What's the current picture?
There are signs that the coronavirus situation is improving in Germany. But doctors and other experts are warning that the current number of Covid-19 patients in intensive care wards means there is no reason to breathe a sigh of relief.
The German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) Register reports daily on how many intensive care beds are free in Germany, and the number occupied by Covid-19 patients.
First, there is some cautiously good news: wards have recently been filling up less quickly than feared, reported German daily Welt.
Since the week beginning October 26th, the increase in daily new admissions of Covid-19 patients has tended to decrease compared to the previous week.
At that time, the increase was around 65 percent, but has now reached around 30 percent.
Since last week, the same applies to the growth in the total number of Covid-19 patients in intensive care units. The trend is downward, so the curve is flattening slightly.
However, the absolute numbers continue to rise, signalling that the peak of the coronavirus resurgence has not yet been reached in Germany.
Here's a look at these numbers:
Let's look at the bigger picture first: as of November 11th, a total of 1,289 hospitals or departments reported to the DIVI registry. Overall, 28,502 intensive care or ICU beds were registered, of which 21,787 (76 percent) were occupied, and 6,715 (24 percent) were currently available.
According to the register, on October 26th 1,362 coronavirus patients were receiving medical treatment in ICU, with 46 percent receiving ventilation.
About two weeks later on the report for November 10th there were 3,127 registered coronavirus patients in intensive care, with around 56 percent receiving (1,737) ventilation.
The table below including in a recent report by the Robert Koch Institute shows the latest ICU details:
At the peak of the first wave in April this year, there were 2,850 Covid-19 patients receiving intensive care treatment, according to the DIVI register.
Doctors and scientists therefore do not yet see any reason to sound the all-clear that contact restrictions and measures are working, reported Welt.
DIVI President Uwe Janssens points out that the number of infections also rose steadily in the first week of November, “significantly above the values in spring”. And at the same time the proportion of over 60-year-olds contracting Covid-19 is again increasing.
“We must therefore be worried that the proportion of inpatient treatment cases will also increase – and consequently the number of intensive care cases,” Janssens said.
It is true that the number of people requiring intensive medical care is currently below the expected figure of 1.5 to 2.0 percent of all people infected by Covid-19.
“However, we will have to monitor the situation very closely over the next few days to see how it develops. We must not forget that the treatment of a Covid-19 patient in intensive care can be very lengthy – in some studies the median is up to 24 days,” said Janssens.
In particularly affected regions, where hospitals are already at the limits of their capacity, experts say it makes sense to put clinics back into emergency operation. That would result in non-urgent procedures being postponed.
This is “not about keeping beds free, but about the sensible use of the available resources that we need to be able to operate intensive care adequately”, Janssens said.
Above all, the question of available staff is crucial. Intensive care treatment requires specially trained nurses, and Germany is concerned about a shortage.
'Wait another one to two weeks'
Fluctuations in growth rates have repeatedly occurred in intensive care cases in recent weeks, Viola Priesemann, who is conducting research on coronavirus at the Max Planck Institute for Dynamics and Self-Organisation in Göttingen, told Welt.
“In this respect, we should wait another one or two weeks before drawing any reliable conclusions,” said the Priesemann.
An ICU unit treating coronavirus patients in Germany. Photo: DPA
Clemens Wendtner from the Munich Schwabing Clinic also believes that it's too early to draw conclusions on if the situation is improving.
“I think it is still too early to see an effect of the new contact restrictions in the slightly declining growth figures of the intensive care units, as we have to take into account a latency period of about three to four weeks until intensive care is available for Covid-19 at the onset of the disease,” said the chief physician for infectiology.
As a warning example, Wendtner cites neighbouring European countries, which also reported slow occupancy of intensive care beds in late summer and now have to transfer patients to other regions or to other European countries due to overcrowding.
Are there any positive trends?
It's not all bad news.
In contrast to the first wave, doctors say there are two positive trends. In many cases, intensive care can be prevented thanks to improved treatment methods, and because a diagnosis is now available much earlier, said Munich Schwabing's chief physician Wendtner.
Advances in medical treatment such as “refined ventilation techniques” and the administration of dexamethasone, a corticosteroid used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects, could also shorten the time spent in intensive care for individual patients.
Matthias Kochanek, head of internal intensive care medicine at the University Hospital of Cologne, reports similar results.
He is currently observing significantly more cases on the regular wards and, in the cases of severe courses, a shorter stay in the intensive care unit. He attributes that to treatments like dexamethasone. But on the whole it is too early to draw firm conclusions from the current figures, he said.