Will the incidence soon be obsolete? There are signs of a change of course in corona policy in Germany: In the future, restrictions should no longer depend solely on the incidence value ?? but above all the hospitalization, i.e. the number of hospital admissions due to Covid-19. Only: how meaningful is that? In addition to the incidence, it is very important to consider the occupancy of the practices and clinics, says Dr. Matthias Held, lung specialist and medical director at Klinikum Würzburg Mitte. “That does not mean that the incidence value is insignificant,” explains the expert, “it shows when, usually with a delay, more seriously ill people can be expected”.
Question: What is the current situation in the Würzburg Mitte Clinic (KWM)?
Dr. Matthias Held: As of Thursday, we have four Covid 19 patients in the KWM: two at the Missioklinik location, two at the Juliusspital location. We have two patients in intensive care at both locations. A 29-year-old who is currently being treated with non-invasive mask ventilation in the prone position and a 60-year-old patient who is being treated with so-called high-flow oxygen therapy. These two intensive care patients were not vaccinated.
The incidences are rising nationwide and in Lower Franconia, in some cases rapidly. Do you worry?
Held: We view the climbs with some concern but are prepared accordingly. At the moment, the volume does not affect the care of the other patients. Our experience from the last few weeks is that emerging patients with acute infections were usually not vaccinated and were often returning from vacation.
In the future, politicians are planning to move away from incidence as the sole yardstick for restrictions. How do you rate that?
Held: Basically you have to consider: What are the goals? How can you get there? And: are the measures appropriate? The aim is always to protect people from a corona virus infection and, above all, to avoid severe courses. Above all, the aim is to prevent those affected from being cared for and also to prevent other patients who do not suffer from Covid-19 from being adequately cared for due to the emergence of Covid-19. So in addition to protecting the individual, one must above all keep the balance between demand and capacity of medical care in mind. In this context it is very important to consider not only the incidence but also the occupancy of the practices and clinics.
“I have the impression that you have generally learned from the first waves.”
Dr. Matthias Held, Medical Director at the Würzburg Center Clinic–So do you think the change of course in the corona policy makes sense?
Held: It is likely that there will be adjustments over and over again in the next few weeks and months, so you will actually have to redefine the rules flexibly, depending on the situation. That does not mean that the incidence value is insignificant, it also provides information about the dynamics of a wave of infection and also shows when, usually with a delay, more seriously ill people can be expected. However, since the infection is not only significant, but also the severity of the disease, it is important to also query the utilization of the intensive care units and the peripheral isolation wards.
In the past few waves, the occupancy of the intensive care units has been looked at again and again. Often there were doubts about the reported figures. How meaningful can hospitalization be as a new benchmark? Where do you see difficulties?
Held: I have the impression that you have generally learned from the first waves. It has also been learned that intensive care capacity should by no means only be made dependent on the beds and ventilators that can be set up, but rather on the available health personnel. And this is precisely where the difficulty of a generally applicable measurement tool lies. Society has to trust the assessment of the individual facilities and clinics as to how many patients they can cope with. And the total of reported free or already used capacities results in necessary restrictions. Unfortunately, I cannot give you a simple answer. Health care is demanding and complex. You can’t just talk about it. But in Germany we have highly professional medical care with highly motivated employees.
“Taking vaccination status, recovered status and tests into account includes three correct pillars in dealing with the pandemic.”
Lung specialist Dr. Matthias Held on the 3-G rule–Do you personally fear that the fourth wave will be more violent than the third? And will it be the unvaccinated pandemic?
Held: Because of the vaccinations, we are better prepared than last autumn or spring. Unfortunately, the vaccination rate is not yet where we would like to see it. From our current experience, unvaccinated people are mainly at risk. The further development of the virus will decide when vaccinated people need a third vaccination.
How important is the 3-G rule? Can they prevent further waves?
Held: The consideration of vaccination status, recovered status and tests includes three correct pillars in dealing with the pandemic. Since further changes can result from the virus development, we will have to adjust the rules again and again and we will have to make further adjustments to the strategy. As a society and in the health system, we have to be vigilant and take responsibility for our fellow human beings and not just look at ourselves.
Priv.-Doz. Dr. Matthias Held has been the Medical Director of the Würzburg Center Clinic since October 2020, where he is responsible for the care of Covid patients. He was born in Kassel in 1970 and completed his medical studies and training in Würzburg. Held’s focus is on pulmonology. He set up the pulmonary hypertension center at the Missioklinik, and has been the chief physician of the medical clinic since 2018. During the second lockdown in the Main-Post and at www.mainpost.de/corona-tagebuch, he regularly provided insights into everyday hospital life in a diary.
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