants in seven days. It is currently 69.
Chancellor Angela Merkel (CDU) and other prominent politicians will not tolerate the fact that the incidence of seven days has increased slightly since mid-February. They also certainly do not hide the fact that the vaccination strategy is still slowly being implemented. But how does this fit into mitigation?
This is the question posed by three of Germany’s top intensive care doctors and published on Thursday Updated forecast model. In this model, the German Interdisciplinary Society for Intensive Care and Emergency Medicine (DIVI) simulates the occupancy of an intensive care bed depending on the dynamics of the infection and the expected vaccination effect.
The relaxing picture, according to this model: combining infection dynamics and vaccination campaign progress does not actually allow mitigation at the beginning of March. Just over 8,000 doses of vaccine have been vaccinated per 100,000 people in Germany.
A comparison with pioneers like Israel or Great Britain shows just how meager this is: In Israel, about 97,000 doses of vaccine have already been vaccinated per 100,000 inhabitants, and in Great Britain there are more than 30,000 doses administered per 100,000 inhabitants.
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In Israel, the lockdown mostly ended two weeks ago, but only for those who recovered and received the so-called green passport. In Great Britain, slight opening steps of lockdown, which is difficult compared to Germany, are planned on Monday. In Germany, too, there is mitigation, although the vaccination campaign does not seem sufficient.
Therefore, DIVI with its forecast model warns of the now-outlined mitigation. Because the curves projected for the ICU bed occupancy do not bode well. In a total of three curves, intensive care physicians calculate what time opening steps have an effect.
The openings are always based on opening nationwide – which is possible with an incidence of under 100 in every federal state. Meanwhile, there are about 350 from more than 400 rural and urban areas less than 100. Intensive care doctors have also included the vaccination rate in the forecast – which is pessimistic and optimistic. According to DIVI, the pessimistic scenario is currently the de facto scenario.
Expectations result: Due to a slight opening at the beginning of March, the number of intensive care patients for the Coronavirus could rise again to more than 4,000 in May, and if it opens nationwide, to more than 6,000 in June.
The last time there were nearly 6,000 cases at the end of December, and two weeks later, the number of daily deaths peaked at 1,200. Since then, according to data from the DIVI, about 30 percent of ICU patients have died so far. More than 1,000 coronavirus deaths are expected again per day as of May.
For comparison: on Thursday, DIVI reported nearly 2,800 intensive care patients for coronavirus. Health authorities, Robert Koch Institute (RKI), reported 387 new deaths Thursday or in connection with the Coronavirus.
Instead of the opening steps that are now outlined, intensive care doctors advised the first dilution in April at the earliest. According to the model, intensive care bed occupancy would have increased slightly and then decreased – and with it the number of corona deaths.
Especially since the numbers in the DIVI record must include an unannounced number of deaths. Because: The record only counts Corona deaths who die in the intensive care unit, as a spokeswoman for Tagesspiegel confirmed. Patients who are transferred to the regular ward and die there from the consequences of Covid disease do not appear in the statistics.
Intensive care doctors also expect a 22% spread of mutated virus B.1.1.7. Leading virologists, including Christian Drosten, now assume that B.1.1.7 is present in about half of positive tests.
“We are counting the family, not the data on patients,” the spokeswoman said. While 30 percent of intensive care patients die, even half of intensive care patients who have to be ventilated.
Great Britain is holding back because the numbers show it
The figures from Great Britain show the positive effects a long, strict lockdown combined with rapid advances in vaccination can have – especially against a background of rampant mutations. While the number of deaths from or associated with the coronavirus in Germany is now in decline and new infections are increasing slightly, in Great Britain both numbers continue to fall dramatically.
The UK vaccination campaign began in early December when a 90-year-old was injected with the first dose of Biontech. A second dose of the vaccine had to be administered within three weeks for it to reach its promised 95 percent efficacy after one week – about four weeks after the first vaccination.
So at the beginning of January the first elderly Britons were vaccinated. Lo and behold: In mid-January, the hospitalization curve began to decline. They have grown up Data from the National Health Service (NHS). In the greater part of the country, England, where more than four in five Britons live, the number of hospitalizations has steadily decreased from around 4,000.
The delay from one to two weeks can be explained by the fact that it takes exactly this time at the most for an infection to appear and people must be accepted because of it.
However, the decrease in hospitalizations is not only due to the progress made in vaccination. The strict lockdown went into effect at the beginning of January, and it is much tougher than it was in Germany. People in Great Britain are only allowed to leave their homes in a few justified exceptional cases, and they are not allowed to meet people from other families.
Around the same time, the number of second vaccinations has increased dramatically, and the lockdown has reduced people’s contacts and thus the number of new cases of corona. This has been in steady decline since January 10th. So far there has been no increase in hospitalizations in England. The number dropped from about 4,000 in mid-January to less than 1,000.
After two weeks of the start of the lockdown and the dramatic increase in the second vaccinations, the number of deaths has also decreased. This delay, in turn, can be explained by the fact that hospitalized Corona patients usually die from one to two weeks.
On January 20, more than a week after the peak of hospitalizations of nearly 4,000 people, more than 1,800 people had died from or associated with Corona. From the end of January to the end of January, the number of deaths was reported. It decreased daily to a weekly average of around 300.
The seven-day incidence rate compared to Germany shows a clear picture: if it rose from 63 cases per 100,000 to 69 cases in Germany in the past seven days, then in Great Britain it has decreased from 115 cases per 100,000 population due to lockdowns and 76 vaccinations.
The effect of the second vaccination is evident in Israel
The numbers of Corona deaths from Israel show the impact of the vaccination campaign more impressive. The vaccination campaign began there at the end of December, and nearly everyone over the age of 50 has now been vaccinated. At the end of January, the first people received the second vaccination, at that time the daily death toll was around 80 according to official data from the Israeli Ministry of Health.
As in the UK, the number of dangerous diseases has increased Published by the Israeli Ministry of Health, From two weeks after the first second vaccination. After the number of critically ill patients with Covid was still around 1,200 at the end of January, the number fell below 1,000 on February 12th. 699 critically ill patients were reported on Wednesday.
About two weeks after the number of critically ill people dropped to less than 1,000, the number of deaths remained steady at below 30. According to the Ministry of Health, people who had not yet been vaccinated now make up 78 percent of Corona deaths. The percentage of those vaccinated twice is negligible.
Infection numbers in Israel also match the progress of vaccination. Since the end of January, the incidence rate for seven days, except for a few outliers, has decreased steadily – from over 500 to now below 300. In this case, this means: Only with a faster vaccination strategy does relaxation have less effect. On the number of injuries and hospitalizations and as a result, the number of deaths from.
In Great Britain, the number of infections continues to decrease, in Israel they have decreased and they are now at a consistently high level with an incidence of about seven days of about 300. In Germany, they have also decreased, but they have increased again slightly since mid-February.
Due to the extensive coverage of the population, Britain and Israel can afford the relief. This is especially evident in Israel: although the number of new reported infections is no longer decreasing sharply there, the number of reported deaths continues to decrease despite the decline. An indication that vaccinations involve less severe courses.
This effect can also be expected in Great Britain, where a strong lockdown will open at the German level before a new easing. For example, there should not be significantly more connections until the end of March. On the other hand, Germany is relieving more than Great Britain and Israel, although progress in the slow vaccination campaign is not yet ready for it. This is how Germany’s leading intensive care doctors interpret the numbers.
Dilution is not recommended in any country of the European Union
Incidentally, there is currently no country in the European Union (EU) to advise mitigation due to the combination of vaccination progress and lockdown. The European Union country with the most vaccine doses per 100,000 inhabitants is Denmark, with 11,000. Denmark has now reached the level that Great Britain was already at at the end of January.
Germany and Denmark are the two countries with the lowest infection rate in the European Union, and the infection status is highly comparable. After a sharp increase in the number of infections and deaths, these have decreased sharply until recently, but have increased slightly in the past two weeks. Denmark is also lax to a similar extent as Germany.
Procedures are also now being adapted in France. There were fewer doses of vaccine per 100,000 people than in Germany. For seven days, the incidence rate remains at a high level of over 200, and the number of deaths has not stagnated recently, as in Germany, but has increased slightly. Logical result: narrowing.
So the rationale for possible actions can be: if the infection rate is stable and the vaccination strategy is rapid, then it can be mitigated – as in Israel and Great Britain. If the infection rate is high and the vaccination strategy is slow, tightening should be considered – as in France. And with a stable, slightly increased infection rate and slow vaccination strategy, everything must remain the same at the start – as in Germany and Denmark.
According to Chancellor Angela Merkel’s pledge to offer every German a vaccination by the end of September, it is unlikely that Germany will achieve the vaccination progress Great Britain achieved until May or June. Until then, any further relief could come too soon – if the ’emergency brake’ doesn’t have to be pulled soon anyway.
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