How important will clinical data be in the pandemic? | Free press

Berlin (dpa) – The only perfect value from which the necessary corona measurements can be derived never existed during the pandemic. Several factors will also have to be taken into account.

Changes in the weighting of the data are, however, quite possible with the progress of vaccination. The situation in hospitals will soon play a more important role than the sheer number of infections. What are the clinical indicators and what do they say?

What does “incidence of 7-day hospitalizations” mean?

In addition to the 7-day incidence of newly recorded infections, the pandemic is also recording the number of people who visit a clinic due to a diagnosis of Covid 19. This “7-day hospital incidence” maps the cases declared over one week per 100,000 inhabitants. Hospitals should not report cases in which a patient comes to the clinic because of another illness or because of an operation and in which the crown is detected during a test. In Thursday’s Robert Koch Institute (RKI) MD&A, the value exceeded 1.5, and the trend is up. The previous record was around 15.5 at Christmas time. The incidence at 7 days is calculated according to RKI information based on the date of declaration to the local health department.

Is there a critical limit to the incidence of hospitalization?

For the German Hospital Association (DKG), there is currently no fixed limit beyond which the situation would get out of hand. Rather, you have to differentiate. “The bottleneck remains the patients who have Covid in an intensive care unit”, explains Gerald Gaß, CEO of DKG. From the experience of pandemic waves, it is known that nationally, in intensive care units, there is basically a load limit of around 5,000 cases of Covid-19. However, this already applies provided that the operations that can be scheduled are postponed.

What does the increase in incidences of hospitalization mean for normal services?

With more Covid 19 patients, you would have a lot more stress, for example through isolation and protective measures for staff, adds Gaß. But in view of an intensive care unit, where a Covid 19 patient needs much more intensive care than other patients, there is no comparison. “It takes up to five nurses just to reposition a ventilated Covid patient.” In this context, however, it is important to know how many Covid 19 patients need to be transferred from normal care units to intensive care units due to the severity of their illness. In the first wave, it was 14%, or about one in seven. The rate is likely lower today, but final valid data is still pending, according to the DKG.

What influences the number of Covid-19 patients in clinics?

It’s a whole bunch of factors. Besides the incidence of infections, vaccination rates, infection dynamics and age groups also play major roles for DKG. For example, the hospitalization rate in the RKI tables shows the proportion of all reported corona cases that need to be treated in a clinic. This value was calculated to be around 12% around Christmas time, and then it dropped in waves. For the moment, it is around 5%, but late registrations are possible.

What are the other figures for the clinics?

The German Interdisciplinary Association for Intensive and Emergency Medicine, in collaboration with the RKI, records the number of occupied or free intensive care beds (Divi register). These figures are updated daily and reports are mandatory for clinics according to the association. The number of Covid-19 patients in intensive care units is also recorded. The maximum number for the pandemic was 5,762, it is currently around 840 – and the trend is on the rise again.

What is the significance of all these clinical indicators?

For experts, they show trends. They cannot be viewed in real time. On the one hand, according to the RKI, about ten days on average still elapse between infection and hospitalization. On the other hand, incidences of hospitalization record admission, but not, for example, early discharge.

Can the incidence of hospitalizations nationwide be a guideline?

Rather not. The regional perspective is provided here. According to the ideas of the Federal Ministry of Health, the occupation of the regional clinic with corona patients should become in the future the essential criterion for triggering countermeasures such as daily restrictions. The Länder would then have to decide.

What parameters do the medical advisers want?

For epidemiologist Nicolai Savaskan, a medical consultant in Berlin’s Neukölln district, there is no legally prescribed reporting system for the occupation of hospital beds. “I mean a clear hospital reporting system in which all clinics have to feed their capacity and occupancy rates,” he says. An alert level system can then be developed on this basis. “This would mean, for example, that there must be consequences of a certain percentage of occupancy with Covid patients. So measures to contain the pandemic. “

Would it be a mistake to remove the policy limit of 50 on the 7 day incidence of new infections?

For military doctor Savaskan, the incidences of infection remain significant and important information – but only coupled with other values ​​such as the average age of Covid-19 patients currently being treated. An alert system should work faster with many older people than with many younger people, he says. Because the risk of severe gradients is significantly higher with them. When it comes to vaccination rates, we also need to keep an eye on the age distribution and then make more targeted offers to unvaccinated groups. Because the vast majority of infections are among the unvaccinated, says Savaskan. “Vaccine breakthroughs are very rare. And even if they do exist, the infection is usually milder. “

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