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Intensive care medicine prognosis: opening steps could lead to more than 1000 deaths per day – knowledge

From March 8, Germany will open up with a first major step out of the lockdown in the corona pandemic. Late on Thursday evening, the federal and state governments even decided to relax the contact restrictions. An “emergency brake” was also decided if the nationwide incidence should rise again to over 100 cases per 100,000 inhabitants in seven days. It is currently 69.

Chancellor Angela Merkel (CDU) and other leading politicians will not have overlooked the fact that the seven-day incidence has increased slightly since mid-February. They also certainly do not hide the fact that the vaccination strategy is still being implemented slowly. But how does that fit together with the easing?

Three of the leading intensive care physicians in Germany are also asking themselves this question and published an updated forecast model on Thursday. In this model, the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) simulates the intensive care bed occupancy depending on the infection dynamics and the expected vaccination effect.

The sobering picture, according to this model: The combination of infection dynamics and progress in the vaccination campaign does not actually allow easing at the beginning of March. Only a little more than 8,000 vaccination doses per 100,000 inhabitants have currently been inoculated in Germany.

A comparison with pioneers such as Israel or Great Britain shows how little that is: In Israel, around 97,000 vaccine doses per 100,000 inhabitants have already been vaccinated, in Great Britain there are more than 30,000 doses administered per 100,000 inhabitants.

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In Israel, the lockdown ended for the most part two weeks ago, but only for those recovered and vaccinated with a so-called green passport. In Great Britain, slight opening steps from the lockdown, which is tough compared to Germany, are planned for Monday. And in Germany, too, there are easing, although the vaccination campaign does not seem to be far enough.

Therefore, the DIVI warns with its forecast model against the loosening that has now been decided. Because the forecast curves for intensive care bed occupancy do not bode well. In a total of three curves, the intensive care physicians calculate at what point in time opening steps have what effect.

The openings are always based on nationwide opening – which is possible with an incidence below 100 in every federal state. In the meantime, around 350 of the more than 400 rural districts and urban districts are below the incidence of 100. The intensive care physicians also included the vaccination rate in the prognoses – a pessimistic and an optimistic one. According to DIVI, the pessimistic scenario is currently the realistic one.

The result of the forecasts: Due to the slight opening at the beginning of March, the number of corona intensive care patients could rise again to more than 4,000 in May and, should it be opened nationwide, to more than 6,000 in June.

The last time it was almost 6,000 at the end of December, two weeks later the number of daily deaths peaked at 1,200. Since, according to data from the DIVI intensive care register, around 30 percent of corona intensive care patients have died so far, more than 1000 daily corona deaths would again be expected from May.

For comparison: On Thursday, the DIVI reported around 2800 corona intensive care patients. The health authorities reported 387 new deaths to the Robert Koch Institute (RKI) on Thursday or in connection with the corona virus.

Instead of the opening steps that have now been decided, the intensive care physicians advised the first easing in April at the earliest. According to the model, the intensive care bed occupancy would initially have increased slightly and then decreased – and with it the number of corona deaths.

Especially since the numbers in the DIVI intensive care register should include an unreported number of deaths. Because: The register only counts those corona deaths who die in the intensive care unit, confirmed a spokeswoman for the Tagesspiegel. Patients who are transferred to the normal ward and die there from the consequences of Covid disease do not appear in the statistics.

The intensive care physicians also expect a spread of the virus mutant B.1.1.7 of 22 percent. Leading virologists, including Christian Drosten, now assume that B.1.1.7 is found in around half of the positive tests.

“We count beds, not patient-related data,” said the spokeswoman. While 30 percent of intensive care patients die, even half of those intensive care patients who have to be artificially ventilated.

Great Britain is easing because the numbers show it

Figures from Great Britain show what positive effects a long hard lockdown paired with rapid vaccination progress can have – especially against the background of rampant mutants. While the number of deaths from or in connection with the coronavirus in Germany is now in a kind of trough and new infections are increasing slightly, both numbers in Great Britain continue to decrease significantly.

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 so that it would reach its promised 95 percent effectiveness one week later – around four weeks after the first vaccination.

So at the beginning of January the first British very old people were immunized. Lo and behold: in mid-January the curve in hospitalizations began to decline. The data was collected by the National Health Authority (NHS). In the largest part of the country, England, where more than four out of five British people live, the number of hospital admissions fell continuously from around 4,000.

The delay of one to two weeks can be explained by the fact that it takes exactly this time at most until an infection breaks out and people have to be admitted because of it.

However, the decline in hospitalizations is not only due to the progress made in vaccination. A hard lockdown came into effect at the beginning of January, much harder than in Germany. People in Great Britain are only allowed to leave their homes in a few well-founded exceptional cases and are also not allowed to meet people from other households.

Almost at the same time, the number of second vaccinations increased significantly, the lockdown minimized people’s contacts and thus also the number of new corona cases. This has been falling continuously since January 10th. To date there has been no increase in hospitalizations in England either. The number fell from around 4,000 in mid-January to less than 1,000.

Two weeks after the start of lockdown and the significant increase in second vaccinations, the number of deaths also decreased. This delay can in turn be explained by the fact that it usually takes one to two weeks for corona patients admitted to the hospital to die.

On January 20, more than a week after the peak in hospitalizations of around 4,000, the number of people who died from or in connection with Corona was more than 1,800. From the end of January to the end of January, the number of deaths reported daily fell to the weekly average around 300.

The seven-day incidence compared to Germany shows a clear picture: if it rose in Germany from 63 cases per 100,000 to 69 in the past seven days, in Great Britain it fell from 115 cases per 100,000 inhabitants due to lockdown and vaccination progress 76.

The effect of the second vaccination is evident in Israel

The corona death numbers from Israel demonstrate the influence of the vaccination campaign even more impressively. The vaccination campaign there began at the end of December, and now almost everyone over the age of 50 has been vaccinated. At the end of January, the first people received their second vaccination, at that time the number of deaths per day was around 80 according to official data from the Israeli Ministry of Health.

As in the UK, the number of serious illnesses published by the Israel Ministry of Health decreased from two weeks after the first second vaccinations. After the number of seriously ill patients with Covid was still around 1200 at the end of January, the number fell below 1000 on February 12th. 699 seriously ill patients were reported on Wednesday.

Around two weeks after the number of seriously ill people fell below 1000, the number of deaths remained constant below 30. According to the Ministry of Health, people who have not yet been vaccinated now make up 78 percent of the corona deaths. The proportion of those who have already been vaccinated twice is negligible.

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