The pandemic caused by SARS-CoV-2/Covid-19
– an initial balance sheet

>> The epidemiological situation has calmed down to the extent that the sporadic occurrence can be differentiated from the currently dominant focal outbreaks, which primarily reflect social risk factors (e.g. living and working situation). There is currently no threat of a second wave, unless a situation arises (e.g. severe economic crises) in which outbreaks lead to a general spread in the population (Fig. 1, Thesis 1). In this respect, a set of epidemiological key figures makes sense for control purposes (see Dimension 1 in the Balanced Infection Control Score in Chapter 2.3), which replace the previous dramatizing figures on frequency and mortality (4.7% instead of the real <0.5%). should: sporadic and focal epidemic occurrence as well as infected and sick people must be reported separately, the focus is on clinical endpoints (e.g. hospital admission), the connection to the regional scope of testing should be recognizable, general representative and special cohorts (in special risk situations, e.g. staff in facilities) and longitudinal cohorts with progression must be taken into account (Thesis 2). The test strategies must be designed accordingly (Thesis 3).
For prevention, the different goals are first weighed against each other: eradication, stable control and herd immunity. Since eradication is hopeless and reaching the focal point
Immunity is too difficult to control, the need of the hour remains stable control of the infection process, which includes both varying levels of general prevention measures (e.g. ban on major events) and a goal-oriented, specific prevention strategy. This “third way” (Schrappe et al. 2020C) envisages a combination of ex post measures (e.g. tracking of infection chains) and ex ante measures (e.g. early identification of risk situations) (Thesis 4). Epidemics do not represent a purely biological-medical problem, but should also be understood as a social or social phenomenon, in two respects: firstly, they occur due to social or societal risks (e.g. working conditions in the meat industry), and secondly, they are successful Control is only possible on the basis of social interactions or interventions (similar to modern infection control strategies in combating nosocomial infections). Effective prevention measures must therefore focus on the societal and social context at the level of society as a whole and at the level of organizations (Thesis 5). In order to develop a “compass” for this, a four-dimensional matrix is proposed based on the Balanced Score Card, which provides for the dimensions of epidemiology, economics, knowledge/training and fundamental rights. The number of dimensions and the criteria they contain in this Balanced Infection Control Score do not cover all possible aspects, but rather select individual aspects that are considered fundamental for control. The social situation of children and women under the conditions of the crisis and the lockdown makes it clear how crucial it is to monitor not only medical or epidemiological criteria (e.g. number of new infections), but also other aspects such as the social situation for control purposes to be used (thesis 6).
As already stated in paper 2.0, general prevention measures (e.g. physical distance) must be supplemented by specific prevention strategies in order to achieve optimal effectiveness. On the one hand, these include the protection of the group of people who are exposed to a high risk, who can be identified, for example, by a risk score (thesis paper 2.0). On the other hand, special attention must be paid to the prevention of focal outbreaks, as has been impressively confirmed by the current situation. When preventing such emergent (unforeseeable, unpreventable) focal outbreaks, one must distinguish between measures that can be used to limit an outbreak (ex post approach) and measures that primarily attempt to prevent the occurrence of a focal event (ex ante approach, thesis 7). The ex post approach is first described specifically using four examples: preventive training teams, crisis intervention teams, emergency nursing services and test teams (Thesis 8). The ex ante approach is the focus of the following chapter on the public health system, whose competence in social-medical ex ante prevention must be further strengthened in the future. This includes the early identification of possible outbreaks and corresponding risk situations through approachable, low-threshold offers that, if possible, avoid the aspect of sanctioning measures: the health authorities as “advocates of prevention” (Thesis 9).
In recent weeks, the situation of children and young people has been at the center of public and scientific interest. Numerous epidemiological and clinical questions remain open and appropriate studies are of utmost importance. Outcome-relevant endpoints (morbidity rate, mortality) should be preferred to surrogate markers (e.g. viral load), although important insights can also be drawn from the latter. Socio-political issues are just as important, because children and young people need (pre-)school care and training to protect their future opportunities, and in a society with a division of labor, parents need this care so that they can do their jobs. However, it is increasingly becoming clear that the transition from shutdown to regulated operation of the facilities triggers an enormous need for regulation (Thesis 10).
At the heart of this thesis paper 3.0 is once again the demand to rely on rationally justifiable bases for action (and not to forget the multidimensionality of the answers). An important example is clinical research - the disease caused by SARS-CoV-2/Covid-19 represents an imperative for increased research. Only in this way can this disease become tangible in its pathophysiological context and therefore treatable, so that it can also be beneficial for the social perception creates the opportunity to deal with this challenge rationally. However, the standards of clinical research based on the findings of evidence-based medicine and health technology assessment must be taken seriously, especially under the conditions of enormous pressure to act, as a prerequisite for any gain in knowledge and the decisions based on it. Speed is not more important than thoroughness simply because the propagation of false conclusions can lead to the wrong decisions being made at the political level (Thesis 11).
The contradiction between individual and social demands is particularly pronounced when dealing with people in need of care and with disabilities as well as with people who are in the process of dying, as the concept of the dignity of the individual person emerges very clearly here. The situation of the relevant facilities as hotspots for the emergence of focal outbreaks is well described, so there is no doubt about the justification to introduce restrictions, for example with regard to contacts. However, in the future, we must work diligently on solutions that make this situation more bearable, even if these solutions result in an increased need for resources (covering the costs of testing residents and visitors, etc.) (Thesis 12). The legal evaluation is very crucial here, because the further the anti-corona policy moves away from general, general measures (“lockdown”) or only maintains a few fundamental measures, the more necessary special and specific prevention and measures will become in the future Reaction measures (strategy of stable control) the principle of differentiated assessment, especially from a constitutional perspective.
All forms of general contact or visit bans appear problematic because where specific preventive measures are possible and necessary, general bans without exception will no longer be appropriate (Thesis 13). Under the changed conditions of knowledge, experience and specific prevention strategies, general isolations/lockdowns in inpatient health and care facilities are fundamentally becoming disproportionate as serious restrictions on fundamental rights (Thesis 14).
The federal government's so-called Corona tracing app is currently playing an important role, both in the public discussion and in the political sphere. From a purely legal perspective, the Corona tracing app in its implemented form initially does not encounter any significant legal concerns. However, it is absolutely necessary to secure this introduction legally in order to exclude misuse - for example in private business transactions - and to prevent extensions and accompanying uses that are questionable under data protection law. The organization of the processes surrounding this app can be improved (Thesis 15).
The decentralized approach and open source technology were particularly well received, but questions remain unanswered:
(1) the anonymity of the user at the operating system level is unclear;
(2) the parameterization by the operator, e.g. with regard to contact duration and spatial distance, is not regulated transparently (new declaration of consent necessary in the event of a change?);
(3) the proportionality of the behavior modification through the obligation to register with Apple or Google, not to switch off the smartphone and to continuously activate the camera, Bluetooth and (Android) location functions does not yet appear to have been conclusively clarified;
(4) social aspects of the provision of appropriate devices (e.g. existence of a mobile phone contract) are ignored;
(5) it is primarily an ex post measure;
(6) the effectiveness and efficiency are doubtful at first glance;
(7) the risk of misuse cannot be ruled out;
(8) According to official bodies, use in private business transactions with the undermining of voluntary activity is not possible, but is already being discussed - which is why legal regulation is urgently required.

In a final chapter, the social and socio-political context of the SARS-CoV-2/Covid-19 epidemic is problematized. This relationship is not without tension, because the crisis promotes state intervention - certainly desired by the population - and at the same time and significantly changes the prioritization of social issues. On the one hand, the resulting situation offers great dynamics (e.g. questions are asked that were previously taboo), but on the other hand, there is a massive narrowing of discourse. In public discussion, certain patterns of thought and interpretation predominate to such an extent that there is hardly any room for different opinions (and so-called conspiracy theory formulas are growing rapidly on the Internet). The ability of a free society to derive its special problem-solving skills from the plurality of knowledge and opinions is overridden. However, this tension, which is due to the goal of pooling all forces, must be resolved at some point. However, this de-briefing leads to a situation in which society has to find solutions to “questions that were never asked”, in any case a difficult task. The solution to paternalistic concepts in government action is one of the most important prerequisites, indeed the model, for the success of this normalization process.
The most important messages at a glance:
• Differentiate sporadic and epidemic patterns: In epidemiological analysis, it is currently necessary to clearly distinguish sporadic occurrences from current focal outbreaks (in critical living or work situations); both must be reported and addressed separately (Fig. 1).
• Dysfunctional dramatization: The reporting system of the Robert Koch Institute (RKI) and the federal government urgently needs to be updated; a proposal presented here includes the differentiated presentation of sporadic and epidemic cases and the report of disease states relevant to care (e.g. asymptomatic infected people, inpatients need for treatment).
• Stable control of the infection process: Eradication of the epidemic cannot be achieved, but stable control of sporadic cases, and especially of focal outbreaks (which cannot be predicted and cannot be prevented), is possible.
• Situation is manageable: The current situation is manageable through a prepared and well-equipped healthcare system, so the discussion about lifting the pandemic status and restricting fundamental rights should be opened (preserving proportionality).
• Balanced Infection Control Score: To assess the effectiveness of prevention measures, a multidimensional matrix is necessary that not only includes infection epidemiological key figures, but also those from the areas of economics, fundamental rights and knowledge/training.
• The “third way”: In addition to general and follow-up measures, successful prevention also includes target group-oriented, specific measures
• Clinical research promotes rational handling: addressing the clinical and nursing issues relating to Covid-19 represent a central element of a rational handling of the epidemic by society and the population.
• Human dignity: Particularly in the case of long-term care, disabilities or in the process of dying, every conceivable effort must be made to prevent situations and measures that limit human dignity. From a legal perspective, general restrictions appear to be particularly problematic when specific, individual solutions are possible and the proportionality is questioned due to the general improvement in the epidemiological situation.
• Corona tracing app raises worrying questions: anonymity, location determination, voluntariness, behavior modification, effectiveness and efficiency - there are considerable doubts about all of these aspects (and others). <<