1 Introduction
>> The group of authors of the theses on the corona pandemic is speaking out at a time when the new appointment at the top of the Federal Ministry of Health makes a new beginning seem possible.
The corona pandemic represents a difficult challenge. However, the measures and strategy so far have not led to resounding success. This may be due to the characteristics of the pathogen, and people's behavior must also be taken into account, but a self-critical assessment of the political leadership is essential at this point in time. Questioning the previous strategic orientation offers the opportunity for a new beginning, especially at the time of political change.
1. Improve communication in a risky situation.
The basis of a new beginning is the move away from a paternalistic style and towards a cooperation-oriented approach that strengthens people's independence and encourages them to work together. The communication style needs to be redesigned from top-down to two-way leadership. The situation has not yet been optimally controlled and it should be emphasized that the political leadership sees itself as having a clear responsibility. This makes it possible to reopen the channels of social exchange and strengthen a rational discourse based on appreciation. This discourse is an essential prerequisite for dealing with the next few months.
2. Leadership needs advice, which does not replace political decisions.
The coalition agreement of November 24, 2021 indicated that a new advisory structure should be created in the Federal Chancellery. This is a very welcome step, but it should not be seen as a sure-fire success. It is now crucially important to bring to the table, in addition to theoretically oriented scientists, clinically experienced scientists and experts who have practical experience in combating epidemics (including clinical infectiologists, hospital hygienists, doctors in the public health service, nursing managers). can assess the secondary consequences of measures based on their expertise and relate them to the benefits of the measures.
3. Understand the epidemic as a multidimensional event.
The corona pandemic is not a linear process, but rather obeys complex conditions. This fact can be well proven by current as well as past developments in their surprising, often seemingly paradoxical course. Therefore, limiting it to a purely biological view of the infectious disease Covid-19 (“the mutant kills”) is not sufficient; the focus must instead be on host characteristics (e.g. age) and environmental factors (e.g. indoor spaces, social gradient). A pandemic is at least as much a social event as it is a pathogen-related event.
4. The basis of every control: cohorts and score systems.
Measures for controlling the pandemic situation must be based on reliably collected data. According to the current state of science, prospective cohorts are the method of choice. In addition to a general, representative cohort, problem-oriented cohorts must be set up; an example is a prospective cohort of vaccinated people (equally children and adolescents, groups of people with strong exposure or special comorbidities). Because of the multidimensionality of the pandemic, it does not make sense to try to control it using a single parameter. High priority must be given to working on a score system that can capture the different aspects of the epidemic development and also reflects the fine-grained characteristics of the spread.
5. Focus on caring for the infected (mitigation).
The containment strategy set by the Robert Koch Institute since the beginning of the pandemic, which presents the health authorities with almost impossible tasks, must be abandoned in favor of the long overdue protection strategy. The containment strategy only makes sense in the initial phase of a pandemic and has led to avoidable deaths, for example in retirement and nursing homes, because the health authorities did not have or do not have enough trained staff to monitor these critical facilities due to the increased number of PCR tests.
Above all, however, the consequences of the disease must be considered and limited (mitigation). First and foremost, in accordance with international models, we should think about improving pre-hospital (outpatient) care so that hospitalization becomes more targeted, planned and possible with better condition of the patients - to the extent that inpatient treatment is still necessary in the case of intensive outpatient care. This aspect deserves particular attention, especially given the tense situation in hospitals.
6. Clinical inpatient care depends largely on the general conditions.
The lack of skilled nursing staff is an ongoing issue that is becoming particularly acute and shows the limitations in the current care process: the operation of the 26,000 intensive care beds identified in January and the opening of intensive care reserves is due to the inadequate quality how quantitative nursing availability has become THE central problem in the epidemic. A one-time reward or campaign won't fix this. It is therefore important to seek rapid agreement with the Federal Nursing Chamber, the German Nursing Council, the German Hospital Association and the trade unions on a package of measures that will immediately provide relief, restore trust and promise the prospect of lasting calm.
7. Opening of the intensive care emergency reserve.
There is no doubt about the decrease in intensive care beds, a disturbing and paradoxical development in an absolutely emergency situation. The emergency reserve must therefore be opened in parallel with point (6). The high priority of this measure must be made clear to the hospital authorities and the relevant federal state bodies - an approach that is certainly promising given the need for action. At the same time, supra-regional relocations must be authorized, strengthened and firmly planned.
8. Targeted prevention.
In an emergency situation, resources must be used where action is most urgently needed. The first two “waves” were the waves of older people and people cared for in nursing homes, the consequences are known. In the current wave, the focus is on the younger population, but this is not accompanied by a higher hospitalization rate. However, the increased positivity rate (% positive PCR results) is a clear indication that the vulnerable groups will actually suffer the most, especially when it comes to morbidity and mortality. “Targeted prevention” does not just mean “protecting the vulnerable”, but also avoiding measures for children and young people where the relationship between the benefits and harm of the measures is unfavorable. The primary goal in the current situation must therefore be to keep daycare centers, schools and other educational institutions open. Children and young people of all ages have the same rights as vaccinated and recovered adults. As demanded by the STIKO, the social participation of children and young people must not be made dependent on the existence of a vaccination.
9. Targeted prevention must begin in a decentralized manner.
The health authorities should initiate a change in their mandate: From now on, the focus must be on specifically addressing population groups that have not yet been the focus in terms of vaccination status, but also with regard to the care of infected people and the understanding of necessary measures, but a high one bear the burden of infection. Culturally sensitive approaches are in the foreground here, as are the other fundamental references to common prevention concepts.
10. The vaccination campaign requires a new communication strategy.
The vaccination campaign suffers from mutually reinforcing contradictions (compulsory vaccination, vaccine availability, etc.), which have led to uncertainty and rejection among skeptical population groups. A restart is particularly important at this point. A good start would be to adopt a more open, low-threshold strategy to better document adverse events (e.g. via freely available apps) to neutralize the credibility problem created by widespread distrust of non-reporting of potential adverse events. Such an approach also corresponds to the standard in the control of complex systems (registration of so-called weak signals).
11. Eliminate the polarization of society.
The polarization and speechlessness between different groups currently being observed in Germany requires a decisive communication strategy. Especially at the beginning of a new legislative period, there is an opportunity to counteract this polarization through appreciative offers, discussions and open listening. No population group can be motivated to cooperate through negative connotations. A return to dialogue in the sense of the basic understanding mentioned at the beginning of “independent thinking instead of paternalism” is the only way to prevent further division and departure.
12. Develop appropriate strategies for this and future pandemics.
In summary, it must be stated that so far too few resources have been earmarked for the competent management of the corona pandemic in the areas of public health, infectious disease medicine, vaccination, etc. Some political decisions lacked a forward-looking perspective; in the future, anticipation, prevention and resilience must be given greater priority. Above all, a consensual, scientifically based, convincingly understandable platform should be developed for future pandemics. The Infection Protection Act must be restructured accordingly, the responsible authorities must be restructured and the breadth and depth of cooperation between science and politics must be improved. <<
