Outbreak Silent Killers

At the end of December news came from China, that a new type of a deadly virus had developed there. With horror, I texted this news to my children, in my head scenes from American pandemic disaster movies, such as “Outbreak-Silent Killers” with Dustin Hoffman. After that, I think we all followed the news footage from China, from Wuhan. “Corona” and “Wuhan” were the first words to enter to our new everyday language. But for us here in Germany it was still very far away. You could see how one regionally closed off, how special gigantic hospitals were built, how an authoritarian and rigid apparatus took over the rigorous control. The high number of deaths was related to the Chinese regime, which at the beginning obviously tried to cover up the virus, but then with the publication of the information the epidemic seemed to be brought under control with these massive measures. In this respect, the threatening virus had remained far away in Wuhan, an epidemic, not a pandemic.

From Wuhan to Heinsberg

At the beginning of March I was supposed to have good friends from Russia visit me and go with them to the hardware fair in Cologne. Insofar I always looked at the website of the hardware fair and noticed that more and more exhibitors were cancelling their participation. Because a large part of them came from China. At the end of February, I received an official letter of cancellation from the hardware fair – where I was registered – with a detailed explanation of why it was postponed because of Corona. That was quite a big thing! Thousands of registered exhibitors, tens of thousands of visitors. What a financial loss for the companies, for the city of Cologne, for the hotel and tourism industry! Nevertheless, it was clear that my friends would come to visit me without the trade fair. This virus was exaggerated somehow, it is similar to a flu and only dangerous for older people. All the time you received jokes on Whatsapp about it and passed them on in an amused way. But exactly in this last week of February this clarity changed with every day and finally almost hourly. In Italy, a “hot spot”, as we have also incorporated into our language usage, had been formed. Here the number of infected people had risen sharply during this week and by the end of February it was over 1000 and there were already almost 30 deaths. Also in Germany there were already more than 60 infected people. My friends were due to arrive on the 3rd of March and we talked on the phone every day during this time. Are you coming or not? On the morning of the 3rd they did not  fly. In Germany, in the federal state of North Rhine-Westphalia, in the district of Heinsberg, now also a hot spot had developed. Here several people had been infected during a carnival meeting.

What exactly is this virus?

In these first two weeks of March the Corona era began for Germany. The first thing one did in the morning was to look at the development based on the number of infected and dead people, especially in almost neighbouring Italy and the German district of Heinsberg. And the development was rapid, exponential. The number of deaths had risen from 30 to over 2000 in Italy, and the first deaths were also recorded in Germany. Had the virus been underestimated? Didn’t they say that the majority of the cases were mild and that some people had the disease and did not even notice it? It was at least clear at the time that it was highly infectious and that it was to be taken very seriously by the elderly and those with pre-existing illnesses.

The time began when all information about the virus were absorbed. Learned that it is not a virus like the flu virus, which puts on a new dress every year, but the shape of which is nevertheless known to the majority of the population and against which defence mechanisms are in place. No, this is a completely new type of virus, not only does it wear a new dress, but its whole shape is unknown and therefore there is no immune defence (herd immunity) against it yet. There are also no researched treatment-supporting drugs and of course no vaccine yet. We learned that it comes from the viral species that causes the severe acute respiratory syndrome (SARS), which claimed 800 lives in a pandemic in 2002. A virus that had “mutated” from animals to humans in China. Possibly from certain cat or bat species ingested through food. There are also theories that it was developed in gene laboratories that conspiracy theorists like to mess with.

Although it is a highly infectious droplet infection, it appears to be transmitted for the most part by the breath of an infected person. For example, we have been buying fresh goods in supermarkets every day since the beginning, but there are hardly any ways of infection to be found here. It is said that even if an infected person has sneezed on a loaf of bread beforehand, the quantity is not sufficient to infect another person who touches the bread afterwards. Just as little through to door handles, chairs etc. Priority is therefore given to keeping a distance and washing hands. In contrast to its predecessor from 2002, however, the coronavirus of 2019 is further developed in the following respect. It can multiply well in the throat and then more efficiently reach the target of its desire, the lungs, where it can cause the severe pneumonia typical of SARS. It can spread unnoticed for two weeks from an already occupied body. This is the virus’ dangerous weapon. What it looks like microscopically, we all know by now, it is certainly the most widespread image of the month March 2020. It got its name from the appearance of its surface structure, the virus with the crown.

Tsunami dynamics

The time began here in Germany, where the words of our Federal Minister of Health, Jens Spahn (one of the three successor candidates in the ruling party to Angela Merkel), were followed with great excitement every day. With impressive calmness and objectivity in a restless and unclear situation, he always stressed that the situation was “dynamic”. That actions and measures must be adapted to the respective dynamics. The first measures were the recommendations to better refrain from events with more than 1000 people, quarantine regulations in the hot-spot Heinsberg or the pursuit of “infection chains”, another new word of our today’s virally determined everyday life.

A new phase of the crisis was certainly triggered by the pictures from Italian hospitals on the TV screens in our living rooms in mid-March. For days there had already been the parallel comparison with the German small hot spot in Heinsberg and the big hot spot in Bergamo in northern Italy.  Now we saw naked, lifeless bodies laid on their stomachs on respirators, overcrowded hospital corridors and provisional halls with terminally ill patients. Totally exhausted and overstrained doctors who were traumatized because they had to decide personally every day who to connect to the insufficient ventilators and who not. Who they let die and who not. And even with ventilators, patients died away from them. These corona images had branded in us as well as the voices echo of Italian doctors and politicians who fervently warned us of a tsunami.

The difference is in the way you die

By then at the latest, we had all come together. The jokes on whatsapp faltered, the matter was obviously very serious. The thought that a parent or grandparent in a makeshift hall would suffocate painfully with bilateral pneumonia all alone and fully conscious, that was a very clear “no go” for everyone. We knew, of course, that there are worse viruses and worse diseases or that in Germany we lose almost 1 million people every year due to cardiovascular diseases, almost a quarter of a million due to cancer or over 3000 due to traffic accidents. And also, it goes without saying, that the life expectancy of older people is lower than that of younger people. Nevertheless, it makes a difference whether one’s own mother, after a stroke, is quickly taken by an emergency ambulance to a “stroke unit” for the best possible treatment, or whether she is taken by astronaut people to a makeshift hall and has to die miserably all alone.

Flatten the curve

And after all the knowledge about the virus and its spread that had loaded up in the last two weeks, there was, in all ignorance and ambiguity, at least one logical explanation of how we might be able to prevent such a scenario. The face of the German corona crisis, the internationally renowned virologist Prof. Christian Drosten, director of the Berlin Charité, specialized in novel viruses and experienced with the SARS predecessor of COVID 19, explained it to us. How spellbound we hung on his lips these days. Since there were no medical measures against the spread of the novel virus and also our health system, which is well positioned in a global comparison, would be overwhelmed with a simultaneous high number of serious cases, there was only one solution at that time, when there was an acute need for action to prevent a horror scenario like the one in nearby Italy: “Flatten the curve”, as it has now also become part of our language usage. To keep the infection rate so low that we can provide intensive medical care for the serious cases. And you didn’t have to be a mathematician to understand the diagrams and video animations. In order not to let the number of infections increase exponentially, there was only one quick and realistic non-medical solution at that time, the “shutdown” or “lockdown”, as it has become our language.

The emergency brake in the Mercedes

However, this shutdown has always been linked to a political commitment that everything will be done to cushion the financial losses of this unique, elementary and drastic measure. Our “black zero”, i.e. a balanced national budget, which we have treated as a sacred cow for 5 years, has now been willingly slaughtered to prevent this horror scenario. This is what the German Chancellor stood for in her television speech to the people on March 18th, and there was no wrangling about it among the politicians or in the population. Basically, the Chancellor had said, yes, we have a piggy bank, which we have filled up well in recent years by the black zero and now we are ready to slaughter it.

After closed schools, kindergartens, partial restrictions on entry and exit, quarantine regulations, bans on major events, we have now closed down the entire tourism, travel and leisure sectors. In addition, the home office was applied to all companies throughout Germany as far as possible. Meanwhile, one may move publicly only in twos or with several, if these are from the same household, whereby there are always deviations within the individual Lands of the Federal Republic, in the Land Bavaria e.g. one may have only contacts within the household and leave the house only for good reason. Catalogues of fines for offences are published, starting from 200 € for example if one moves with more than 2 persons in the public area, for repeat offences around 1000 € and for repeat offences of larger offences such as the execution of a larger leisure event up to 25.000 €.

Close together in distance

It’s not that we all followed the shutdown like a herd of sheep, no, there were and are non-stop reports, documentaries, discussions, extra, special and superspecial broadcasts in the media with doctors, virologists, financial experts, politicians, affected, non-affected, psychologists, VIPs, everyday heroes, whatever. No, it was an absolute majority decision.

Meanwhile we are already dyed-in-the-wool representatives of “social distancing” or correct already in the term “physical distancing”, further terms which now belong firmly in our everyday linguistic life. The minimum distance of 1.5 meters to others has become second nature to us. We almost get a fright when we see scenes in films where people shake hands or even hug each other. Even here in my small village in Hessian Siberia we automatically stand in queues, always with a proper distance, that goes without saying. Even within the family in the same household we keep our distance. The parents or grandparents can only be seen through the window next to the entrance door and cashiers are now all separated by glass panes. Our skin on our hands is already flaky like leaves from the constant washing of our hands.

There is the hashtag action #We stay at home, everywhere and always present as well as #We say thanks. Well-known personalities support them in short video clips from home. The thanks go to all employees and volunteers of the companies and facilities that maintain the system. Especially in the health care sector, where people work almost 24/7, or the cashiers in the supermarkets, who are exposed to the onslaught of “hamster buyers“ drooling over toilet paper and a not inconsiderable residual risk. (The term “hamster buying“ is very common in Germany and basically means hoarding or panic buying.)

Our economic airbag

On March 25th, a subsequent federal budget was passed within a very short time, faster than ever before in German history, i.e. officially leaving behind the holy black zero with seven-league boots and thus releasing a total aid package of 156 billion euros for the economy. Companies with up to 5 employees can receive a non-repayable immediate aid of 9000 €, with up to 10 employees, of 15.000 €. The application can be made online recently and since then the flood of applications has not stopped. It seems to be relatively uncomplicated and the response is extremely fast. There are reports of 15 minutes. The money is then transferred just as immediately. An economic stabilisation fund of EUR 600 billion has been set up for large companies. The main point here is that the state provides (90-100%) credit guarantees to the banks. The loans must nevertheless be repaid in full by the borrowers. One elementary economic support is above all the acquisition of short-time work compensation by the Federal Employment Agency. Landlords are also currently not allowed to give notice to their tenants.

Reference date April 20th.

Where are we today on the first day after this dynamic, unique, world-changing March 2020? After a good two weeks of shutdown and social distancing, after the probably most unusual two weeks that we as German society have experienced together after World War II? Yes, without a doubt we are a bit like impatient children who want to unwrap their birthday present. A parcel in which there is at least a significant decrease in the number of infected people. But for the time being we have only found a piece of paper with a date on it, like in a paper chase. April 20th. On this day we receive the next clue.

© English Corona Virus graffiti – save lives, stay at home; CC BY-SA 4.0

Side effects of the “Drug Shutdown”

The drug Shutdown was indicated against the deficient treatment of the severe cases and the resulting undignified death of – due to the non-valid data – approx. 0.5 -10 % of our population. The “compliance”, i.e. the cooperation of the patient himself in the therapy, was and still is extremely high. Currently, compliance is strengthened above all by the pictures from New York, by halls filled with coffins, by dead people transported in body bags by forklift trucks, by sad “record numbers” of over 1000 Covid-19 deaths on a day when there was not a single fatality two weeks ago. For all the inaccuracy of the data, these pictures clearly show that the American government has played down the situation for too long and switched the system too late.

Compliance is also strengthened by the actions already mentioned, such as “We stay home, we say thank you,” with examples of everyday heroes who go shopping for risk groups, who sew protective masks, who implement creative ideas in coping with the virus-determining everyday life. And now just with the mention of a concrete date, one can begin to gradually phase out the strong medication. Because it is also clear that this is a bitter pill that has not yet been clinically tested and has countless dangerous side effects that increase with the longer period of use. These side-effects can occur to varying degrees depending on the patient group. It is clear that under these conditions this orderly voluntary retreat into one’s own four walls together with social distancing is not a life on the Pony Farm for any of us. But for an intact family of five with a large apartment and garden it is different than for a family with potential for domestic violence in a small appartemnet of a high-rise housing estate. What are their children going through right now?

And certainly the manufacturer of “deficit goods” such as breathing masks, disinfectants, respirators tolerates the bitter pill much better than the owner of a restaurant, café or other “non-systemically relevant” shop who does not have large reserves. How are all those people who are worried about their livelihood? How long will young people swallow the bitter pill if the neighbour calls the police because he is standing with two friends on the street? How far should control and punitive mechanisms be allowed to cut into fundamental freedoms?

Time for sorting, dynamic standstill

“What happens after the 20th?” is the question that’s on everyone’s mind. But for this we need more and more concrete data, it still remains a dynamic process, every day anew. We hope for a valid quick antibody test soon, which is in progress and could be on the market in about a month. As things stand at present, people who have already had Covid-19 cannot reinfect themselves or others, and would therefore be very useful in the crisis. The number of infection tests is also to be increased significantly. We are currently conducting clinical trials with 3 existing drugs that could be effective for Covid-19. There are first successes here. Downlocked companies such as Volkswagen, for example, have shifted production areas to the manufacture of ventilators or clinical accessories, others to the manufacture of protective masks, where they are unable to keep up with orders. The number of intensive care beds continues to increase, and medical personnel are being expanded and trained. University hospitals and research centres are networking more and more. An ethics committee has been set up to give instructions to intensive care doctors in the “triage” (classification of patients according to severity in the emergency ward) in order to spare them the traumatic experiences of Italian doctors. In addition to intensive care units, palliative departments with access for relatives are also connected.

Anonymous temporary Bluetooth tracking apps are currently being advertised by the government. We are learning more new terms for different strategies: “Mitigation” is the prevention of contact in the sense of flattening the curve, “Suppression” the prevention of contact for the complete eradication of the virus, “Cocooning” the shielding of risk groups, “Containment” the opposite of herd immunisation. And with the whole numbers of dead, infected, recovered, treated, risk groups and unreliable mortality rates, mathematicians and virologists model the potential future of these strategies. For example, a mathematician from Kaiserslautern answers the question: What strategy do we follow in Germany with flatten the curve – suppression or weakening?

“The government has never said that very specifically. It is true that the measures currently in force are very strict. But I don’t know whether they are strict and long-term enough to successfully suppress the virus. That depends on how much you can reduce off-home contacts. If you reduce them by about 90 per cent, it will take just over a year. And if you want Covid-19 to disappear within a year, you would have to permanently eliminate about 95 percent of all off-home contacts, compared to the period from March 5th to 20th. But I would like to emphasize that we have made these estimates based on our simulation model. How exactly it can describe the actual course of the pandemic, as with all models, we will only be able to say afterwards.”

So we can only say afterwards whether the operation was successful and the patient survived? Good thing that mathematicians alone do not decide the fate of the patient.

– Dr. phil Carmen Krusch-Grün, ISHR-Germany –