35, 50, 100: These have been the milestones in German politics for almost a year and a half. Depending on how high the 7-day incidence is, whether 35 new infections per 100,000 people, 50 or 100, appropriate measures follow to contain the corona pandemic – laid down in the Infection Protection Act. But that is about to change.
By August 31, the federal government was called upon to “submit formulation aids for an amendment to Section 28a of the Infection Protection Act (IfSG),” as the Federal Ministry of Health announced in response to a DW request. The protective measures against the coronavirus should then be based in particular on the hospitalization rate, i.e. the number of hospital admissions of COVID-19 patients. The 7-day incidence is no longer a central benchmark due to the progress made in vaccination.
European countries are showing the way
Hospitalization rate instead of 7-day incidence – Germany is taking a path that several European countries have already taken. In Austria and Italy, the hospitalization rate has also been a factor in decision-making for a long time. Austria uses a corona traffic light that takes into account numerous indicators such as the age of people infected, the proportion of people infected with symptoms and the resources in the health system. In Italy, the regions are divided into different colored zones, depending on how badly the region is affected by the spread of the coronavirus. When assessing the situation, in addition to the 7-day incidence, the occupancy of both intensive care and normal wards plays a role.
More in focus in the future: hospital occupancy
“Each indicator has its advantages and disadvantages,” says epidemiologist and statistician Emilio Gianicolo at the University of Mainz in an interview with DW. The 7-day incidence helps to understand the dynamics of the pandemic, while the hospitalization rate provides conclusions about the overload of the health care system. However, he considers the hospitalization rate to be only of limited significance because it “shows the incidence of infection late”. Because hospital admissions usually happen with a two-week delay. “The 7-day incidence, on the other hand, carries the risk of a large number of unreported cases”. Because the higher the vaccination rate, the less testing is done. Therefore, according to Gianicolo, one is not well advised to rely on only one indicator when assessing the pandemic.
Some federal states are already converting
In Germany, meanwhile, some federal states are leading the way without waiting for a new regulation from Berlin. In Baden-Württemberg in the south, regardless of the incidence, social life is restarted. In Mecklenburg-Western Pomerania in the north, a modified traffic light system is to be used which, if the incidence is high, also includes the occupancy of hospitals and intensive care units. In the city-state of Hamburg, the 7-day incidence is now broken down into vaccinated and unvaccinated persons for the first time, which has revealed a much higher incidence among unvaccinated persons. Epidemiologist Gianicolo finds this to be a very important finding. Because it means a difference for the further course of the infection process who is infected.
Regardless of which indicator is used decisively – transparency and traceability are particularly important. “The methods of how a decision criterion comes about must be clearly understandable,” says Gianicolo. In Austria, for example, he believes that the weighting of the indicators is understandable for professionals, but difficult to understand for the normal population.
The epidemiologist also observes that although the criterion “overload of the health system” is considered a benchmark, it is almost never precisely defined. Neither in Denmark nor in Great Britain, for example, has it been defined from which indicator there is a risk of overload – especially since health systems have different levels of performance. In fact, in the UK, the 7-day incidence has all but been eliminated with no further definition of system overload. The publicly available roadmap for further handling of the pandemic states that the government will regularly keep an eye on the data to ensure that the health system is not exposed to an “intolerable burden”.
Details still unclear
In Germany, too, the details of which key figure should replace the 7-day incidence are still completely open. At the request of DW, the Federal Ministry of Health announced that it wanted to wait for the decisions out of “respect for Parliament” before making a statement. The Robert Koch Institute, the state’s central health authority, has already reported the hospitalization rate of COVID-19 patients per 100,000 inhabitants in the past few days. It is unclear when there is a risk of overloading the health system.
It is also unclear how admissions to hospitals will develop in the fourth corona wave that has now begun. If you look at the numbers, it can hardly be predicted: On October 23, 2020, at the beginning of the third wave, the number of new infections was 3839, the number of COVID-19 patients in intensive care units who had to be ventilated was 148 On August 19, 2021, while almost 60 percent of the population are now fully vaccinated, there were 3,684 new infections, about as many as on October 23. The number of ventilated COVID-19 patients was similar: there were 135. It remains to be seen whether these numbers will not increase this winter, unlike a year ago, as older people are increasingly protected against infection due to their vaccination .
The details of the reformulation of the Infection Protection Act will show whether the approach does justice to a new phase of the pandemic with significantly more vaccinated people: an approach that takes into account several indicators, does not lose sight of the pandemic dynamics and defines an overload of the health system in a transparent and comprehensible manner .