Mr. Marx, the number of Covid-19 intensive care patients has more than halved since the beginning of January. But now you sound the alarm, a new lockdown is planned. Why?
Marx: Our demand is actually nothing new and also corresponds to what was decided at the Prime Minister’s Conference. When the incidence goes over 100, the easings need to be reversed. We have developed a forecast model at DIVI and this shows us very clearly on a scientifically valid basis: an incidence of 100 – this will be the case throughout Germany as early as the end of March. If we continue like this, then we will be in the second half of April at an incidence of 200 and that is really dangerous. We would then have as many patients as in the second wave in the intensive care units. Recapturing that would be particularly difficult, especially with the British mutant. There would then also be a lot more sick people in the 30 to 60 age group, because the number of infections will then be higher in this age group, since the older people are then already vaccinated. But also because the British mutant is probably more dangerous for younger people.
Gernot Marx, President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine, in January during a press conference
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Image: EPA
But people are tired, and many want their freedoms back at last. The economy too. Don’t you understand that?
Marx: Acting now would also be advantageous for the economy, otherwise we would face longer restrictions later. A lockdown will save our summer. On the other hand, we are currently endangering our summer.
What time frame are you talking about?
Marx: We need a lockdown again until the end of the Easter break. That would help us to buy time. Time to vaccinate. And that is what it is about. We have already said it once: we have to get ahead of the wave of infections with the wave of vaccinations. A lockdown until the end of the holidays would have the beneficial effect that the schools would then be closed for a while anyway. It’s about preventing severe gradients. But also in general about infections. Because even if you don’t end up in an intensive care unit, it often becomes clear what the long-term consequences of an illness are. I personally know a number of people who are still not their old age even after months and who have lost their sense of taste and smell again. We’re also talking about those who are between 35 and 60 years old.
Christian Karagiannidis is head of the intensive care register of the German Interdisciplinary Association for Intensive Care and Emergency Medicine and head of the ARDS and ECMO center at the Cologne-Merheim Lung Clinic
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Image: Felix Schmitt
Mr Karagiannidis, you said in a conversation with us a few months ago: Once the risk groups have been vaccinated, the situation for the clinics will ease.
Karagiannidis: Right: only vaccinations can save us. But when we soon have 4,000 to 5,000 intensive care patients again, we will stay at this high level for quite a while. We will find it very difficult to keep the R-value below 1 with the British mutant. That is only possible with the vaccination. The city of Cologne, for example, already had an incidence of 101 on Monday. For the moment, the following applies: Without a lockdown, we won’t get out of there, no chance!
How do you see the German vaccination campaign?
Karagiannidis: We don’t understand the slow rate of vaccination. We need to vaccinate faster. It is important that GPs vaccinate, and they should also decide who to give the vaccine to if anything is left. I think it’s terrible if at the end of the day there is even one dose of vaccine left. I have no understanding at all. That doesn’t happen anywhere else in Europe, only here.
Marx: General practitioners know their patients best. You should give your colleagues this freedom. We are sure that they will live up to their responsibilities.
How could Germany’s decision to temporarily suspend vaccinations with Astra-Zeneca affect the situation?
Marx: The situation is getting worse. Because in a situation with generally few vaccine doses, there is now much less vaccine available in Germany – but the vaccination speed should actually increase drastically. So fewer people will be protected and we will again see more patients with a severe course of Covid-19 in the intensive care units. All the more important are our calls for a return to the lockdown measures, as in February with an incidence of 100 to 100,000, so that we do not end up in a very threatening third wave. Only the vaccination leads to a significant reduction in new infections and thus also in intensive care patients with Covid-19. But I would like to emphasize: In every study with such complications as observed now at Astra-Zeneca, it is necessary to pause for a moment and evaluate again more precisely whether it is a coincidence or actually a connection. Medically, I consider the decision to be the right one. This is a vaccination. There should be an even lower risk than with the use of a drug.
Which age groups would have to be vaccinated in order for you to feel the effect in the intensive care units?
Karagiannidis: For us, the age group over 50 is decisive. As far as I’m concerned, if you look at it a little more loosely, over 60. We’ll get by below that. That is tragic then and we should prevent these cases. But they don’t make up the bulk of intensive care patients. And we expect that we can already achieve an effect two weeks after the first vaccination, so that a severe course is prevented. Above all else, you have to see that our teams on the stations are not machines. Our people urgently need support and not a third wave, a third marathon. At some point this is no longer affordable. And what many forget: At the end of the year, too, we will have fewer intensive care beds because the staff will blow us away.
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