Intensive care physician Kluge: Why the number of corona deaths is hardly falling

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To person

Stefan Kluge is Director of the Clinic for Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf. His specialties are internal medicine and pulmonology. He is also a member of the Presidium of the German Interdisciplinary Association for Intensive and Emergency Medicine DIVI. Among other things, she manages the DIVI intensive care registry and creates guidelines for inpatient treatment, such as Covid-19 patients.

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tagesschau.de: How long does it take for changes to become visible in the death rate?

Kluge: If we assume it will be severe, it takes about seven to ten days after an infection for someone to develop pneumonia so severe that they have to go to the intensive care unit and may also be ventilated. That’s the first delay. And then the patients now spend an average of ten days in intensive care units – longer if they are ventilated. For example, we had a patient who had been on the artificial lung for more than two months.

The number of deaths lag behind the number of new infections by around three to four weeks. We will see in the next few weeks that the number of deaths is also slowly falling further.

tagesschau.de: What symptoms do these younger patients come to the hospital with?

Kluge: Little has changed. Patients still find it difficult to breathe and therefore breathe quickly. Additional symptoms are cough, fever and, in every fifth patient, disorders of the sense of smell and taste. Depending on the severity of the illness, they then have to go to the intensive care unit; age and previous illnesses also play a role. At the moment, according to the RKI, there are five percent of those infected who come to the hospital and around one to two percent of those infected who are subject to intensive care. These numbers have changed in the course of the pandemic, because they depend on the infection rate in the various age groups, and currently the infection rate is more in the younger age groups.

tagesschau.de: What treatment options are currently available for patients in intensive care units?

Kluge: When we look at drug therapies, there are three main things: We saw relatively early on that these patients have more frequent thromboses and pulmonary embolisms than patients with other infectious diseases. For example, patients who come to the hospital should be given the blood-thinning drug heparin. After examining some studies, we have included this in the treatment guidelines.

We also know from many studies that a substance reduces mortality if a severe course has occurred in the intensive care unit: This is the cortisone preparation dexamethasone. This has been in the guidelines for almost a year.

And the third – this is new – we have been recommending in the updated guideline since the beginning of the week. This is a preparation that can only reduce mortality in hospitals and only in severe cases. It’s called tocilizumab. This is a rheumatism drug that has been on the market for several years. Like dexamethasone, it can reduce the body’s excessive immune response. It can be given in addition. In a large study from Great Britain it can be seen that the mortality rate could be reduced from 35 to 31 percent. We are of course grateful for such a reduction, because we will not find a drug that will reduce mortality to zero any time soon. And about 30 percent of Covid 19 patients still die in intensive care units.

tagesschau.de: If you now look at the easing in the various federal states, could it be that our situation will quickly worsen again if we are too careless?

Kluge: We should definitely continue to adhere to the AHA rules, and we must put all our energy into vaccination – first those over 60 years of age and those with severe pre-existing illnesses who are at higher risk of becoming seriously ill.

On the one hand, we still have the British version with us, and it’s very contagious. This is still underestimated by many. And then there is the so-called Indian variant, which is spreading in Great Britain and which, as things stand, is even more contagious than the British variant. A possible spread of this variant in Germany should therefore be carefully observed. Regardless of this, it is problematic if it is loosened too quickly now, since many people are still not fully vaccinated.

If people really no longer keep their distance and no longer wear masks and think that I have been vaccinated once, nothing can happen to me, then I think it is relatively easy to calculate that we will have problems again even without the so-called Indian variant and the number of new infections increases again.