It's January 22nd, a really cold night. As usual, some workers at a small factory in Stockdorf, Germany, gather at the dinner table. The atmosphere is still calm and nobody feels intimidated while they are complaining about the new Corona. The news comes from China about cases approaching the thousand mark. No one is sure exactly how accurate the Chinese numbers are, but apparently we are safe here, and perhaps within a month or a little more everything ends there.
The patient is zero
Meanwhile, a Chinese worker at the same factory was suffering from a slight fever, which was slowly escalating. By January 27, it became known that she had an emerging corona, at that moment the emergency bells hit the nearby health center, and care professionals would start The health department searches behind the Chinese patient (patient Zero who carried the disease to the country) to discover that she sat next to an employee of the same factory on January 20, the employee who went to dinner on January 22 with his companions and one of them took the salt, but gave him With her is a dangerous virus.
The Munich cluster (1) was the first in Germany, within a few days after the first case was announced that the region was completely closed, and by mid-March Germany had closed schools, shops, restaurants, stadiums, sports facilities and a group of companies, at first there was a degree of confusion Germany is a federal country, which means - in a simple way - that there is a kind of power sharing between the central government and its political regions, when Angela Merkel called for partially shutting down the country, and any of the provincial governors could listen to the words but not implement them, which allowed the virus to penetrate into Germany. For a while.
On the other hand, there was a positive side to this (2), there are more than 400 health offices in Germany that are not subject to one authority, and each of them has special laboratories for virus tests in different aspects of the country with additional non-governmental contributions, which allowed them to conduct greater As much as possible of tests directly without the need for communication from the ministries concerned, these decentralized authorities accelerated the examination procedures so that Germany reached a massive weekly rate of 350-500 thousand checks per week.
Safety plan
The foregoing was the center of answering an important question that circles in the corridors of government buildings around the world and on social media pages alike, how did Germany manage to reduce the number of deaths to this extent? If we consider the numbers of deaths in neighboring countries, we will find a clear difference of four times. In fact, there is no specific proportion yet to describe the coronary deaths of the new (Covid-19), but a study that examined mortality rates in a closed sample - Princess Diamond ship on the Japanese border (3) - indicated that it was a figure of about 1%, that means Any higher number is an indication that a number of patients have not yet been examined. But the high number of tests is not enough to control the disease, the population of Germany is 83 million people, and if you set out randomly in the examination you will be like someone looking for a needle in a haystack, here comes the role of tracking.
In fact, the salted story of the Munich cluster, which was internationally famous, was not just a “story.” The communication of cases has already been tracked to such a degree of accuracy. Besides the data of the infected, the German team of scientists relied on the study of the virus’s DNA change from case to case. To link the injuries together, the goal has always been to return each new case to a single tree with clear branches, which helps strongly in directing the screening intensity towards specific groups of people, this duo - examination and tracking - is the most successful plan to date in the whole world (South Korea and Hong Kong are clear examples, and you can review a previous report The author is entitled (4) "The Safety Plan ... How did South Korea gain control of" Covid-19? "".
But in spite of that, that plan did not prevent the spread of the disease, the response was delayed, and so what she did was that it reduced its outbreak - and still is - until the country prepared itself to receive the first wave, which was really harsh and put the country's health system in a very test In cruelty, the Munich cluster emerged in January, and the top of the curve was in March (5), when the country crossed the barrier of 6,000 confirmed injuries daily, while the main German provinces had equipped themselves with intensive care beds (6) ( 621 beds per 100,000 citizens, which is a large number compared to other European countries), which helped reduce numbers Deaths because the health system did not cross its borders, as happened in Italy and Spain, for example.
With the arrival of the new Corona in the pandemic stage, and with the matter exceeding the barrier of 100,000 confirmed global infections (now more than four million), it became clear that the primary goal of governments around the world is (7) "flattening the curve", a concept that means reducing the number of daily cases as possible In order not to exceed the capabilities of the health system, doctors are forced to make tough decisions that may include leaving some patients to treat others. This happened in Italy and Spain, and it is now happening in Brazil.
On the other hand, Angela Merkel went out several days ago to say that her country is preparing to ease the measures of social isolation in a slow, gradual way, to open schools within days. In Merkel's words, this is the result of countries skipping the top of their curve, to understand that point. Let's start by understanding what the term “Reproduction Number” means, and it means the number of individuals who can be infected by one person during an injury.
At the beginning of the introduction of the new Corona to Germany, this number R0 was 3, it is a large number that allows numbers to exponentially increase, which we saw clearly during the month of March, but this number is not fixed (8), affected by many things, including various isolation procedures As the chances of the virus spreading are less social, according to the Robert Koch Institute (9), an independent federal agency with heavy weight in Germany concerned with infectious and unknown diseases, this number has become 1.3 on April 8, and by the end of April it had become 0.9.
When the number of reproduction falls below the number 1, this means that the number of injured begins to decrease, and when it is 1, there is a relatively stable number of cases, which prompted the country to balance its decisions again, at some point the escalation of the number of cases represented a heavy burden on the health system Compared to the social and economic effects of social isolation, but with the new numbers remaining below the maximum capacity of the health system, there is an opportunity to reduce pregnancy slightly and gradually, with a number of reproduction equal to 1 the matter will settle quietly until next October.
The calm before the storm ?!
A study (10) recently published in the prestigious Science journal already indicates that the main success factor in dealing with new corona is the number of incoming intensive care departments, and the state should take all possible measures to prevent overcoming the point where it needs A patient goes to a bed of intensive care and does not find it. Procedures begin to isolate the injured and prohibit contacts, go through the closure of schools and unnecessary activities, and then reach complete closure sometimes.
But the same study has also indicated that this does not mean that the new corona waves will stop coming, and according to the human immune response to the virus and the effect of summer heat on it - the two things that we do not know so far - this will determine its future until the year 2025, whether as small or high waves are The latter is the smallest, meanwhile, every country should reduce or tighten social isolation measures according to the outbreak of the epidemic and the suitability of its health system. Until a vaccine arrives, unfortunately everything is possible.
As for the German National Academy of Sciences, it stressed, in a statement issued (11) about two weeks ago, that the process of returning to normalcy should include work to support measures to protect the mouth and nose in places of contact, as well as support the health system readiness so that it is always able to receive The largest possible number of cases of intensive care for "Covid-19", and to continue to increase the diagnostic ability significantly to detect the virus by increasing two types of diagnostics, virus detection and antibody detection, and to support - technology, people and procedures - a tracking process Illness and detection of new infected.
The mitigation process itself, however slow and thoughtful, is an adventure that we hope will end well
Adhere to the procedure
It is not only Germany that is doing this. Many European countries such as Spain, the Czech Republic, Austria, Britain, Switzerland, Denmark and Italy are preparing to gradually lift the embargo measures during the coming days. As for the Arab countries, there are signs from several countries such as Egypt and Saudi Arabia that easing the measures of social isolation is soon.
But that does not mean that the risk will pass, the number of injured will return to increase with the mitigation measures, and the size of the increase will determine the next decision. Indeed, the mitigation process itself, however slow and thoughtful, is an adventure that we hope will end well. To understand this idea, we can consider the recent statement of the World Health Organization about the mitigation measures taken by a number of countries, where (12) WHO Director-General Tidros Adhanum Gebresos said that the way down is much slower than the way to the top, the new Corona is escalating rapidly, but it It decreases very slowly after reaching the top, and this means that the isolation procedures must be raised slowly, with a great degree of control, because everything can return to the explosion in a few weeks, and this will cost more time and lives.
On the other hand, there are many important factors, but they are not yet known. For example, the main variable (13) that will determine the final political decision in the "Covid-19" pandemic is understanding the human immune response to disease, which we still do not know, and we basically do not yet know the actual numbers of infected people, especially as More than a third do not show clear symptoms, and there is an additional percentage that suffers from slight symptoms, which may help in a hidden outbreak of the disease and then we are surprised by a dangerous outbreak that returns things to the starting line.
In any case, the matter will become more clear during the next few months, and in the meantime - dear reader - keep cautious and do not imagine that the opening procedures are the end of the virus, what happens is that life has changed, no return to normal before December 2019 But there is what we can call a "new normal", if you have to go down, stick to the precautions, and here we mean covering the nose and mouth with medical or home-made wipes (CDC advice), with hand-washing habits and a distance of 1-2 Meter between you and others, avoid touching the face. The danger remains.