Karagiannidis on Corona: “Good situation to scale back measures”

The number of corona infections is falling, and other waves of infection are also subsiding. Therefore, the situation is now favorable to lift the protective measures, says intensive care physician Karagiannidis.

tagesschau.de: Is now the right time to drop all measures?

Karagiannidis: Yes, we have a really favorable situation that we didn’t expect. Because we had such an extremely strong wave of infections before Christmas, which was primarily characterized by influenza, by RSV, also among children, and partly also by Corona, we now have a much better situation at the beginning of the year.

For example, we can see in wastewater monitoring that the numbers of corona infections have fallen significantly in parallel with the incidences. We have significantly fewer admissions to hospitals with influenza or RSV, so I think – even if it’s a coincidence – it’s really a good situation now to scale back the measures.

Good immunity situation in the population

tagesschau.de: Is it really right to drop all measures at once, i.e. the obligation to isolate and also the obligation to wear a mask?

Karagiannidis: We have to make a fundamental distinction: What are the measures for and how are they legally justified? The obligation to wear masks and isolation relates solely to Covid-19 and not to other infectious diseases. And since we have a really good immunity level in the population with Covid and low infection rates at the moment, it is also justified that these measures are withdrawn.

But that doesn’t mean you can’t protect yourself. For example, I do it in such a way that when I notice that there are many people around me on the plane or now also on the train, who sniffle, who have to sneeze and cough a lot, then I put on my mask, just for self-protection . And I think that’s a good measure that we should continue. At least up to two weeks after carnival.

Hospitals no longer so burdened

tagesschau.de: If you take a look at the occupancy in the hospitals, what is the current situation there at the moment?

Karagiannidis: Unusually, we had a wave of influenza very early this season, which ran parallel to the so-called RS virus wave. This is something that we have not seen in this form in previous years. We were very lucky that we had very few severe flu cases, so the H1N1 cases, which is also known as swine flu, was really an absolute rarity this year.

That’s why the clinics have not overflowed as extremely as it could have been in the worst case. Although we really had a very heavy load for a few weeks, especially in December, it is now declining again. For example, we have an average of around ten percent free intensive care beds across Germany, which was significantly lower before Christmas.

disease burden is falling

tagesschau.de: So would you say the pandemic is over?

Karagiannidis: Pandemic is a term that is characterized by how a virus spreads around the world. And in the end, the WHO has to say when the pandemic will really be over. I would rather look at the burden of disease caused by Covid and other infectious diseases.

And fortunately it is the case that the burden of disease, at least as far as hospitals are concerned, has fallen so much that this disease is now part of what we also had pre-pandemic with influenza or the RS virus. That doesn’t mean it’s safe for risk groups, but it’s nowhere near what we saw in the pandemic.

tagesschau.de: These three years have also shown us where the weak points in our hospital landscape are. What have you seen as an intensive care physician?

Karagiannidis: We have done a few things well, such as recording capacity via the DIVI intensive care register. However, the pandemic has also meant that we have significantly fewer nursing staff at the bedside. And she also revealed that we have extreme structural deficits in the German hospital system, which is partly due to the fact that we have an extremely large number of hospitals spread over a wide area, but that we only have relatively few hospitals that really offer everything in one location , especially intensive care medicine, where you can do anything.

And that is a structural deficit that has built up here in Germany over the last 20 to 30 years and has also been cemented, which we now absolutely have to resolve. Because we will experience the next health crises, also the next pandemics, and we have to be better prepared for that than we are at the moment.

500 to 600 large centers

tagesschau.de: That means what would be necessary now? How to solve this problem?

Karagiannidis: We have with the government commission submitted a proposal as to how we would restructure the hospitals in Germany. It is very important to us that we continue to have very good care across the board, which means that we really do have basic care close to where we live. But that we have to focus much more on it, especially when it comes to serious illnesses – and this not only affects illnesses like Covid, but also cancer and other serious illnesses.

And we have to work on it so that in the end we have around 500 to 600 hospitals in Germany that can really offer a lot where I have high-quality care. And I believe that we will then also be in a robust position. But this process is difficult and we have to approach it at an enormous speed because we are running out of time. We notice it everywhere, key word lack of staff. The time has now advanced so far that we must act very quickly.

Pressure to cooperate increases

tagesschau.de: Now there is a special feature in Germany, namely that hospitals are privatized. And we have some in church sponsorship and some in municipal sponsorship. How is this supposed to work?

Karagiannidis: For the first time in about a year or two, in this heterogeneous environment, we have seen that the providers have now recognized across the board that things simply cannot go on like this. I just want to say as an example that we are currently expecting around 60 percent of the clinics to be in the red. A substantial part will really be at risk of insolvency simply because energy costs have risen, wages have risen because we can no longer handle as many cases. And that is leading the carriers to work together now.

And I would really underline that again and encourage them to think across carriers now: It’s about regional care and that has to become independent of carriers in the future. And then it must be possible for the municipal hospitals to work together with church hospitals, for example to join forces in a new building. We owe that to our people to some extent.

Fundamental reform within three years

tagesschau.de: How much time do we have left?

Karagiannidis: We have a demographic change ahead of us in the next ten years, which means that we will now lose around half a million employees a year – and who will not be filled. Provided we don’t get an immense wave of migration, which I don’t see in Germany at the moment.

This means that within ten years we will lack at least five million employees who are no longer available to us as workers and who also no longer pay into health insurance to the same extent. This means that this demographic change, which is starting now, will put the whole system under so much pressure that we will be forced to use the next two to three years to fundamentally reform the system. But then I am optimistic that by 2030 we will be able to provide high-quality medical care nationwide in Germany.

The interview was conducted by Anja Martini, science editor of tagesschau. It has been edited and abridged for the written version.