Corona: Pandemic evaluation overdue | nd-aktuell.de

The debate about the previously incompletely published documents from the Robert Koch Institute (RKI), a subordinate authority of the federal government, has brought the corona pandemic back into the media spotlight. Why is such an affair needed to finally put a much more important question on the political agenda: the long-overdue, repeatedly delayed evaluation of this pandemic? So far, the Ministry of Health and other political bodies have refused to take on such a task, for example by holding a national conference or finally doing this work in some other way.

Undoubtedly, formulating lessons from this pandemic is challenging given its complexity. In addition to political will, it also requires a certain systematic approach and clear questions that must span the spectrum from medicine to all affected areas of society. In addition to a large number of entries on the Internet, there are also politically relevant announcements: In April 2022, the German Ethics Council took a worthy position in 111 theses and twelve recommendations and formulated a series of criticisms and conclusions. Advisory committees such as the Infection Protection Act Expert Committee or the Health & Care Expert Council as well as specialist societies also commented. The Leibniz Society of Sciences addressed the pandemic early on in a public debate.

The aforementioned Bundestag expert committee declared in June 2022: “The historical reconstruction of the course of the pandemic must not be followed by an unhistorical assessment. Afterwards you are always wiser and in a crisis of world-historical proportions, mistakes and bad decisions are inevitable.” This applies to individual decisions at all levels of responsibility as well as to institutional processes. »But this doesn’t mean carte blanche. Rather, a critical assessment of crisis management is required in order to reveal personal misconduct, systemic deficiencies, dysfunctional organizational forms and/or unsuitable procedures and to enable corrections. A highly developed error culture is also an expression of resilience.«

There is nothing to add. Just a few of the decisions in question will be mentioned here as examples: Was and is the relevant legislation and the associated regulations for structures, responsibilities, stocks and financing sufficiently geared towards a uniform and effective approach? To this end, the Ethics Council demands that the executive branch “should be able to rely on previously developed and tested emergency plans and, if necessary, implement them consistently.”

It should also be clarified: Were all relevant and important specialist areas and experts included in the medical-epidemiological advice given to politicians right from the start? What mandate did the experts brought in have? Why were the suggestions from the medical community such as the German Medical Association to form a pandemic council not taken up?

The statistical analysis and description of the pandemic partly fell short of recognized epidemiological standards, at times omitted tried-and-tested indicators and left the media with a simplistic, often fear-inducing presentation of figures. It is incomprehensible why such priority was given to incidence as an indicator. Despite persistent demands from experts, the differentiation into healthy, infected and actually sick people and the distinction according to age groups were carried out far too late, and the actual disease burden for the healthcare system was also determined. The cumulative numerical representations often used in the media contradicted the rules of morbidity statistics.

Regarding the closure of children’s and educational institutions, the Ethics Council stated: The very long closure, which has now been admitted as a mistake, did not have the hoped-for effect in combating the pandemic, “but it left a lot of young people and their families in an unsuitable, uncontrolled social environment and “prevented appropriate but necessary educational support and support for the children.” In addition to their educational role, children’s and educational institutions also have “a social and health function.” So far so good, since even Health Minister Karl Lauterbach (SPD) agrees with this assessment? No, because no practical conclusions have yet been made here either. One such lesson would be to understand these facilities as places of health and social well-being and to allocate meaningful structures for this, for example regular medical care.

The possibility of combating an epidemic disease with vaccinations remains a key challenge and practical task. The pandemic evaluation must be carried out with particular care here, especially since, to my knowledge, the goal of vaccinating an entire adult population has been pursued for the first time since the vaccinations against smallpox. The gratifyingly rapid development and production of vaccines and the impressive willingness of most people to be vaccinated were later opposed, in addition to the initially well-equipped vaccination centers, not only by poorly functioning practice in the outpatient sector, but also by the rightly failed attempt to establish a legal one To introduce compulsory vaccination against the coronavirus. It was clear at a relatively early stage that vaccinations can always have side effects and that in this case they did not lead to an interruption of the chain of infection. The exclusion and demonization of people who were unwilling or unable to be vaccinated was never medically, legally or socially justifiable. The role of pharmaceutical companies and, above all, their responsibility for the quality of the vaccines also needs further work.

A key feature of the fight against communicable epidemic diseases are all the measures that affect the behavior of the healthy population and the work of other areas of society, including the economy. Paolo Giordano formulated clever thoughts on this in his booklet “In Times of Contagion” at the beginning of the pandemic and appealed to people’s insight, solidarity and reason: “The epidemic encourages us to see ourselves as part of a collective”; We would have to develop more ideas as to why the behavior of every healthy person influences the epidemic events. A “mathematics of caution” applies, but it helps to endure and understand the “dilemma of quarantine” for those who are not infected.

The decisions made about quarantine, contact restrictions, distances, wearing masks, hygiene requirements, the closure of facilities and so on, the lockdown and even the zero-Covid idea harbored great potential for conflict. Even though the last measures were lifted a year ago, they still determine the political debate today and must be assessed particularly carefully. A number of them were to be accepted, others were not sufficiently justified in medical and epidemiological terms. Some measures were not justified at the time they were ordered, such as the contact restrictions outdoors or the ban on contact for relatives of old people in homes. The zero Covid campaign (eradicating the virus with a total lockdown), favored by some actors and tested in some countries, also turned out to be a misguided approach given the fact that this virus does not only occur in the human population. “All indicators currently suggest that final eradication of the virus will not be possible,” the Ethics Council also stated.

According to the Bundestag’s expert committee, the RKI pointed out as early as 2001 that “the effectiveness of the non-pharmacological interventions anchored in the Infection Protection Act in the event of a pandemic, such as the closure of schools and community facilities, the ban on events or the imposition of quarantine just like border controls or restrictions on international travel, have not been examined in detail and their effectiveness is therefore unknown. It was already clear to the RKI that such measures could only be ordered on a trial basis. “It was requested that their effectiveness be clarified before the pandemic.”

The Ethics Council says: »Two important poles around which these considerations revolve are the pole of freedom and that of health protection. Relations would have to be formulated in which cases, when combating pandemics, freedom should take a back seat in favor of health protection or vice versa.

Thinking further, a lesson from the pandemic could also be this: to finally include the protection of health as a fundamental right in the constitution.

Heinrich Niemann is a specialist in social medicine and was city councilor for health in the former Berlin district of Hellersdorf until 2001.

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