News – AU – step-by-step plans without the yo-yo effect


The coronavirus pandemic is in a critical phase Delayed and inadequate measures have meant that the winter wave has become protracted The infection rates are now falling and decisions about the next steps in the strategy are imminent. More infectious variants are at play here of the virus and vaccination potential play a key role Another wave of infections due to a premature relaxation of restrictions should be avoided Our proposal aims to balance the needs and desires of large segments of the population, as well as practical feasibility with the medical and epidemiological need, the main aim of this Strategy aimed at long-term sustainability is to avoid a yo-yo effect, i.e. the constant return of high infection rates caused by loosening the rules too early. We want for every citizen as well as for our society and di e economy as a whole create a perspective

A productive public debate on the strategy to fight the pandemic is immensely important Unfortunately, this current debate is becoming increasingly polarized: people are usually identified as either proponents or opponents of bans. There is too little differentiation due to the different and targeted measures Our aim as representatives of different disciplines is to counteract this climate of polarization.Instead, we try to bring together the various aspects that result from the compromise between the protection of health, the satisfaction of people’s needs and, last but not least, the social, psychological, cultural and economic collateral damage resulting from protracted blocking measures In the future, we have to act in a flexible manner that is geared to specific contexts, instead of anchoring ourselves in an either / or logic without any differentiation. And differentiated measures require differentiation ized criteria

There are two poles in the debate about which target and limit values ​​are desirable and realistic: (1) a high-incidence corridor without overloading the health system, and (2) rapid and complete elimination of the virus

If we decide in favor of a corridor at the capacity limit of the intensive care units (Pole 1), we could temporarily loosen the restrictions.Before or at the latest when the capacity limit is reached, the relaxations would have to be revoked, however, so that the number of cases can stabilize, Stricter social constraints are required when the incidence is high than when it is low.This is because health officials can do less to help containment when infecting large numbers of people to deal with high case numbers in a narrow corridor the behavior of the people has to be strictly monitored. This is not realistic. In addition, with this approach we would have to accept that a large number of people will get sick and die from the disease: More than 25 million people in Germany are between 50 and 75 years old If you get infected with the coronavirus, your statistical he probability of death at around 03 to 1 percent In addition, the health system would be severely overloaded over a period of months, especially the intensive care units.We should also not ignore the long-term social, health and economic consequences of a long COVID It is unlikely that the situation will change due to Improved by Vaccinations by Summer Finally, with this approach, there is no buffer to contain B117 and other variants Nor is the seasonal effect expected to offset this: if ot is around 20-30%, it may not be able to fully compensate for the effect of B117

Solutions at the second pole aim to quickly reach zero incidence, the key benefit would be that the virus would not spread any further. With just a few precautionary measures, we could live fairly normal lives in some regions, this target has been zero Achieved last summer It would be difficult to maintain at the moment, as it would require extremely tight testing at regional and national borders – which is neither possible nor desirable. In order to reach absolute zero of the current infection rate within a few weeks, highly complex and rigid rules would have to be implemented that would continue to severely restrict public and social life

These two extreme poles therefore have significant disadvantages. We therefore propose a strategy of local and differentiated containment that accepts that small local outbreaks can occur, but should keep the incidence consistently low (and further reduce) The lower the incidence, the easier it is to control the outbreak.Health officials can then isolate those who have come into contact with infected people more quickly and break chains of infection.This would also make it easier to track outbreaks in hospitals, nursing homes, and residential communities Prevent larger groups as fewer undiscovered cases would slip through the cracks in the system. The same applies to large social gatherings, which can easily become overarching events when the incidence is high, when the incidence is low, vulnerable groups are much better protected, and when in a large one When the number of districts and states reaches a low incidence, we all benefit because the level at which infection rates settle is proportional to the rate at which the virus invades from the outside

From a sociological point of view, however, we must remember that low case numbers are not easy to achieve and maintain unless there is broad social consensus and it is also practically difficult for people to obey the rules be considered:

(1) Not everyone adheres to the rules at all times. There are a number of reasons for this: First, when people are dissatisfied with the rules that are viewed as ineffective or unfair, the motivation drops after, Second, although that If the behavior of people in organized environments is relatively controllable, they become less alert in more relaxed environments – during breaks at work or in everyday situations. Third, the longer the crisis lasts, the more people have to struggle with social, psychological and financial problems can no longer keep many of the rules

(2) Falling or low case numbers increase the desire for restrictions to be relaxed, and this makes it more difficult to adhere to the rules in daily life. This in turn has a negative effect on infection rates and the development of the number of cases. Any future strategy must follow this Consider mechanism

(3) A liberal society cannot be fully controlled at either low or high incidence – and even if it were possible, it would not be desirable Because of this situation, we are not maintaining the ambitious goal of low incidence values ​​as opposed to what People often claim that this strategy does not deny them their freedom. The opposite is the case: it is intended to motivate people to work towards realistic goals and in this way ultimately to gain more freedom

But how do we do that? Our overall strategy of local containment is based on a balance between virological, epidemiological and sociological considerations.We combine the necessary reduction in incidence and the R-rate with considerations on the design of everyday behavior of people and also with consideration of the collateral damage caused by the pandemic.We are trying to do this to do without playing these aspects off against each other

The following are critical: For any measure introduced, the underlying reasoning and evidence must be clearly communicated Ideally, the data underlying the evidence should also be made available to the public (and at least the scientific community) In addition, people must be provided with the resources they need to be able to comply with measures and rules.It is becoming increasingly important to react to and reduce inequalities.This can be done, for example, with interim aid, government loans or stabilization programs, which are not only for companies but are also available for private households Direct support as well as social and therapeutic programs should be made available urgently, especially for people in precarious situations The medium and long-term goal must be to eradicate poverty – this is the only way to prevent difficulties and an even stronger polarization of society. And only in this way can large parts of the population be motivated and convinced of the measures

We need well-considered step-by-step plans that transparently determine which parts of public life can be opened in which order – and based on which considerations. The ultimate goal must be clear: only when a stable and safe level of incidence is reached is one Targeted, intelligent and regionally determined relaxation of the measures possible. In the medium term, our proposal is based on a weekly incidence of 10 per 100000 people or even below wherever possible The numbers 25, 35 or 50 are hard caps here, with the aim of achieving a reasonable margin of safety. For example, if the incidence exceeds 50, there is an urgent need to put in place strict lockdown measures The faster and The more effectively the incidence is reduced again after the limit values ​​are exceeded, the faster such a blocking is ended

The step-by-step plan provides representative infection rates that are recorded, for example, from random tests in the entire population, regardless of whether a person is symptomatic or not.This data would also – broken down by region and age – the assessment of the various containment strategies significantly facilitate

The step-by-step plans currently being discussed are mainly based on incidence values.These values ​​and the control mechanisms must be selected with caution in order to avoid the following three risky situations: (1) Limitations are relaxed too early: this leads to a further uncontrolled increase in the number of cases and may forfeit hard-earned successes (2) stagnation at too high incidence levels: easing the restrictions slows the decline down so much that cases are not reduced further. If this happens in regions with high case numbers, the restrictions need to be adjusted Restrictions become a distant possibility (3) Inadequate response to rising case numbers: If the numbers rise, measures are tightened as planned, but may not be rigorous and fast enough. The risk of new variants that are more contagious or bypasses the immune system must be taken into account A staged plan therefore requires a strong mechanism that rigorously stops and reverses the rise in the number of cases

Our society is a complex system in which many aspects interact. Measures to combat the pandemic cannot therefore be planned in the long term Instead, we need an approach that perceives society as a learning system.When developing measures, every step must be clearly justified and communicated, evaluated and, if necessary, adjusted.However, this is only possible if we have the right data. The decisive factor here is regular random tests The results of such tests can be used as a basis for assessing whether a particular combination of measures is effective or whether individual elements need to be adjusted – for example if certain activities are found to affect the results affect different ways than previously thought

This also applies to stage plans The stage plans currently being discussed cover a number of areas in detail, but the industrial sector and labor market should also explicitly include space, hygiene, mask ventilation and app Avoid closed spaces, groups, crowds and lively conversations Working side by side from home or, alternatively, tight testing programs help contain the pandemic

All phases of relaxation should be accompanied by tests. Rapid tests, in particular, can detect chains of infection at an early stage. In order for people to be followed, tracked and isolated before the infection can spread, mandatory reporting of positive results should be introduced.This is where digital transformations within the health authorities can be helpful Without this follow-up, rapid tests will not reach their full potential Access to rapid tests should not be a privilege, they should not be a financial burden on anyone The number of rapid tests available is currently limited The distribution should be controlled to ensure that enough tests are available are to help vulnerable people at work, in schools, etc. To protect Again, the principles for access to vaccines, protective equipment or masks should apply

Vaccination programs for the entire population are a promising way out of the pandemic. In addition to improving vaccination logistics, various vaccination regimens should also be investigated in clinical studies

Tests, technical measures, room, hygiene, mask ventilation and app If we avoid closed rooms, groups, crowds and vaccination programs, we can gradually contain the virus in the coming months, but many questions remain unanswered: To what extent does vaccination reduce transmission? What challenges do new virus variants pose? How long does immunity last and how will the behavior of those who received the vaccine change in the coming months? Until these questions have been answered and vaccination programs give us hope for an end to the pandemic, we consider the dynamically adjusted strategy proposed here with an incidence rate of the upper limit as the best way out of the pandemic

Barbara Prainsack, Institute for Political Science, University of Vienna; Global Health Division & Social Medicine, King’s College London

This text was published in slightly abbreviated and modified form as a guest article in the German weekly newspaper Die Zeit on 17 Published February 2021

Coronavirus, pandemic, sustainability

News – AU – Step-by-step plans without the yo-yo effect
Associated title :
step-by-step plans without the yo-yo effect
Scientists propose a sustainable strategy for the COVID-19 pandemic