Any ground of hopes from the graphs? (Part 3)

19 April 2021

What now about hopes based on declining death figures, dashed or confirmed? Undecided, since hope refers to the future, and statistics to the past. Day-to-day developments show that the 7-day mean value of deaths has notably risen since 7 April and has again been falling since 16 April. On the other hand, infections notably declined between 3 and 8 April but increased again lately, so that at best this may be interpreted as slowed growth – not proven in any way, but it would clearly indicate progress.

Comparable to Christmas during the second wave, we witness a temporary decline in documented infections over Easter with a subsequent rise. In contrast to Christmas, the overall trend is still upwards, and the first peak after the lowest point on the holidays is above, and not below, the previous level. No doubt, the third wave is still gathering speed.

Death figures, however, continue far below those with similar infection figures during the second wave. Adding the time between infection and death to the calculation, the current peak of deaths in the third wave approximately corresponds to the number of deaths after infections around the middle of February. And compared to the number of people infected during that period, the number of deaths is consistently falling: this means that the lethality of the disease is on a downward trend.

Summing up: The rise of the third wave will certainly mean more deaths again, and everything must be done to break it. But: the currently prevailing variant B.1.1.7 turns out to be no more lethal than the original virus, and the vaccination campaign – despite a slow start – actually appears to be successful so that, in relation to infection figures, less people die of CoVID-19.

Prof. Markus Deckert

Any ground of hopes from the graphs? (Part 2)

6 April 2021

About two weeks ago, I boldly asserted that the number of deaths per day is declining – notwithstanding the third wave of infection – and I promised to keep an eye on this trend. To date, the typical time lag between the death rate curve and the curve of new infections has been exceeded several times, and the trend continues at an increasingly slower rate. I see this as a sign of hope that the third wave may be less deadly that the second one.

The more infectious virus variant B 1.1.7 is predominant in the third wave and has turned out to be more aggressive in the course of illness. The declining number of deaths is therefore not a natural development but a consequence of successful containment efforts. In contrast to the generally despondent mood and uncertainty about lockdowns and openings, the measures taken are not as ineffective as frequently claimed. My guess is that the vaccination campaign for the most vulnerable group of people over 80 is the main reason, despite all difficulties involved.

One thing cannot be deduced from the curve, however: infection rates seem to decline as well over the past few days; but this may be due to the long Easter weekend and probably incomplete reporting. Reports will be complete towards the end of the week, and the 7-days mean value in the curve will be correct again, and we will have more information.

Despite all justified criticism: I truly believe that the development of indicators gives reason to hope that an end of the crisis is in sight.

Best wishes for the Easter holidays,

Prof. Markus Deckert

What has health to do with climate?

23 March 2021

In our second virtual "consultation hour" last Friday, Philipp Jaehn, Hannah Leichsenring, Fanny Pfahler and I talked about health. For all who took notice – even without major demos in town: it was World Climate Day, or Climate Action Day. That health is connected to the climate should come as no surprise: the existence of the human species as the biological compromise mammal depends on weather conditions that are not too extreme. In the hottest and coldest spots on earth, the highest and deepest, the driest and dampest, there are always specialized creatures which thrive best exactly there whereas humans endure these conditions for short periods only, if at all. Somewhere in between the optimum for human life during the past 11,000 years and such extremes, things seem to get uncomfortable. Somewhere between good living conditions and no living possibilities at all, things seem to get unhealthy. All this has been well known for over 4 decades, but the practical implications appear to surprise many people, and some of them so much that they cannot see the connection.

Planetary health

Whether higher temperatures with longer heat periods in summer, resulting droughts with reduced water and food supply, shifts in ecological balances, the spread of disease-carrying insects, rising saltwater levels or increasingly frequent weather extremes – all this appears to affect human health negatively. The term “planetary health” implies the correlation: surrounded by global conditions of ecological imbalance, humans will not be able to live permanently in balance.

But is this not a "Corona Blog", and are we not faced with entirely different concerns just now? Counter question: Is CoVID-19 no health issue? But what, please, is the connection between CoVID-19 and our climate?

Answers could easily fill several pages. Let me name two reoccurring considerations:

1. 1. CoVID-19, or more exactly the transmission of the SARS-CoV-2 virus to humans, is a consequence of the same causes, and of climate change itself. Human settlements and economic regions advance into natural and wilderness areas; climate changes displace wildlife from its natural habitats; wild animals are traded as commodities; all this leads to closer contacts between wild animals and humans and considerably increases the statistical probability of new zoonoses, and this is exactly what we are observing: SARS, MERS, SARS-CoV-2, swine fever, and in between some isolated outbreaks of lethal hemorrhagic fever such as Ebola.

2. However, CoVID-19 also indicates a way out of the climate crisis. Over the past years we have seen lots of debates and decision-making, but little action. A reason frequently given is that politics cannot act against the will of the economic sector. Reactions from governments worldwide to CoVID-19 have demonstrated that this is not true; in times of great need politicians can act fast, radically and with drastic effects.

Use of common property

The need caused by the climate crisis is indeed greater and more permanent and demands more human lives than CoVID-19. Effective measures to protect the climate would affect us to a clearly lesser extent compared to a lockdown, on the contrary: our quality of life would improve in total. Healthy ecosystems right on the doorstep are perfect for local recreation. Less mobility based on combustion engines means a more livable environment. Ecologically diverse agriculture ensures better food. And what about economic prosperity? The great thing about humans is that they have wonderful and intelligent ways to adapt, also in their economic activities. Every single government demand for improvement, without exception, triggers an innovative thrust. In the 1980s the automotive industry claimed catalytic converters were a commercial impossibility. When California made them obligatory all manufacturers came on board immediately. Until very recently, coal was considered indispensable, wind power and solar energy counted as nonsense thought up by Green activists. Today they are among the cheapest sources of energy and in 2020 covered more than 50 % of electricity generation in Germany.

Why are we still discussing certain issues? What is needed to achieve CO2 neutrality in industry and transport? Where is resistance against changes in society which promise human survival and a better life for everybody? I think the answer is clear: Resistance exists where somebody uses free resources for personal gain. This happens when CO2 is emitted into the atmosphere which is the property of the entire planet and all creatures – including all humans – in equal shares. The solution is simple in theory but ambitious in implementation: we need to fix a price for the use of common property.

Less can be more

Genuine controlled CO2 certificates with a cost price reflecting actual costs are an important step in the right direction. They would provide the required innovative thrust, and things that defy reform – such as plastic bags – would disappear in no time. What is more, they would not overtax individual citizens. The NGO atmosfair sets a price of ca. 100 Euro (23 € / t CO2) as compensation for 30,000 km at a Diesel consumption rate of 5.5 l per 100 km. Even if we use a more realistic price of 140 € / t CO2, additional costs are approximately 600 €. These additional costs are no disadvantage for people who can afford a car; but they can be an incentive to go to the baker by bicycle, or for commuters to take the train to work.

All this shows that it can be done, the climate crisis can be managed. We will see changes but not necessarily catastrophes. By the way: we are in Lent, the fasting period. In future it will be necessary to give up some things, to consume less. But as a result, we shall enjoy a better quality of life. People suffering from massive overweight will appreciate the benefits of a more normal weight. Less can be more, and this applies not only to design.

Prof. Markus Deckert

And what about AstraZeneca?

19 March 2021

This is about the CoVID vaccine ChAdOx 1 Cov19, not the pharmaceutical manufacturer. The corporation has earned a poor reputation all over Europe for reducing confirmed delivery volumes more than once. But the point here is whether the vaccine is effective, and not whether we like the company.

And then we hear that the efficacy of the vaccine is “only” 60% compared to the other two vaccines already approved, and that the side effects are far stronger. And the latest bad news is that administration of the vaccine has been completely suspended due to several cases of cerebral venous thrombosis. There must be something seriously wrong about it.

We already discussed the efficacy issue. What we need is a vaccine not against cough but against serious and terminal courses of a disease. And in this respect, the AstraZeneca vaccine is equal to the other vaccines which have been approved to date. Vaccination responses are signs of a successful stimulation of the immune system. But the approval study recommends the intake of one gram of paracetamol prior to and another gram eight hours after vaccination. And now: rare cases of thrombosis.

The problem is that the drug is new and urgently needed. Without the urgency the question would not arise; any signs of unexpected and serious undesired side effects would be followed by immediate suspension, careful examination and decision on continuance of approval. But here, every day of suspended vaccinations costs human lives. On the other hand, this would not justify a drug which is not safe. What is more: if confidence in the vaccine is lost then the entire immunization campaign threatens to fail.

It is debatable whether it was correct to stop vaccinations temporarily – based on available information at the time I would probably have decided against a suspension. But in view of so many earlier mistakes by politicians, all we can say is, you will be blamed no matter what you do.

What are the implications of the EMA (European Medicines Agency) investigation? In short: Cerebral venous thromboses occurred in a small group of mainly females between 20 and 55 years of age, caused a form of stroke and were lethal in a few cases. This involves a reduction in the number of platelets, a rare complication with a possible immunological cause where a causal link to the vaccine cannot be excluded. The risk is in the range of 1 to 1 million. Even if the vaccine should have been the cause, the benefits outweigh the risk.

So, are we forced to just accept the risk? The answer is no. An analysis of the documented cases indicates potential risk factors. And we now know the signs which vaccinated patients and physicians must pay attention to so that problems can be identified early on and treated successfully. Problems of this type which require special attention may occur with any other vaccine as well.

Vaccinated persons must know that reactions like fever with chills and attendant symptoms such as headaches are normal in the first three days after vaccination. But prompt medical attention should be sought if one or several of the following symptoms appear after the fourth day after vaccination:

  • strong and persistent headaches or blurred vision
  • shortness of breath
  • chest pain or abdominal pain
  • swelling or sensation of cold in arm or leg
  • persistent bleeding
  • several bruises without cause, small red or violet spots or subcutaneous blood blisters.

Prof. Markus Deckert

Any grounds for hope from the graphs?

18 March 2021

Without any doubt, we are right in the middle of the third wave of the CoVID pandemic before the second wave has drawn to an end. And, also without doubt, the B1.1.7 variant which was first discovered in UK is far more infectious and pushes up infection rates faster than ever. To make matters worse, there are clear indications that this variant results in more aggressive disease progressions.

The vaccination campaign “has not worked out well so far”, and we are facing a scenario where not only the freedom to travel over the Easter holidays but also the much longed-for summer holidays threaten to remain a pipe dream. Will we sink into an eternal lockdown? (And how much of our social life – even if it is only the beer garden near the park or the nice restaurant around the corner – will be left when everything is over? Many of us have witnessed how an entire state that felt like made for eternity disappeared in record time. Now we see once again how a society that seemed safe and stable is changing in a short time, and perhaps forever.)

One thought, however, may give us some hope until the vaccination campaign picks up speed again: we see a sharp increase in the number of registered infections, but not in the number of deaths. Our graph shows both curves with different scales, superimposed so that the graphic mean value is the same (number of deaths presented in 30-times magnification). This is helpful to compare the changes in direction of the curves.

Effects of the vaccination campaign?

A first point to note is that the curve of deaths follows the infection curve with a delay of two to three weeks: with rising infections, this is how long it takes until deaths occur among newly infected persons. With declining infection figures, there are still people dying who became infected before. The red area in the curve marks this distance of three weeks from the time when the third wave became visible as emerging from the second, abating wave, that is, when previously falling infection figures started to increase again. Starting with the right end of this red area, an increase in deaths would have to be expected, but this has not happened so far, on the contrary: the number of deaths is generally falling.

What might this mean? The vaccination campaign among the groups most at risk may have been so successful to date that there are almost no more infections with serious or lethal progression. The interpretation is optimistic but not far-fetched. Another possible conclusion is that we have learned to treat even serious progressions so much better that patients survive longer and the death curve will rise later. But if the downward trend continues this would indicate that the vaccination campaign is successful. And sinking death figures might suggest that containment measures can be based on new indicators which permit earlier relaxations compared to currently applied standards.

We will continue to monitor developments and keep you informed.

Best wishes,
Prof. Markus Deckert

Corona virus: Well informed at all times

To keep burdens on the health system as low as possible and ensure provision of care to seriously ill patients, it is necessary to slow down the spread of the Corona virus. All efforts on the part of government, administration and health system aim to slow down the increase of daily new infections. We can all help by modifying our behaviour – adhering to rules of hygiene, wearing mouth-nose covers, keeping distance, airing rooms at regular intervals. The website of the Brandenburg Medical School offers information on the current state of the pandemic and on measures in connection with Corona vaccinations in the State of Brandenburg.